Mary Ellen Schneider

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

The news may be less bad for neurologists. An increase in their work relative value units (RVUs) may partially offset the Medicare fee cut.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually.

This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy.

“If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work RVUs for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties.

Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA.

“For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005. Family physicians will break even once all factors are calculated. Cognitive specialties such as neurology will see a 4% cut once all the changes have been considered. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

The final rule also implements a cut in payments for imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements cuts called for under the Deficit Reduction Act of 2005. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session.

The groups have been lobbying for months for Congress to pass stop-gap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And as of press time, 80 senators and 265 representatives have signed letters to the congressional leadership calling for the cuts to be stopped.

“They certainly are aware that this is a problem,” said Michael Amery, legislative counsel for the American Academy of Neurology. The question is whether members of Congress will act and, if so, when. Congress may take action during the lame-duck session or wait until early 2007 to address the issue, he said.

“Physicians are really frustrated that everyone in Congress agrees” that there is a problem, “but they aren't doing anything,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians.

In the final regulation, CMS officials are giving with one hand and taking away with the other, Dr. Kellerman said. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said.

CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, Dr. Kellerman said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure.

Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

The combined impact of the work and practice expense RVU changes are estimated by CMS to result in a 5% increase in charges for primary care specialties such as family medicine and internal medicine, and a 2% increase for neurology. However, once the 5% across-the-board SGR cut is made, neurologists will see a 4% cut in allowed charges under Medicare.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them.

For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs. These cuts will be in addition to the 5% drop in reimbursement based on the SGR formula and the cuts related to in-office imaging services.

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

The news may be less bad for neurologists. An increase in their work relative value units (RVUs) may partially offset the Medicare fee cut.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually.

This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy.

“If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work RVUs for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties.

Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA.

“For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005. Family physicians will break even once all factors are calculated. Cognitive specialties such as neurology will see a 4% cut once all the changes have been considered. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

The final rule also implements a cut in payments for imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements cuts called for under the Deficit Reduction Act of 2005. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session.

The groups have been lobbying for months for Congress to pass stop-gap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And as of press time, 80 senators and 265 representatives have signed letters to the congressional leadership calling for the cuts to be stopped.

“They certainly are aware that this is a problem,” said Michael Amery, legislative counsel for the American Academy of Neurology. The question is whether members of Congress will act and, if so, when. Congress may take action during the lame-duck session or wait until early 2007 to address the issue, he said.

“Physicians are really frustrated that everyone in Congress agrees” that there is a problem, “but they aren't doing anything,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians.

In the final regulation, CMS officials are giving with one hand and taking away with the other, Dr. Kellerman said. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said.

CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, Dr. Kellerman said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure.

Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

The combined impact of the work and practice expense RVU changes are estimated by CMS to result in a 5% increase in charges for primary care specialties such as family medicine and internal medicine, and a 2% increase for neurology. However, once the 5% across-the-board SGR cut is made, neurologists will see a 4% cut in allowed charges under Medicare.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them.

For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs. These cuts will be in addition to the 5% drop in reimbursement based on the SGR formula and the cuts related to in-office imaging services.

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

The news may be less bad for neurologists. An increase in their work relative value units (RVUs) may partially offset the Medicare fee cut.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually.

This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy.

“If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work RVUs for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties.

Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA.

“For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005. Family physicians will break even once all factors are calculated. Cognitive specialties such as neurology will see a 4% cut once all the changes have been considered. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

The final rule also implements a cut in payments for imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements cuts called for under the Deficit Reduction Act of 2005. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session.

The groups have been lobbying for months for Congress to pass stop-gap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And as of press time, 80 senators and 265 representatives have signed letters to the congressional leadership calling for the cuts to be stopped.

“They certainly are aware that this is a problem,” said Michael Amery, legislative counsel for the American Academy of Neurology. The question is whether members of Congress will act and, if so, when. Congress may take action during the lame-duck session or wait until early 2007 to address the issue, he said.

“Physicians are really frustrated that everyone in Congress agrees” that there is a problem, “but they aren't doing anything,” said Dr. Rick Kellerman, president of the American Academy of Family Physicians.

In the final regulation, CMS officials are giving with one hand and taking away with the other, Dr. Kellerman said. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said.

CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, Dr. Kellerman said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure.

Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

The combined impact of the work and practice expense RVU changes are estimated by CMS to result in a 5% increase in charges for primary care specialties such as family medicine and internal medicine, and a 2% increase for neurology. However, once the 5% across-the-board SGR cut is made, neurologists will see a 4% cut in allowed charges under Medicare.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them.

For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs. These cuts will be in addition to the 5% drop in reimbursement based on the SGR formula and the cuts related to in-office imaging services.

PHILADELPHIA — Routine screening of spina bifida patients for attention-deficit hyperactivity disorder should become a standard practice for physicians, Dr. Scott W. Stuart said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. Stuart, a developmental pediatrics fellow at the Medical University of South Carolina (MUSC) in Charleston, and his colleagues performed a chart review of 151 children with spina bifida, looking for diagnoses of ADHD and of medication use.

“Children with spina bifida are at significantly higher risk for ADHD behavior and medication treatment” than are those in the general population, he said.

Previous studies of patients with spina bifida have found that they are at risk for multiple neurobehavioral deficits. And clinicians who care for this population have long suspected that there is a high prevalence of ADHD symptoms in this group of patients, Dr. Stuart said.

Dr. Stuart and his colleagues performed a chart review of all patients who received care at the MUSC spina bifida clinic between Jan. 1, 1995, and Nov. 30, 2005, to determine the prevalence of ADHD in a population of spina bifida patients and compare that with general national and state trends for ADHD prevalence.

They set strict inclusion criteria that restricted subjects to those patients who were at least 7 years old at the last documented visit and who had a diagnosis of myelomeningocele or lipomeningocele. The study excluded diagnoses of spina bifida occulta, sacral agenesis, meningocele, and sacral dimple. To be considered a positive case, the diagnosis of ADHD had to be documented in the chart and the patient had to have a past or current history of taking medications for ADHD.

Of 151 patients in the clinic, 96 met the study criteria for diagnosis and age. Of that group, 22 patients also had a history of ADHD medication use and were included as positive ADHD cases.

The researchers found that 24% of the patients at the MUSC spina bifida clinic had a diagnosis of ADHD, compared with an 8% ADHD prevalence nationwide and a 10% prevalence in South Carolina. In addition, 19% of the MUSC sample had a diagnosis of ADHD combined with current medication use. On the national level, the current use of ADHD medication is reported to be 4%; it is 6% statewide.

The researchers also found that a history of ventricular shunt and shunt revision was associated with ADHD behaviors in their sample. For example, among patients whose charts included either documented concerns about ADHD, a confirmed diagnosis, or a history of medication use, all had a history of a ventricular shunt.

The study is limited by its small size, gaps in documentation, and lack of racial diversity, Dr. Stuart said.

PHILADELPHIA — Routine screening of spina bifida patients for attention-deficit hyperactivity disorder should become a standard practice for physicians, Dr. Scott W. Stuart said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. Stuart, a developmental pediatrics fellow at the Medical University of South Carolina (MUSC) in Charleston, and his colleagues performed a chart review of 151 children with spina bifida, looking for diagnoses of ADHD and of medication use.

“Children with spina bifida are at significantly higher risk for ADHD behavior and medication treatment” than are those in the general population, he said.

Previous studies of patients with spina bifida have found that they are at risk for multiple neurobehavioral deficits. And clinicians who care for this population have long suspected that there is a high prevalence of ADHD symptoms in this group of patients, Dr. Stuart said.

Dr. Stuart and his colleagues performed a chart review of all patients who received care at the MUSC spina bifida clinic between Jan. 1, 1995, and Nov. 30, 2005, to determine the prevalence of ADHD in a population of spina bifida patients and compare that with general national and state trends for ADHD prevalence.

They set strict inclusion criteria that restricted subjects to those patients who were at least 7 years old at the last documented visit and who had a diagnosis of myelomeningocele or lipomeningocele. The study excluded diagnoses of spina bifida occulta, sacral agenesis, meningocele, and sacral dimple. To be considered a positive case, the diagnosis of ADHD had to be documented in the chart and the patient had to have a past or current history of taking medications for ADHD.

Of 151 patients in the clinic, 96 met the study criteria for diagnosis and age. Of that group, 22 patients also had a history of ADHD medication use and were included as positive ADHD cases.

The researchers found that 24% of the patients at the MUSC spina bifida clinic had a diagnosis of ADHD, compared with an 8% ADHD prevalence nationwide and a 10% prevalence in South Carolina. In addition, 19% of the MUSC sample had a diagnosis of ADHD combined with current medication use. On the national level, the current use of ADHD medication is reported to be 4%; it is 6% statewide.

The researchers also found that a history of ventricular shunt and shunt revision was associated with ADHD behaviors in their sample. For example, among patients whose charts included either documented concerns about ADHD, a confirmed diagnosis, or a history of medication use, all had a history of a ventricular shunt.

The study is limited by its small size, gaps in documentation, and lack of racial diversity, Dr. Stuart said.

PHILADELPHIA — Routine screening of spina bifida patients for attention-deficit hyperactivity disorder should become a standard practice for physicians, Dr. Scott W. Stuart said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Dr. Stuart, a developmental pediatrics fellow at the Medical University of South Carolina (MUSC) in Charleston, and his colleagues performed a chart review of 151 children with spina bifida, looking for diagnoses of ADHD and of medication use.

“Children with spina bifida are at significantly higher risk for ADHD behavior and medication treatment” than are those in the general population, he said.

Previous studies of patients with spina bifida have found that they are at risk for multiple neurobehavioral deficits. And clinicians who care for this population have long suspected that there is a high prevalence of ADHD symptoms in this group of patients, Dr. Stuart said.

Dr. Stuart and his colleagues performed a chart review of all patients who received care at the MUSC spina bifida clinic between Jan. 1, 1995, and Nov. 30, 2005, to determine the prevalence of ADHD in a population of spina bifida patients and compare that with general national and state trends for ADHD prevalence.

They set strict inclusion criteria that restricted subjects to those patients who were at least 7 years old at the last documented visit and who had a diagnosis of myelomeningocele or lipomeningocele. The study excluded diagnoses of spina bifida occulta, sacral agenesis, meningocele, and sacral dimple. To be considered a positive case, the diagnosis of ADHD had to be documented in the chart and the patient had to have a past or current history of taking medications for ADHD.

Of 151 patients in the clinic, 96 met the study criteria for diagnosis and age. Of that group, 22 patients also had a history of ADHD medication use and were included as positive ADHD cases.

The researchers found that 24% of the patients at the MUSC spina bifida clinic had a diagnosis of ADHD, compared with an 8% ADHD prevalence nationwide and a 10% prevalence in South Carolina. In addition, 19% of the MUSC sample had a diagnosis of ADHD combined with current medication use. On the national level, the current use of ADHD medication is reported to be 4%; it is 6% statewide.

The researchers also found that a history of ventricular shunt and shunt revision was associated with ADHD behaviors in their sample. For example, among patients whose charts included either documented concerns about ADHD, a confirmed diagnosis, or a history of medication use, all had a history of a ventricular shunt.

The study is limited by its small size, gaps in documentation, and lack of racial diversity, Dr. Stuart said.

Vioxx Cases Dismissed

Merck & Co. will face fewer lawsuits related to its arthritis drug Vioxx thanks to a ruling by a New Jersey judge. Judge Carol Higbee of the Superior Court of New Jersey in Atlantic County dismissed about 50 Vioxx cases that had been filed in New Jersey—where Merck is headquartered—by plaintiffs from the United Kingdom, ruling that plaintiffs should pursue claims within their own legal systems. A U.S. District Court judge in New Orleans, where all federal Vioxx litigation has been referred, recently made a similar ruling that plaintiffs from France and Italy should file their claims within their own legal systems. To date, 10 Vioxx cases have gone to trial. Merck has won five cases and lost three cases. In addition, one Merck victory was set aside and a judge in New Orleans overturned the damages associated with a plaintiff's win.

Specialty Drug Demand Inelastic

Patients who need expensive specialty drugs will keep using the products even if they have to pay more—and that can drive up the cost of health care, said RAND Corp. researchers, who argued against tight restrictions and higher patient cost sharing for such drugs. The researchers used 2003–2004 data covering 1.5 million beneficiaries from 55 health plans to gauge private coverage for patients with four conditions—cancer, kidney disease, rheumatoid and/or psoriatic arthritis, and multiple sclerosis. They included drugs administered at physicians' offices and other nonhospital health care facilities. Health plan spending ranged from $3,200 per user for Lupron (leuprolide acetate), to $10,000 per user for Enbrel (etanercept), to $100,000 per user for recombinant factor VIII. Patients spent between $3,301 and $8,878 out of pocket on these four conditions. Writing in the September/October issue of Health Affairs, the researchers said their data showed that even if a plan doubled the patient's share, overall spending on specialty drugs by insurers would drop by only 1%–21%, depending on diagnosis. The study was supported by Amgen, the National Institute on Aging, and United Healthcare.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). More than one in five (22%) individuals who had taken prescription medication for arthritis, gout, or lupus reported supplement use during the last year.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences (OSSD)—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies such as the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Serving as cochairs of the coalition are the last three secretaries of the Department of Health and Human Services.

Vioxx Cases Dismissed

Merck & Co. will face fewer lawsuits related to its arthritis drug Vioxx thanks to a ruling by a New Jersey judge. Judge Carol Higbee of the Superior Court of New Jersey in Atlantic County dismissed about 50 Vioxx cases that had been filed in New Jersey—where Merck is headquartered—by plaintiffs from the United Kingdom, ruling that plaintiffs should pursue claims within their own legal systems. A U.S. District Court judge in New Orleans, where all federal Vioxx litigation has been referred, recently made a similar ruling that plaintiffs from France and Italy should file their claims within their own legal systems. To date, 10 Vioxx cases have gone to trial. Merck has won five cases and lost three cases. In addition, one Merck victory was set aside and a judge in New Orleans overturned the damages associated with a plaintiff's win.

Specialty Drug Demand Inelastic

Patients who need expensive specialty drugs will keep using the products even if they have to pay more—and that can drive up the cost of health care, said RAND Corp. researchers, who argued against tight restrictions and higher patient cost sharing for such drugs. The researchers used 2003–2004 data covering 1.5 million beneficiaries from 55 health plans to gauge private coverage for patients with four conditions—cancer, kidney disease, rheumatoid and/or psoriatic arthritis, and multiple sclerosis. They included drugs administered at physicians' offices and other nonhospital health care facilities. Health plan spending ranged from $3,200 per user for Lupron (leuprolide acetate), to $10,000 per user for Enbrel (etanercept), to $100,000 per user for recombinant factor VIII. Patients spent between $3,301 and $8,878 out of pocket on these four conditions. Writing in the September/October issue of Health Affairs, the researchers said their data showed that even if a plan doubled the patient's share, overall spending on specialty drugs by insurers would drop by only 1%–21%, depending on diagnosis. The study was supported by Amgen, the National Institute on Aging, and United Healthcare.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). More than one in five (22%) individuals who had taken prescription medication for arthritis, gout, or lupus reported supplement use during the last year.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences (OSSD)—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies such as the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Serving as cochairs of the coalition are the last three secretaries of the Department of Health and Human Services.

Vioxx Cases Dismissed

Merck & Co. will face fewer lawsuits related to its arthritis drug Vioxx thanks to a ruling by a New Jersey judge. Judge Carol Higbee of the Superior Court of New Jersey in Atlantic County dismissed about 50 Vioxx cases that had been filed in New Jersey—where Merck is headquartered—by plaintiffs from the United Kingdom, ruling that plaintiffs should pursue claims within their own legal systems. A U.S. District Court judge in New Orleans, where all federal Vioxx litigation has been referred, recently made a similar ruling that plaintiffs from France and Italy should file their claims within their own legal systems. To date, 10 Vioxx cases have gone to trial. Merck has won five cases and lost three cases. In addition, one Merck victory was set aside and a judge in New Orleans overturned the damages associated with a plaintiff's win.

Specialty Drug Demand Inelastic

Patients who need expensive specialty drugs will keep using the products even if they have to pay more—and that can drive up the cost of health care, said RAND Corp. researchers, who argued against tight restrictions and higher patient cost sharing for such drugs. The researchers used 2003–2004 data covering 1.5 million beneficiaries from 55 health plans to gauge private coverage for patients with four conditions—cancer, kidney disease, rheumatoid and/or psoriatic arthritis, and multiple sclerosis. They included drugs administered at physicians' offices and other nonhospital health care facilities. Health plan spending ranged from $3,200 per user for Lupron (leuprolide acetate), to $10,000 per user for Enbrel (etanercept), to $100,000 per user for recombinant factor VIII. Patients spent between $3,301 and $8,878 out of pocket on these four conditions. Writing in the September/October issue of Health Affairs, the researchers said their data showed that even if a plan doubled the patient's share, overall spending on specialty drugs by insurers would drop by only 1%–21%, depending on diagnosis. The study was supported by Amgen, the National Institute on Aging, and United Healthcare.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). More than one in five (22%) individuals who had taken prescription medication for arthritis, gout, or lupus reported supplement use during the last year.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences (OSSD)—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies such as the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Serving as cochairs of the coalition are the last three secretaries of the Department of Health and Human Services.

The field of palliative care took a major step forward in September when members of the American Board of Medical Specialties voted to approve hospice and palliative medicine as a recognized subspecialty.

The application to recognize the subspecialty had broad support and was cosponsored by 10 medical specialty boards.

As a result, physicians in a number of specialties—including internal medicine, family medicine, pediatrics, psychiatry, neurology, surgery, emergency medicine, and obstetrics and gynecology—will be able to seek the certification.

The first certification examination is expected to be administered in 2008, according to Dr. F. Daniel Duffy, senior adviser to the president of the American Board of Internal Medicine. “It's going to be a real boost to patient care,” Dr. Duffy said.

The milestone is just the latest in a series of developments in the size and status of the field of palliative care.

Between 2000 and 2004, the number of hospital-owned palliative care programs in the United States increased by nearly 75%, jumping from 632 in 2000 to 1,102 in 2004.

As of 2004, 63% of large hospitals—those with at least 200 general adult beds—reported that they had some type of palliative care program in operation, according to the Center to Advance Palliative Care.

This summer, palliative medicine received a nod from the Accreditation Council for Graduate Medical Education (ACGME) when the organization voted to approve an accreditation process for hospice and palliative medicine fellowship training programs.

ACGME is expected to begin accepting applications in summer 2007.

“We're well beyond the tipping point,” said Dr. Diane Meier, director of the Center to Advance Palliative Care and director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York.

At her institution, palliative care has become so well accepted that asking for a palliative care consult is as routine as calling for an infectious disease consult.

Physicians no longer see it as a personal failure in their treatment of the patient to get assistance from palliative care, she said.

Now the focus has shifted from selling the concept of palliative medicine to ensuring that programs around the country have consistently high standards, Dr. Meier said.

Work is already underway in this area. The National Consensus Project for Quality Palliative Care, which is sponsored by three national palliative medicine organizations, has released quality guidelines.

These guidelines include having interdisciplinary teams, making grief and bereavement services available to patients and families, and providing evidence-based pain and symptom relief, among others.

The standards are a guidepost but will be challenging for smaller programs, Dr. Meier said, and should be filtered by the size of the facility, the staff available, and the needs of the institution.

The National Quality Forum approved its own framework for palliative and hospice care earlier this year.

“That's real legitimacy,” Dr. Meier commented.

In an effort to ensure that new programs have high-quality processes in place, the Center to Advance Palliative Care launched the Palliative Care Leadership Centers—six centers of excellence in palliative care around the country that train teams of health care providers.

The program includes intensive, 2-day training sessions in which teams are sent to one of the six centers and leaders at the centers act as mentors for a year after training.

The cost of the program is about $1,750 for a four-person team.

When the site visits started in 2004, Dr. Meier and others at the Center to Advance Palliative Care estimated that about 30% of the teams trained would successfully establish a program, she said, but it's been closer to 70% to date.

However, the process isn't fast, and it sometimes takes more than a year for teams to get their programs up and running, she said.

The Mount Carmel Health System in Columbus, Ohio, is one of the six leadership centers. The program was launched in 1997 in an effort to treat patients with serious, advanced diseases who were not candidates for hospice care, Mary Ann Gill, executive director of palliative care services at Mount Carmel, said.

The Mount Carmel program, which includes a palliative care consult team as well as three dedicated palliative care units across three hospitals, is popular with teams working to start programs in community hospitals.

During the training, the members of a palliative care team are encouraged to get to know each other better and begin drafting a work plan to take back to their institution.

The training focuses on the clinical aspects of the program, as well as on financial management and how to sustain the program, Ms. Gill said.

While much of the interest in palliative medicine has been from physicians at midcareer, there is increasing interest among young physicians and residents, said Dr. Philip H. Santa-Emma, medical director for the palliative care service at Mount Carmel. “I've seen a huge increase in the number of residents coming through,” he said.

But the training of new physicians in palliative care also represents one of the next big challenges in the field, Dr. Meier said.

Currently there is a cap on the number of residency positions funded by Medicare, making it hard for a new subspecialty to gain a foothold, she said. Palliative care fellowships are currently funded by philanthropy.

As the field continues to move forward, there also needs to be continual education of the health care team about when to get palliative care involved, Dr. Santa-Emma said.

This is a message that has to get out to all members of the health care team, not just physicians, he said.

And members of the palliative care team need to figure out better ways to integrate their care into the intensive care unit and the emergency department, he said.

The field of palliative care took a major step forward in September when members of the American Board of Medical Specialties voted to approve hospice and palliative medicine as a recognized subspecialty.

The application to recognize the subspecialty had broad support and was cosponsored by 10 medical specialty boards.

As a result, physicians in a number of specialties—including internal medicine, family medicine, pediatrics, psychiatry, neurology, surgery, emergency medicine, and obstetrics and gynecology—will be able to seek the certification.

The first certification examination is expected to be administered in 2008, according to Dr. F. Daniel Duffy, senior adviser to the president of the American Board of Internal Medicine. “It's going to be a real boost to patient care,” Dr. Duffy said.

The milestone is just the latest in a series of developments in the size and status of the field of palliative care.

Between 2000 and 2004, the number of hospital-owned palliative care programs in the United States increased by nearly 75%, jumping from 632 in 2000 to 1,102 in 2004.

As of 2004, 63% of large hospitals—those with at least 200 general adult beds—reported that they had some type of palliative care program in operation, according to the Center to Advance Palliative Care.

This summer, palliative medicine received a nod from the Accreditation Council for Graduate Medical Education (ACGME) when the organization voted to approve an accreditation process for hospice and palliative medicine fellowship training programs.

ACGME is expected to begin accepting applications in summer 2007.

“We're well beyond the tipping point,” said Dr. Diane Meier, director of the Center to Advance Palliative Care and director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York.

At her institution, palliative care has become so well accepted that asking for a palliative care consult is as routine as calling for an infectious disease consult.

Physicians no longer see it as a personal failure in their treatment of the patient to get assistance from palliative care, she said.

Now the focus has shifted from selling the concept of palliative medicine to ensuring that programs around the country have consistently high standards, Dr. Meier said.

Work is already underway in this area. The National Consensus Project for Quality Palliative Care, which is sponsored by three national palliative medicine organizations, has released quality guidelines.

These guidelines include having interdisciplinary teams, making grief and bereavement services available to patients and families, and providing evidence-based pain and symptom relief, among others.

The standards are a guidepost but will be challenging for smaller programs, Dr. Meier said, and should be filtered by the size of the facility, the staff available, and the needs of the institution.

The National Quality Forum approved its own framework for palliative and hospice care earlier this year.

“That's real legitimacy,” Dr. Meier commented.

In an effort to ensure that new programs have high-quality processes in place, the Center to Advance Palliative Care launched the Palliative Care Leadership Centers—six centers of excellence in palliative care around the country that train teams of health care providers.

The program includes intensive, 2-day training sessions in which teams are sent to one of the six centers and leaders at the centers act as mentors for a year after training.

The cost of the program is about $1,750 for a four-person team.

When the site visits started in 2004, Dr. Meier and others at the Center to Advance Palliative Care estimated that about 30% of the teams trained would successfully establish a program, she said, but it's been closer to 70% to date.

However, the process isn't fast, and it sometimes takes more than a year for teams to get their programs up and running, she said.

The Mount Carmel Health System in Columbus, Ohio, is one of the six leadership centers. The program was launched in 1997 in an effort to treat patients with serious, advanced diseases who were not candidates for hospice care, Mary Ann Gill, executive director of palliative care services at Mount Carmel, said.

The Mount Carmel program, which includes a palliative care consult team as well as three dedicated palliative care units across three hospitals, is popular with teams working to start programs in community hospitals.

During the training, the members of a palliative care team are encouraged to get to know each other better and begin drafting a work plan to take back to their institution.

The training focuses on the clinical aspects of the program, as well as on financial management and how to sustain the program, Ms. Gill said.

While much of the interest in palliative medicine has been from physicians at midcareer, there is increasing interest among young physicians and residents, said Dr. Philip H. Santa-Emma, medical director for the palliative care service at Mount Carmel. “I've seen a huge increase in the number of residents coming through,” he said.

But the training of new physicians in palliative care also represents one of the next big challenges in the field, Dr. Meier said.

Currently there is a cap on the number of residency positions funded by Medicare, making it hard for a new subspecialty to gain a foothold, she said. Palliative care fellowships are currently funded by philanthropy.

As the field continues to move forward, there also needs to be continual education of the health care team about when to get palliative care involved, Dr. Santa-Emma said.

This is a message that has to get out to all members of the health care team, not just physicians, he said.

And members of the palliative care team need to figure out better ways to integrate their care into the intensive care unit and the emergency department, he said.

The field of palliative care took a major step forward in September when members of the American Board of Medical Specialties voted to approve hospice and palliative medicine as a recognized subspecialty.

The application to recognize the subspecialty had broad support and was cosponsored by 10 medical specialty boards.

As a result, physicians in a number of specialties—including internal medicine, family medicine, pediatrics, psychiatry, neurology, surgery, emergency medicine, and obstetrics and gynecology—will be able to seek the certification.

The first certification examination is expected to be administered in 2008, according to Dr. F. Daniel Duffy, senior adviser to the president of the American Board of Internal Medicine. “It's going to be a real boost to patient care,” Dr. Duffy said.

The milestone is just the latest in a series of developments in the size and status of the field of palliative care.

Between 2000 and 2004, the number of hospital-owned palliative care programs in the United States increased by nearly 75%, jumping from 632 in 2000 to 1,102 in 2004.

As of 2004, 63% of large hospitals—those with at least 200 general adult beds—reported that they had some type of palliative care program in operation, according to the Center to Advance Palliative Care.

This summer, palliative medicine received a nod from the Accreditation Council for Graduate Medical Education (ACGME) when the organization voted to approve an accreditation process for hospice and palliative medicine fellowship training programs.

ACGME is expected to begin accepting applications in summer 2007.

“We're well beyond the tipping point,” said Dr. Diane Meier, director of the Center to Advance Palliative Care and director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York.

At her institution, palliative care has become so well accepted that asking for a palliative care consult is as routine as calling for an infectious disease consult.

Physicians no longer see it as a personal failure in their treatment of the patient to get assistance from palliative care, she said.

Now the focus has shifted from selling the concept of palliative medicine to ensuring that programs around the country have consistently high standards, Dr. Meier said.

Work is already underway in this area. The National Consensus Project for Quality Palliative Care, which is sponsored by three national palliative medicine organizations, has released quality guidelines.

These guidelines include having interdisciplinary teams, making grief and bereavement services available to patients and families, and providing evidence-based pain and symptom relief, among others.

The standards are a guidepost but will be challenging for smaller programs, Dr. Meier said, and should be filtered by the size of the facility, the staff available, and the needs of the institution.

The National Quality Forum approved its own framework for palliative and hospice care earlier this year.

“That's real legitimacy,” Dr. Meier commented.

In an effort to ensure that new programs have high-quality processes in place, the Center to Advance Palliative Care launched the Palliative Care Leadership Centers—six centers of excellence in palliative care around the country that train teams of health care providers.

The program includes intensive, 2-day training sessions in which teams are sent to one of the six centers and leaders at the centers act as mentors for a year after training.

The cost of the program is about $1,750 for a four-person team.

When the site visits started in 2004, Dr. Meier and others at the Center to Advance Palliative Care estimated that about 30% of the teams trained would successfully establish a program, she said, but it's been closer to 70% to date.

However, the process isn't fast, and it sometimes takes more than a year for teams to get their programs up and running, she said.

The Mount Carmel Health System in Columbus, Ohio, is one of the six leadership centers. The program was launched in 1997 in an effort to treat patients with serious, advanced diseases who were not candidates for hospice care, Mary Ann Gill, executive director of palliative care services at Mount Carmel, said.

The Mount Carmel program, which includes a palliative care consult team as well as three dedicated palliative care units across three hospitals, is popular with teams working to start programs in community hospitals.

During the training, the members of a palliative care team are encouraged to get to know each other better and begin drafting a work plan to take back to their institution.

The training focuses on the clinical aspects of the program, as well as on financial management and how to sustain the program, Ms. Gill said.

While much of the interest in palliative medicine has been from physicians at midcareer, there is increasing interest among young physicians and residents, said Dr. Philip H. Santa-Emma, medical director for the palliative care service at Mount Carmel. “I've seen a huge increase in the number of residents coming through,” he said.

But the training of new physicians in palliative care also represents one of the next big challenges in the field, Dr. Meier said.

Currently there is a cap on the number of residency positions funded by Medicare, making it hard for a new subspecialty to gain a foothold, she said. Palliative care fellowships are currently funded by philanthropy.

As the field continues to move forward, there also needs to be continual education of the health care team about when to get palliative care involved, Dr. Santa-Emma said.

This is a message that has to get out to all members of the health care team, not just physicians, he said.

And members of the palliative care team need to figure out better ways to integrate their care into the intensive care unit and the emergency department, he said.

Most pediatricians give the U.S. health care system good marks when it comes to providing well-child care, but many also favor changes such as providing some care by phone or e-mail, according to a national survey.

Dr. Tumaini Coker and colleagues at the University of Chicago surveyed 502 pediatricians from around the country about their views of the current well-child system and what would be an ideal way of providing that care. Pediatricians were told to assume that their income would not be affected by the changes they were asked to evaluate for the survey.

The findings show that there is a high degree of satisfaction with the current system for providing well-child visits (Pediatrics 2006;118:1852–7). Nearly all respondents (97%) said the system was excellent or good for providing well-child visits for healthy children, 93% rated it high for chronic illness management, and 88% said it was excellent or good for providing anticipatory guidance. However, pediatricians reported that the system was less well equipped to provide psychosocial screening with only 55% rating it as excellent or good in that area.

While most of the survey respondents reported that currently they perform most components of well-child care (physician exam, anticipatory guidance, developmental screening, and psychosocial screening) themselves, in an ideal setting 55%–60% said that some of those functions could be performed by nonphysician providers.

For example, when asked who should be the main provider of services in an ideal system, 40% said that psychosocial screening should be done by the pediatrician; 40% said it should be done by a nurse practitioner or physician assistant; and 20% said it should be done by a registered nurse or medical assistant.

More pediatricians (76%) thought it was important for the pediatrician to continue to perform the physical exam in an ideal system, while the remainder said it should be done by a nurse practitioner or physician assistant.

Physicians also were supportive of replacing some in-person office visits with phone or e-mail consultations. For example, 64% of pediatricians surveyed that said much or some anticipatory guidance could be provided by phone or e-mail, and 29% said that “a few” services could be provided by phone or e-mail. In addition, 57% of pediatricians said that many or some visits for minor acute care could be handled by phone or e-mail, and 33% said that a few such visits could be replaced with calls or e-mail.

The surveys were mailed to a random national sample of 1,000 pediatricians under age 70. There was a 60% response rate, with 502 pediatricians returning the survey. The study was supported by the Robert Wood Johnson Clinical Scholars Program.

ELSEVIER GLOBAL MEDICAL NEWS

Most pediatricians give the U.S. health care system good marks when it comes to providing well-child care, but many also favor changes such as providing some care by phone or e-mail, according to a national survey.

Dr. Tumaini Coker and colleagues at the University of Chicago surveyed 502 pediatricians from around the country about their views of the current well-child system and what would be an ideal way of providing that care. Pediatricians were told to assume that their income would not be affected by the changes they were asked to evaluate for the survey.

The findings show that there is a high degree of satisfaction with the current system for providing well-child visits (Pediatrics 2006;118:1852–7). Nearly all respondents (97%) said the system was excellent or good for providing well-child visits for healthy children, 93% rated it high for chronic illness management, and 88% said it was excellent or good for providing anticipatory guidance. However, pediatricians reported that the system was less well equipped to provide psychosocial screening with only 55% rating it as excellent or good in that area.

While most of the survey respondents reported that currently they perform most components of well-child care (physician exam, anticipatory guidance, developmental screening, and psychosocial screening) themselves, in an ideal setting 55%–60% said that some of those functions could be performed by nonphysician providers.

For example, when asked who should be the main provider of services in an ideal system, 40% said that psychosocial screening should be done by the pediatrician; 40% said it should be done by a nurse practitioner or physician assistant; and 20% said it should be done by a registered nurse or medical assistant.

More pediatricians (76%) thought it was important for the pediatrician to continue to perform the physical exam in an ideal system, while the remainder said it should be done by a nurse practitioner or physician assistant.

Physicians also were supportive of replacing some in-person office visits with phone or e-mail consultations. For example, 64% of pediatricians surveyed that said much or some anticipatory guidance could be provided by phone or e-mail, and 29% said that “a few” services could be provided by phone or e-mail. In addition, 57% of pediatricians said that many or some visits for minor acute care could be handled by phone or e-mail, and 33% said that a few such visits could be replaced with calls or e-mail.

The surveys were mailed to a random national sample of 1,000 pediatricians under age 70. There was a 60% response rate, with 502 pediatricians returning the survey. The study was supported by the Robert Wood Johnson Clinical Scholars Program.

ELSEVIER GLOBAL MEDICAL NEWS

Most pediatricians give the U.S. health care system good marks when it comes to providing well-child care, but many also favor changes such as providing some care by phone or e-mail, according to a national survey.

Dr. Tumaini Coker and colleagues at the University of Chicago surveyed 502 pediatricians from around the country about their views of the current well-child system and what would be an ideal way of providing that care. Pediatricians were told to assume that their income would not be affected by the changes they were asked to evaluate for the survey.

The findings show that there is a high degree of satisfaction with the current system for providing well-child visits (Pediatrics 2006;118:1852–7). Nearly all respondents (97%) said the system was excellent or good for providing well-child visits for healthy children, 93% rated it high for chronic illness management, and 88% said it was excellent or good for providing anticipatory guidance. However, pediatricians reported that the system was less well equipped to provide psychosocial screening with only 55% rating it as excellent or good in that area.

While most of the survey respondents reported that currently they perform most components of well-child care (physician exam, anticipatory guidance, developmental screening, and psychosocial screening) themselves, in an ideal setting 55%–60% said that some of those functions could be performed by nonphysician providers.

For example, when asked who should be the main provider of services in an ideal system, 40% said that psychosocial screening should be done by the pediatrician; 40% said it should be done by a nurse practitioner or physician assistant; and 20% said it should be done by a registered nurse or medical assistant.

More pediatricians (76%) thought it was important for the pediatrician to continue to perform the physical exam in an ideal system, while the remainder said it should be done by a nurse practitioner or physician assistant.

Physicians also were supportive of replacing some in-person office visits with phone or e-mail consultations. For example, 64% of pediatricians surveyed that said much or some anticipatory guidance could be provided by phone or e-mail, and 29% said that “a few” services could be provided by phone or e-mail. In addition, 57% of pediatricians said that many or some visits for minor acute care could be handled by phone or e-mail, and 33% said that a few such visits could be replaced with calls or e-mail.

The surveys were mailed to a random national sample of 1,000 pediatricians under age 70. There was a 60% response rate, with 502 pediatricians returning the survey. The study was supported by the Robert Wood Johnson Clinical Scholars Program.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Testosterone therapy should not be offered to all older men with low testosterone levels, according to experts commissioned by the Endocrine Society to examine the treatment of androgen deficiency in adult men.

Guidelines issued by the task force members advise that physicians instead offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency. The guidelines were published in June (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

But task force members disagreed about the serum testosterone threshold that should trigger therapy in older men with symptoms of androgen deficiency, Dr. Shalender Bhasin, chair of the task force, said at the annual meeting of the Endocrine Society. Some would initiate treatment in symptomatic older men with testosterone levels less than 300 ng/dL; others favored a threshold of 200 ng/dL, saying the severity of symptoms should guide treatment.

The Endocrine Society decided to address the treatment of androgen deficiency because it's an area with rapid advances in basic science and product development. In addition, testosterone prescriptions are up; but at the same time, there is considerable misinformation and controversy surrounding the use of testosterone therapy, said Dr. Bhasin, who is chief of endocrinology at Boston University.

“We tried to do the right thing,” he said. “We anguished a great deal because of the realization that … we know so little.”

The new guidelines are based on systematic reviews of available evidence and discussions among the task force members. They outline recommendations for diagnosis, screening, treatment, and monitoring for testosterone therapy in adult men with androgen deficiency syndromes.

Diagnosis

The members of the task force opposed screening for androgen deficiency in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

The experts recommended making the diagnosis of androgen deficiency only in individuals with consistent symptoms and signs of low serum testosterone levels. A diagnosis should not be made during an acute or subacute illness, Dr. Bhasin said.

The diagnosis can be challenging because the signs and symptoms of androgen deficiency are nonspecific and appropriate threshold testosterone levels are unknown and may depend on age, Dr. Bhasin said. Further, testosterone measures may vary because of circadian rhythms as well as accuracy problems with commercial assays, he said.

The task force advised using a reliable assay to measure the morning total testosterone level to establish the diagnosis and confirming it either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level.

Treatment

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, according to the guidelines. The therapy should be used to induce and maintain secondary sex characteristics. It can also be used to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients who have metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications noted in the guidelines include erythrocytosis, hyperviscosity, untreated obstructive sleep apnea, severe benign prostatic hyperplasia symptoms, or uncontrolled severe heart failure.

Because of a lack of randomized controlled trial data, the task force did not make a recommendation on the treatment of men with prostate cancer who have been disease free for two years or more.

For HIV-infected men who have low testosterone levels and weight loss, the task force members suggested short-term testosterone therapy as an adjunctive approach to promote weight maintenance and improvements in lean body mass and muscle strength.

Monitoring

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, 3 months, and annually, the task force recommended. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dose, but evaluations for hypoxia and sleep apnea should be conducted, the task force recommended.

The task force recommended urological consultation if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in any 12-month period.

BOSTON — Testosterone therapy should not be offered to all older men with low testosterone levels, according to experts commissioned by the Endocrine Society to examine the treatment of androgen deficiency in adult men.

Guidelines issued by the task force members advise that physicians instead offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency. The guidelines were published in June (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

But task force members disagreed about the serum testosterone threshold that should trigger therapy in older men with symptoms of androgen deficiency, Dr. Shalender Bhasin, chair of the task force, said at the annual meeting of the Endocrine Society. Some would initiate treatment in symptomatic older men with testosterone levels less than 300 ng/dL; others favored a threshold of 200 ng/dL, saying the severity of symptoms should guide treatment.

The Endocrine Society decided to address the treatment of androgen deficiency because it's an area with rapid advances in basic science and product development. In addition, testosterone prescriptions are up; but at the same time, there is considerable misinformation and controversy surrounding the use of testosterone therapy, said Dr. Bhasin, who is chief of endocrinology at Boston University.

“We tried to do the right thing,” he said. “We anguished a great deal because of the realization that … we know so little.”

The new guidelines are based on systematic reviews of available evidence and discussions among the task force members. They outline recommendations for diagnosis, screening, treatment, and monitoring for testosterone therapy in adult men with androgen deficiency syndromes.

Diagnosis

The members of the task force opposed screening for androgen deficiency in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

The experts recommended making the diagnosis of androgen deficiency only in individuals with consistent symptoms and signs of low serum testosterone levels. A diagnosis should not be made during an acute or subacute illness, Dr. Bhasin said.

The diagnosis can be challenging because the signs and symptoms of androgen deficiency are nonspecific and appropriate threshold testosterone levels are unknown and may depend on age, Dr. Bhasin said. Further, testosterone measures may vary because of circadian rhythms as well as accuracy problems with commercial assays, he said.

The task force advised using a reliable assay to measure the morning total testosterone level to establish the diagnosis and confirming it either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level.

Treatment

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, according to the guidelines. The therapy should be used to induce and maintain secondary sex characteristics. It can also be used to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients who have metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications noted in the guidelines include erythrocytosis, hyperviscosity, untreated obstructive sleep apnea, severe benign prostatic hyperplasia symptoms, or uncontrolled severe heart failure.

Because of a lack of randomized controlled trial data, the task force did not make a recommendation on the treatment of men with prostate cancer who have been disease free for two years or more.

For HIV-infected men who have low testosterone levels and weight loss, the task force members suggested short-term testosterone therapy as an adjunctive approach to promote weight maintenance and improvements in lean body mass and muscle strength.

Monitoring

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, 3 months, and annually, the task force recommended. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dose, but evaluations for hypoxia and sleep apnea should be conducted, the task force recommended.

The task force recommended urological consultation if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in any 12-month period.

BOSTON — Testosterone therapy should not be offered to all older men with low testosterone levels, according to experts commissioned by the Endocrine Society to examine the treatment of androgen deficiency in adult men.

Guidelines issued by the task force members advise that physicians instead offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency. The guidelines were published in June (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

But task force members disagreed about the serum testosterone threshold that should trigger therapy in older men with symptoms of androgen deficiency, Dr. Shalender Bhasin, chair of the task force, said at the annual meeting of the Endocrine Society. Some would initiate treatment in symptomatic older men with testosterone levels less than 300 ng/dL; others favored a threshold of 200 ng/dL, saying the severity of symptoms should guide treatment.

The Endocrine Society decided to address the treatment of androgen deficiency because it's an area with rapid advances in basic science and product development. In addition, testosterone prescriptions are up; but at the same time, there is considerable misinformation and controversy surrounding the use of testosterone therapy, said Dr. Bhasin, who is chief of endocrinology at Boston University.

“We tried to do the right thing,” he said. “We anguished a great deal because of the realization that … we know so little.”

The new guidelines are based on systematic reviews of available evidence and discussions among the task force members. They outline recommendations for diagnosis, screening, treatment, and monitoring for testosterone therapy in adult men with androgen deficiency syndromes.

Diagnosis

The members of the task force opposed screening for androgen deficiency in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

The experts recommended making the diagnosis of androgen deficiency only in individuals with consistent symptoms and signs of low serum testosterone levels. A diagnosis should not be made during an acute or subacute illness, Dr. Bhasin said.

The diagnosis can be challenging because the signs and symptoms of androgen deficiency are nonspecific and appropriate threshold testosterone levels are unknown and may depend on age, Dr. Bhasin said. Further, testosterone measures may vary because of circadian rhythms as well as accuracy problems with commercial assays, he said.

The task force advised using a reliable assay to measure the morning total testosterone level to establish the diagnosis and confirming it either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level.

Treatment

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, according to the guidelines. The therapy should be used to induce and maintain secondary sex characteristics. It can also be used to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients who have metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications noted in the guidelines include erythrocytosis, hyperviscosity, untreated obstructive sleep apnea, severe benign prostatic hyperplasia symptoms, or uncontrolled severe heart failure.

Because of a lack of randomized controlled trial data, the task force did not make a recommendation on the treatment of men with prostate cancer who have been disease free for two years or more.

For HIV-infected men who have low testosterone levels and weight loss, the task force members suggested short-term testosterone therapy as an adjunctive approach to promote weight maintenance and improvements in lean body mass and muscle strength.

Monitoring

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, 3 months, and annually, the task force recommended. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dose, but evaluations for hypoxia and sleep apnea should be conducted, the task force recommended.

The task force recommended urological consultation if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in any 12-month period.

Mental Health Rx Restrictions

Medicare Part D drug plans often employ utilization management techniques, such as prior authorization, for commonly prescribed antidepressants and antipsychotics, according to a report from the Medicare Rights Center. The group, which advocates for Medicare beneficiaries, reported that the use of utilization management strategies varies widely among drug plans, but these approaches are generally used for commonly prescribed drugs and more expensive medications. On average, 23% of antidepressants and 24% of antipsychotics were determined to be either not covered or restricted by utilization management techniques. The Medicare Rights Center called on officials at the Centers for Medicare and Medicaid Services to review all utilization management restrictions to ensure that they are “clinically sound” and are not designed to steer patients to low-cost but medically inappropriate treatments. The group is also pushing for Part D plans that differentiate patients who are beginning a new therapy from those who are stable on a medication at the point of sale. “It is a cruel and devastating hoax to impose insurmountable hurdles between people with mental illnesses and the medicines they need to have decent lives,” Robert M. Hayes, president of the Medicare Rights Center, said. “The CMS should outlaw these barriers to health.” The report analyzed antidepressant and antipsychotic drug coverage across 15 Part D drug plans.

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities, said.

Medicaid Enrollment, Spending

Spending by the states under the Medicaid program increased 2.8% during the state fiscal year 2006, the smallest increase in about a decade, according to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. Improvements in the economy and the implementation of the Medicare prescription drug benefit in 2006 may have helped to keep costs lower, according to the results of the 50-state survey released by the Kaiser Family Foundation. There was also an enrollment slowdown in the program with only a 1.6% increase. “When the economy improves, it is natural for Medicaid spending and enrollment growth to subside because fewer people turn to the program for assistance,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said. “But with the continued growth in the uninsured population, Medicaid remains on the front lines for coverage [of] low-income children and adults.”

FCC Changes Children's TV Rules

Officials at the Federal Communications Commission recently clarified the rules regarding requirements for children's television programming. Under the changes, TV broadcasters that have multiple stations must ensure that they air additional children's programming, and only half the shows can be repeats aired in the previous 7 days. The changes also clarify restrictions on the use of Web site addresses in programming. Under the new FCC rules, Internet addresses that do not offer a substantial amount of noncommercial content will be counted against the network's commercial time limits and must be kept separate from its programming. The changes were praised by the American Academy of Child and Adolescent Psychiatry. The new rules revise rules issued by the FCC in 2004 and are based largely on a compromise agreement among the four major broadcast networks, major children's networks, cable operators, advertisers, and a coalition of children's advocacy groups. “Children should have access to educational as well as entertaining television programs. We also need to protect kids from the overinfluence of television advertising, [which] has been linked to childhood obesity and lower academic performance,” said Dr. Michael Brody, chair of the academy's television and media committee.

Medicare Fraud Decision

The two owners of a former San Diego psychiatric hospital have been found liable for more than $23 million in damages and penalties for submitting false claims to the Medicare program. Robert I. Bourseau, Dr. Rudra Sabaratnam, and their corporations, RIB Medical Management Services Inc. and Navatkuda Inc., were charged with billing Medicare for nearly $8 million in costs for a fake lease, unused hospital space, and expenses unrelated to the operation of the hospital. The two individuals, who owned the hospital formerly known as Bayview Hospital & Mental Health Systems, were charged under the federal False Claims Act. “Those who think about cheating Medicare might want to think again,” Carol Lam, U.S. Attorney for the Southern District of California, said. “The defendants here must now pay more than three times what they stole.”

Mental Health Rx Restrictions

Medicare Part D drug plans often employ utilization management techniques, such as prior authorization, for commonly prescribed antidepressants and antipsychotics, according to a report from the Medicare Rights Center. The group, which advocates for Medicare beneficiaries, reported that the use of utilization management strategies varies widely among drug plans, but these approaches are generally used for commonly prescribed drugs and more expensive medications. On average, 23% of antidepressants and 24% of antipsychotics were determined to be either not covered or restricted by utilization management techniques. The Medicare Rights Center called on officials at the Centers for Medicare and Medicaid Services to review all utilization management restrictions to ensure that they are “clinically sound” and are not designed to steer patients to low-cost but medically inappropriate treatments. The group is also pushing for Part D plans that differentiate patients who are beginning a new therapy from those who are stable on a medication at the point of sale. “It is a cruel and devastating hoax to impose insurmountable hurdles between people with mental illnesses and the medicines they need to have decent lives,” Robert M. Hayes, president of the Medicare Rights Center, said. “The CMS should outlaw these barriers to health.” The report analyzed antidepressant and antipsychotic drug coverage across 15 Part D drug plans.

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities, said.

Medicaid Enrollment, Spending

Spending by the states under the Medicaid program increased 2.8% during the state fiscal year 2006, the smallest increase in about a decade, according to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. Improvements in the economy and the implementation of the Medicare prescription drug benefit in 2006 may have helped to keep costs lower, according to the results of the 50-state survey released by the Kaiser Family Foundation. There was also an enrollment slowdown in the program with only a 1.6% increase. “When the economy improves, it is natural for Medicaid spending and enrollment growth to subside because fewer people turn to the program for assistance,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said. “But with the continued growth in the uninsured population, Medicaid remains on the front lines for coverage [of] low-income children and adults.”

FCC Changes Children's TV Rules

Officials at the Federal Communications Commission recently clarified the rules regarding requirements for children's television programming. Under the changes, TV broadcasters that have multiple stations must ensure that they air additional children's programming, and only half the shows can be repeats aired in the previous 7 days. The changes also clarify restrictions on the use of Web site addresses in programming. Under the new FCC rules, Internet addresses that do not offer a substantial amount of noncommercial content will be counted against the network's commercial time limits and must be kept separate from its programming. The changes were praised by the American Academy of Child and Adolescent Psychiatry. The new rules revise rules issued by the FCC in 2004 and are based largely on a compromise agreement among the four major broadcast networks, major children's networks, cable operators, advertisers, and a coalition of children's advocacy groups. “Children should have access to educational as well as entertaining television programs. We also need to protect kids from the overinfluence of television advertising, [which] has been linked to childhood obesity and lower academic performance,” said Dr. Michael Brody, chair of the academy's television and media committee.

Medicare Fraud Decision

The two owners of a former San Diego psychiatric hospital have been found liable for more than $23 million in damages and penalties for submitting false claims to the Medicare program. Robert I. Bourseau, Dr. Rudra Sabaratnam, and their corporations, RIB Medical Management Services Inc. and Navatkuda Inc., were charged with billing Medicare for nearly $8 million in costs for a fake lease, unused hospital space, and expenses unrelated to the operation of the hospital. The two individuals, who owned the hospital formerly known as Bayview Hospital & Mental Health Systems, were charged under the federal False Claims Act. “Those who think about cheating Medicare might want to think again,” Carol Lam, U.S. Attorney for the Southern District of California, said. “The defendants here must now pay more than three times what they stole.”

Mental Health Rx Restrictions

Medicare Part D drug plans often employ utilization management techniques, such as prior authorization, for commonly prescribed antidepressants and antipsychotics, according to a report from the Medicare Rights Center. The group, which advocates for Medicare beneficiaries, reported that the use of utilization management strategies varies widely among drug plans, but these approaches are generally used for commonly prescribed drugs and more expensive medications. On average, 23% of antidepressants and 24% of antipsychotics were determined to be either not covered or restricted by utilization management techniques. The Medicare Rights Center called on officials at the Centers for Medicare and Medicaid Services to review all utilization management restrictions to ensure that they are “clinically sound” and are not designed to steer patients to low-cost but medically inappropriate treatments. The group is also pushing for Part D plans that differentiate patients who are beginning a new therapy from those who are stable on a medication at the point of sale. “It is a cruel and devastating hoax to impose insurmountable hurdles between people with mental illnesses and the medicines they need to have decent lives,” Robert M. Hayes, president of the Medicare Rights Center, said. “The CMS should outlaw these barriers to health.” The report analyzed antidepressant and antipsychotic drug coverage across 15 Part D drug plans.

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities, said.

Medicaid Enrollment, Spending

Spending by the states under the Medicaid program increased 2.8% during the state fiscal year 2006, the smallest increase in about a decade, according to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. Improvements in the economy and the implementation of the Medicare prescription drug benefit in 2006 may have helped to keep costs lower, according to the results of the 50-state survey released by the Kaiser Family Foundation. There was also an enrollment slowdown in the program with only a 1.6% increase. “When the economy improves, it is natural for Medicaid spending and enrollment growth to subside because fewer people turn to the program for assistance,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said. “But with the continued growth in the uninsured population, Medicaid remains on the front lines for coverage [of] low-income children and adults.”

FCC Changes Children's TV Rules

Officials at the Federal Communications Commission recently clarified the rules regarding requirements for children's television programming. Under the changes, TV broadcasters that have multiple stations must ensure that they air additional children's programming, and only half the shows can be repeats aired in the previous 7 days. The changes also clarify restrictions on the use of Web site addresses in programming. Under the new FCC rules, Internet addresses that do not offer a substantial amount of noncommercial content will be counted against the network's commercial time limits and must be kept separate from its programming. The changes were praised by the American Academy of Child and Adolescent Psychiatry. The new rules revise rules issued by the FCC in 2004 and are based largely on a compromise agreement among the four major broadcast networks, major children's networks, cable operators, advertisers, and a coalition of children's advocacy groups. “Children should have access to educational as well as entertaining television programs. We also need to protect kids from the overinfluence of television advertising, [which] has been linked to childhood obesity and lower academic performance,” said Dr. Michael Brody, chair of the academy's television and media committee.

Medicare Fraud Decision

The two owners of a former San Diego psychiatric hospital have been found liable for more than $23 million in damages and penalties for submitting false claims to the Medicare program. Robert I. Bourseau, Dr. Rudra Sabaratnam, and their corporations, RIB Medical Management Services Inc. and Navatkuda Inc., were charged with billing Medicare for nearly $8 million in costs for a fake lease, unused hospital space, and expenses unrelated to the operation of the hospital. The two individuals, who owned the hospital formerly known as Bayview Hospital & Mental Health Systems, were charged under the federal False Claims Act. “Those who think about cheating Medicare might want to think again,” Carol Lam, U.S. Attorney for the Southern District of California, said. “The defendants here must now pay more than three times what they stole.”

Psychiatrists and neurologists who take the recertification examination in 2007 will face new requirements under the maintenance of certification process.

Starting next year, physicians taking the exam will need to have completed 30 hours of specialty- or subspecialty-specific category 1 continuing medical education credits. Over the next 10 years, that requirement will grow to 300 hours of CME over a 10-year period. Other new requirements will be phased in over the next few years, according to Katie DiOrio, a spokesperson for the American Board of Psychiatry and Neurology (ABPN).

Impetus for the maintenance of certification process comes from the American Board of Medical Specialties, which began developing maintenance of certification several years ago. The basic requirements–evidence of professional standing, self-assessment, and lifelong learning; demonstration of cognitive expertise; and evaluation of performance in practice–apply to all 24 medical specialty boards. The ABPN is still working out the details of the self-assessment activities and performance-in-practice modules, including how to provide the tools for ABPN diplomates to fulfill these components.

“Maintenance of certification implementation is really in its infancy,” Ms. DiOrio said. She advised board diplomates to continue to visit the ABPN Web site at www.abpn.com

Among other requirements, starting with the 2010 examination year (applications for which are due in 2009), diplomates of the ABPN will be required to have completed at least one major self-assessment activity over the 10-year cycle.

Psychiatrists have several approved options in this area. They can complete the American College of Psychiatrists' Psychiatrists In-Practice Examination, postreading questions from the journal Focus, or the American Psychiatric Association's Practice Guidelines Program.

The self-assessment requirement was originally scheduled to go into effect next year, but officials at ABPN postponed implementation to give physicians more time to complete the activities. ABPN officials also wanted more time to approve additional programs for diplomates to use in fulfilling the component. In an effort to gather information about how many physicians have already started using self-assessment tools, ABPN officials are asking physicians to note on their maintenance of certification applications any self-assessment activities that they have completed, Ms. DiOrio said.

The other new requirement being phased in as part of the new maintenance of certification process is a performance-in-practice component, which is aimed at evaluating whether a physician has participated in performance improvement activities over the 10-year cycle. Beginning in the 2013 examination year, psychiatrists and neurologists will need to complete one module in this area. Three modules will be required by the 2017 examination cycle.

Each module will include chart reviews of five cases from a specific diagnostic category, along with feedback from either five peers or five patients seen in the past 3 years. To complete each module, physicians also will be required to compare clinical case data with published practice guidelines or with their peers and obtain feedback on their performance and on how to improve the effectiveness of their practice. Physicians will also need to develop a plan to improve their performance.

Within 24 months of the original assessment, physicians will be asked to reassess their practice using five cases in the same diagnostic category and to get feedback from either at least five peers or five patients.

For physicians who are actively involved in continuing education and are current on the literature, the CME and self-assessment requirements being phased in over the next few years will not be an additional burden, said Dr. Deborah J. Hales, director of the division of education at the American Psychiatric Association.

Performance-in-practice, however, will require more work by physicians. APA officials are working to make the performance review process a learning experience for physicians and to make it easier through online tools, Dr. Hales said.

Elizabeth Hughes, assistant director of education and recertification for the American Academy of Child and Adolescent Psychiatry, agreed that physicians should be aware that the performance-in-practice component is coming. At this point, though, there is still not a clear picture of how those requirements will be implemented, she said.

In the meantime, Ms. Hughes' advice is to stay up-to-date in the field. Don't wait until the last 2 years before recertification to do the work. “It's designed to be an every-year process,” she said.

The APA provides recertification resources online at www.psych.org/edu/recertification.cfm

Psychiatrists and neurologists who take the recertification examination in 2007 will face new requirements under the maintenance of certification process.

Starting next year, physicians taking the exam will need to have completed 30 hours of specialty- or subspecialty-specific category 1 continuing medical education credits. Over the next 10 years, that requirement will grow to 300 hours of CME over a 10-year period. Other new requirements will be phased in over the next few years, according to Katie DiOrio, a spokesperson for the American Board of Psychiatry and Neurology (ABPN).

Impetus for the maintenance of certification process comes from the American Board of Medical Specialties, which began developing maintenance of certification several years ago. The basic requirements–evidence of professional standing, self-assessment, and lifelong learning; demonstration of cognitive expertise; and evaluation of performance in practice–apply to all 24 medical specialty boards. The ABPN is still working out the details of the self-assessment activities and performance-in-practice modules, including how to provide the tools for ABPN diplomates to fulfill these components.

“Maintenance of certification implementation is really in its infancy,” Ms. DiOrio said. She advised board diplomates to continue to visit the ABPN Web site at www.abpn.com

Among other requirements, starting with the 2010 examination year (applications for which are due in 2009), diplomates of the ABPN will be required to have completed at least one major self-assessment activity over the 10-year cycle.

Psychiatrists have several approved options in this area. They can complete the American College of Psychiatrists' Psychiatrists In-Practice Examination, postreading questions from the journal Focus, or the American Psychiatric Association's Practice Guidelines Program.

The self-assessment requirement was originally scheduled to go into effect next year, but officials at ABPN postponed implementation to give physicians more time to complete the activities. ABPN officials also wanted more time to approve additional programs for diplomates to use in fulfilling the component. In an effort to gather information about how many physicians have already started using self-assessment tools, ABPN officials are asking physicians to note on their maintenance of certification applications any self-assessment activities that they have completed, Ms. DiOrio said.

The other new requirement being phased in as part of the new maintenance of certification process is a performance-in-practice component, which is aimed at evaluating whether a physician has participated in performance improvement activities over the 10-year cycle. Beginning in the 2013 examination year, psychiatrists and neurologists will need to complete one module in this area. Three modules will be required by the 2017 examination cycle.

Each module will include chart reviews of five cases from a specific diagnostic category, along with feedback from either five peers or five patients seen in the past 3 years. To complete each module, physicians also will be required to compare clinical case data with published practice guidelines or with their peers and obtain feedback on their performance and on how to improve the effectiveness of their practice. Physicians will also need to develop a plan to improve their performance.

Within 24 months of the original assessment, physicians will be asked to reassess their practice using five cases in the same diagnostic category and to get feedback from either at least five peers or five patients.

For physicians who are actively involved in continuing education and are current on the literature, the CME and self-assessment requirements being phased in over the next few years will not be an additional burden, said Dr. Deborah J. Hales, director of the division of education at the American Psychiatric Association.

Performance-in-practice, however, will require more work by physicians. APA officials are working to make the performance review process a learning experience for physicians and to make it easier through online tools, Dr. Hales said.

Elizabeth Hughes, assistant director of education and recertification for the American Academy of Child and Adolescent Psychiatry, agreed that physicians should be aware that the performance-in-practice component is coming. At this point, though, there is still not a clear picture of how those requirements will be implemented, she said.

In the meantime, Ms. Hughes' advice is to stay up-to-date in the field. Don't wait until the last 2 years before recertification to do the work. “It's designed to be an every-year process,” she said.

The APA provides recertification resources online at www.psych.org/edu/recertification.cfm

Psychiatrists and neurologists who take the recertification examination in 2007 will face new requirements under the maintenance of certification process.

Starting next year, physicians taking the exam will need to have completed 30 hours of specialty- or subspecialty-specific category 1 continuing medical education credits. Over the next 10 years, that requirement will grow to 300 hours of CME over a 10-year period. Other new requirements will be phased in over the next few years, according to Katie DiOrio, a spokesperson for the American Board of Psychiatry and Neurology (ABPN).

Impetus for the maintenance of certification process comes from the American Board of Medical Specialties, which began developing maintenance of certification several years ago. The basic requirements–evidence of professional standing, self-assessment, and lifelong learning; demonstration of cognitive expertise; and evaluation of performance in practice–apply to all 24 medical specialty boards. The ABPN is still working out the details of the self-assessment activities and performance-in-practice modules, including how to provide the tools for ABPN diplomates to fulfill these components.

“Maintenance of certification implementation is really in its infancy,” Ms. DiOrio said. She advised board diplomates to continue to visit the ABPN Web site at www.abpn.com

Among other requirements, starting with the 2010 examination year (applications for which are due in 2009), diplomates of the ABPN will be required to have completed at least one major self-assessment activity over the 10-year cycle.

Psychiatrists have several approved options in this area. They can complete the American College of Psychiatrists' Psychiatrists In-Practice Examination, postreading questions from the journal Focus, or the American Psychiatric Association's Practice Guidelines Program.

The self-assessment requirement was originally scheduled to go into effect next year, but officials at ABPN postponed implementation to give physicians more time to complete the activities. ABPN officials also wanted more time to approve additional programs for diplomates to use in fulfilling the component. In an effort to gather information about how many physicians have already started using self-assessment tools, ABPN officials are asking physicians to note on their maintenance of certification applications any self-assessment activities that they have completed, Ms. DiOrio said.

The other new requirement being phased in as part of the new maintenance of certification process is a performance-in-practice component, which is aimed at evaluating whether a physician has participated in performance improvement activities over the 10-year cycle. Beginning in the 2013 examination year, psychiatrists and neurologists will need to complete one module in this area. Three modules will be required by the 2017 examination cycle.

Each module will include chart reviews of five cases from a specific diagnostic category, along with feedback from either five peers or five patients seen in the past 3 years. To complete each module, physicians also will be required to compare clinical case data with published practice guidelines or with their peers and obtain feedback on their performance and on how to improve the effectiveness of their practice. Physicians will also need to develop a plan to improve their performance.

Within 24 months of the original assessment, physicians will be asked to reassess their practice using five cases in the same diagnostic category and to get feedback from either at least five peers or five patients.

For physicians who are actively involved in continuing education and are current on the literature, the CME and self-assessment requirements being phased in over the next few years will not be an additional burden, said Dr. Deborah J. Hales, director of the division of education at the American Psychiatric Association.

Performance-in-practice, however, will require more work by physicians. APA officials are working to make the performance review process a learning experience for physicians and to make it easier through online tools, Dr. Hales said.

Elizabeth Hughes, assistant director of education and recertification for the American Academy of Child and Adolescent Psychiatry, agreed that physicians should be aware that the performance-in-practice component is coming. At this point, though, there is still not a clear picture of how those requirements will be implemented, she said.

In the meantime, Ms. Hughes' advice is to stay up-to-date in the field. Don't wait until the last 2 years before recertification to do the work. “It's designed to be an every-year process,” she said.

The APA provides recertification resources online at www.psych.org/edu/recertification.cfm

Veterans of the 1990–1991 Persian Gulf War may be at increased risk for developing psychological conditions and their service may be associated with a greater chance of developing amyotrophic lateral sclerosis, according to a report by the Institute of Medicine.

The link between military service in the Gulf and developing amyotrophic lateral sclerosis (ALS) is still inconclusive, but the committee that prepared the Institute of Medicine (IOM) report called for follow-up studies to evaluate the prevalence of the condition among Gulf War veterans.

The report, which was released in September, is based on a review of 850 studies including both self-reported data from veterans and studies using objective measures of symptoms and exposures. The report was sponsored by the Department of Veterans Affairs.

The IOM committee did not find evidence to declare a definitive link between reports of multisymptom illness and Gulf War service. Although nearly 30% of Gulf War veterans reported that they experienced some type of multisymptom illness, compared with about 16% among nondeployed veterans, there were no objective test results to support those reports, the IOM committee wrote. The multisymptom conditions that were reported more commonly among Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity.

The report also notes that there is no single unique cluster of symptoms that make up Gulf War illness.

“Gulf War veterans consistently report experiencing a wide range of symptoms, and this is the case for both American veterans and military personnel from Canada, Australia, and other countries who served in the Persian Gulf,” Dr. Lynn R. Goldman, IOM committee chair and professor of occupational and environmental health at Johns Hopkins University in Baltimore, said in a statement.

“But because the symptoms vary greatly among individuals, they do not point to a syndrome unique to these veterans. Unfortunately, because of the lack of objective predeployment health information, we do not have the baseline data needed to draw more definitive conclusions about many aspects of these veterans' long-term health,” he said.

The idea that there is no unique Gulf War syndrome is “sort of a side issue,” said Lea Steele, Ph.D., who is an epidemiologist at Kansas State University in Manhattan. Veterans continue to be sick and to have unexplained symptoms, said Dr. Steele, who is also the scientific director of the congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses.

Currently, most veterans are being treated for their symptoms, but there have few treatment studies to date, she said. “The treatment area is an area that needs a lot of attention,” Dr. Steele said.

Research in the area of veterans' multisymptom illnesses has been challenging, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM committee that wrote the report.

Part of the problem is that the syndromes are ill defined and there is no test to diagnose these problems, he noted.

However, researchers at the VA have been working in this area and have produced a number of well-designed studies, he said. “It's unraveling little by little.”

The IOM committee also found that:

▸ Deployment to the Gulf puts veterans at increased risk for posttraumatic stress disorder, anxiety, depression, and substance abuse.

▸ There does not appear to be an increase in the prevalence of peripheral neuropathy in deployed Gulf War veterans, compared with their nondeployed counterparts. This finding is based on history, physical examination, and electrophysiologic studies.

▸ There was no statistically significant difference in the rates of hypertension between deployed and nondeployed veterans in primary studies.

▸ Two studies have shown some evidence of an increased risk for birth defects in the offspring of Gulf War veterans, but the studies have been difficult to interpret, according to the IOM report. Urinary tract abnormalities are the only set of defects that have been found in more than one well-designed study, the report said.

The IOM committee called on the VA and Department of Defense to conduct comprehensive pre- and postdeployment screening of health status, perform assessments of exposures during military deployments, and continue surveillance of adverse health outcomes. Surveillance is needed for a number of health outcomes including cancer, ALS, birth defects, adverse pregnancy outcomes, postdeployment psychiatric conditions, and mortality, according to the report.

The report–“Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War”–is available online at www.iom.edu

Veterans of the 1990–1991 Persian Gulf War may be at increased risk for developing psychological conditions and their service may be associated with a greater chance of developing amyotrophic lateral sclerosis, according to a report by the Institute of Medicine.

The link between military service in the Gulf and developing amyotrophic lateral sclerosis (ALS) is still inconclusive, but the committee that prepared the Institute of Medicine (IOM) report called for follow-up studies to evaluate the prevalence of the condition among Gulf War veterans.

The report, which was released in September, is based on a review of 850 studies including both self-reported data from veterans and studies using objective measures of symptoms and exposures. The report was sponsored by the Department of Veterans Affairs.

The IOM committee did not find evidence to declare a definitive link between reports of multisymptom illness and Gulf War service. Although nearly 30% of Gulf War veterans reported that they experienced some type of multisymptom illness, compared with about 16% among nondeployed veterans, there were no objective test results to support those reports, the IOM committee wrote. The multisymptom conditions that were reported more commonly among Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity.

The report also notes that there is no single unique cluster of symptoms that make up Gulf War illness.

“Gulf War veterans consistently report experiencing a wide range of symptoms, and this is the case for both American veterans and military personnel from Canada, Australia, and other countries who served in the Persian Gulf,” Dr. Lynn R. Goldman, IOM committee chair and professor of occupational and environmental health at Johns Hopkins University in Baltimore, said in a statement.

“But because the symptoms vary greatly among individuals, they do not point to a syndrome unique to these veterans. Unfortunately, because of the lack of objective predeployment health information, we do not have the baseline data needed to draw more definitive conclusions about many aspects of these veterans' long-term health,” he said.

The idea that there is no unique Gulf War syndrome is “sort of a side issue,” said Lea Steele, Ph.D., who is an epidemiologist at Kansas State University in Manhattan. Veterans continue to be sick and to have unexplained symptoms, said Dr. Steele, who is also the scientific director of the congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses.

Currently, most veterans are being treated for their symptoms, but there have few treatment studies to date, she said. “The treatment area is an area that needs a lot of attention,” Dr. Steele said.

Research in the area of veterans' multisymptom illnesses has been challenging, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM committee that wrote the report.

Part of the problem is that the syndromes are ill defined and there is no test to diagnose these problems, he noted.

However, researchers at the VA have been working in this area and have produced a number of well-designed studies, he said. “It's unraveling little by little.”

The IOM committee also found that:

▸ Deployment to the Gulf puts veterans at increased risk for posttraumatic stress disorder, anxiety, depression, and substance abuse.

▸ There does not appear to be an increase in the prevalence of peripheral neuropathy in deployed Gulf War veterans, compared with their nondeployed counterparts. This finding is based on history, physical examination, and electrophysiologic studies.

▸ There was no statistically significant difference in the rates of hypertension between deployed and nondeployed veterans in primary studies.

▸ Two studies have shown some evidence of an increased risk for birth defects in the offspring of Gulf War veterans, but the studies have been difficult to interpret, according to the IOM report. Urinary tract abnormalities are the only set of defects that have been found in more than one well-designed study, the report said.

The IOM committee called on the VA and Department of Defense to conduct comprehensive pre- and postdeployment screening of health status, perform assessments of exposures during military deployments, and continue surveillance of adverse health outcomes. Surveillance is needed for a number of health outcomes including cancer, ALS, birth defects, adverse pregnancy outcomes, postdeployment psychiatric conditions, and mortality, according to the report.

The report–“Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War”–is available online at www.iom.edu

Veterans of the 1990–1991 Persian Gulf War may be at increased risk for developing psychological conditions and their service may be associated with a greater chance of developing amyotrophic lateral sclerosis, according to a report by the Institute of Medicine.

The link between military service in the Gulf and developing amyotrophic lateral sclerosis (ALS) is still inconclusive, but the committee that prepared the Institute of Medicine (IOM) report called for follow-up studies to evaluate the prevalence of the condition among Gulf War veterans.

The report, which was released in September, is based on a review of 850 studies including both self-reported data from veterans and studies using objective measures of symptoms and exposures. The report was sponsored by the Department of Veterans Affairs.

The IOM committee did not find evidence to declare a definitive link between reports of multisymptom illness and Gulf War service. Although nearly 30% of Gulf War veterans reported that they experienced some type of multisymptom illness, compared with about 16% among nondeployed veterans, there were no objective test results to support those reports, the IOM committee wrote. The multisymptom conditions that were reported more commonly among Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity.

The report also notes that there is no single unique cluster of symptoms that make up Gulf War illness.

“Gulf War veterans consistently report experiencing a wide range of symptoms, and this is the case for both American veterans and military personnel from Canada, Australia, and other countries who served in the Persian Gulf,” Dr. Lynn R. Goldman, IOM committee chair and professor of occupational and environmental health at Johns Hopkins University in Baltimore, said in a statement.

“But because the symptoms vary greatly among individuals, they do not point to a syndrome unique to these veterans. Unfortunately, because of the lack of objective predeployment health information, we do not have the baseline data needed to draw more definitive conclusions about many aspects of these veterans' long-term health,” he said.

The idea that there is no unique Gulf War syndrome is “sort of a side issue,” said Lea Steele, Ph.D., who is an epidemiologist at Kansas State University in Manhattan. Veterans continue to be sick and to have unexplained symptoms, said Dr. Steele, who is also the scientific director of the congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses.

Currently, most veterans are being treated for their symptoms, but there have few treatment studies to date, she said. “The treatment area is an area that needs a lot of attention,” Dr. Steele said.

Research in the area of veterans' multisymptom illnesses has been challenging, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM committee that wrote the report.

Part of the problem is that the syndromes are ill defined and there is no test to diagnose these problems, he noted.

However, researchers at the VA have been working in this area and have produced a number of well-designed studies, he said. “It's unraveling little by little.”

The IOM committee also found that:

▸ Deployment to the Gulf puts veterans at increased risk for posttraumatic stress disorder, anxiety, depression, and substance abuse.

▸ There does not appear to be an increase in the prevalence of peripheral neuropathy in deployed Gulf War veterans, compared with their nondeployed counterparts. This finding is based on history, physical examination, and electrophysiologic studies.

▸ There was no statistically significant difference in the rates of hypertension between deployed and nondeployed veterans in primary studies.

▸ Two studies have shown some evidence of an increased risk for birth defects in the offspring of Gulf War veterans, but the studies have been difficult to interpret, according to the IOM report. Urinary tract abnormalities are the only set of defects that have been found in more than one well-designed study, the report said.

The IOM committee called on the VA and Department of Defense to conduct comprehensive pre- and postdeployment screening of health status, perform assessments of exposures during military deployments, and continue surveillance of adverse health outcomes. Surveillance is needed for a number of health outcomes including cancer, ALS, birth defects, adverse pregnancy outcomes, postdeployment psychiatric conditions, and mortality, according to the report.

The report–“Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War”–is available online at www.iom.edu

PHILADELPHIA – A 10-minute, daily stress management intervention delivered in an elementary school classroom can decrease feelings of anxiety and improve a child's ability to relax, Dr. Denise Bothe said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

“The technique was adopted by many of the children who continued to use it in their daily lives to help them cope with stressful circumstances,” said Dr. Bothe, a fellow in the division of behavioral pediatrics and psychology at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Bothe and her colleagues conducted a pilot study of stress management techniques among third graders. The stress management intervention was 10 minutes long: It involved deep breathing, movements for stretching and focus, and a 5-minute script with imagery read by the teacher. The intervention was performed daily for 4 months by the classroom teacher.

In the control group, the teacher read aloud to the class out of a children's storybook for the same time each day for 10 minutes.

Two third-grade classes were randomly assigned to receive either the stress management intervention or the control activity. From the two classes, researchers were able to obtain parental consent for 15 children to participate in the intervention and 13 children to participate in the control group.

Data anxiety, heart rate variability, and academic performance were collected immediately before the intervention, after 4 months, and 1 year after the intervention began, Dr. Bothe said.

Children in the control group showed no significant changes in a self-report anxiety scale across the three time periods. But in the intervention group, there was a significant drop in anxiety levels right after the intervention, which continued at the 1-year end point. The mean total anxiety T scores in the intervention group were 49.2 at baseline, 43 after the 4-month intervention, and 41.9 at 1 year after baseline.

The researchers also evaluated relaxation using heart rate variability. The control group children did not show an increase in their ability to relax. The intervention group showed an increase in heart rate variability from baseline to 4 months and a statistically significant improvement between baseline and 1 year.

The intervention did not appear to have any impact on academic performance, which was measured using math test grades and proficiency scores, Dr. Bothe said.

The researchers also collected qualitative data from the teacher and students who participated in the intervention class. The teacher said the intervention helped to settle the children and helped them to relax. The teacher also reported that after the 10-minute intervention, the children seemed ready to return to work. And some of the children used the breathing exercises before the test, Dr. Bothe said.

Students also reported benefits from the daily stress management intervention. Nearly all the students (13 of 15) said it helped them during the school day, and 12 of 15 said they used the techniques outside of school.

PHILADELPHIA – A 10-minute, daily stress management intervention delivered in an elementary school classroom can decrease feelings of anxiety and improve a child's ability to relax, Dr. Denise Bothe said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

“The technique was adopted by many of the children who continued to use it in their daily lives to help them cope with stressful circumstances,” said Dr. Bothe, a fellow in the division of behavioral pediatrics and psychology at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Bothe and her colleagues conducted a pilot study of stress management techniques among third graders. The stress management intervention was 10 minutes long: It involved deep breathing, movements for stretching and focus, and a 5-minute script with imagery read by the teacher. The intervention was performed daily for 4 months by the classroom teacher.

In the control group, the teacher read aloud to the class out of a children's storybook for the same time each day for 10 minutes.

Two third-grade classes were randomly assigned to receive either the stress management intervention or the control activity. From the two classes, researchers were able to obtain parental consent for 15 children to participate in the intervention and 13 children to participate in the control group.

Data anxiety, heart rate variability, and academic performance were collected immediately before the intervention, after 4 months, and 1 year after the intervention began, Dr. Bothe said.

Children in the control group showed no significant changes in a self-report anxiety scale across the three time periods. But in the intervention group, there was a significant drop in anxiety levels right after the intervention, which continued at the 1-year end point. The mean total anxiety T scores in the intervention group were 49.2 at baseline, 43 after the 4-month intervention, and 41.9 at 1 year after baseline.

The researchers also evaluated relaxation using heart rate variability. The control group children did not show an increase in their ability to relax. The intervention group showed an increase in heart rate variability from baseline to 4 months and a statistically significant improvement between baseline and 1 year.

The intervention did not appear to have any impact on academic performance, which was measured using math test grades and proficiency scores, Dr. Bothe said.

The researchers also collected qualitative data from the teacher and students who participated in the intervention class. The teacher said the intervention helped to settle the children and helped them to relax. The teacher also reported that after the 10-minute intervention, the children seemed ready to return to work. And some of the children used the breathing exercises before the test, Dr. Bothe said.

Students also reported benefits from the daily stress management intervention. Nearly all the students (13 of 15) said it helped them during the school day, and 12 of 15 said they used the techniques outside of school.

PHILADELPHIA – A 10-minute, daily stress management intervention delivered in an elementary school classroom can decrease feelings of anxiety and improve a child's ability to relax, Dr. Denise Bothe said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

“The technique was adopted by many of the children who continued to use it in their daily lives to help them cope with stressful circumstances,” said Dr. Bothe, a fellow in the division of behavioral pediatrics and psychology at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Bothe and her colleagues conducted a pilot study of stress management techniques among third graders. The stress management intervention was 10 minutes long: It involved deep breathing, movements for stretching and focus, and a 5-minute script with imagery read by the teacher. The intervention was performed daily for 4 months by the classroom teacher.

In the control group, the teacher read aloud to the class out of a children's storybook for the same time each day for 10 minutes.

Two third-grade classes were randomly assigned to receive either the stress management intervention or the control activity. From the two classes, researchers were able to obtain parental consent for 15 children to participate in the intervention and 13 children to participate in the control group.

Data anxiety, heart rate variability, and academic performance were collected immediately before the intervention, after 4 months, and 1 year after the intervention began, Dr. Bothe said.

Children in the control group showed no significant changes in a self-report anxiety scale across the three time periods. But in the intervention group, there was a significant drop in anxiety levels right after the intervention, which continued at the 1-year end point. The mean total anxiety T scores in the intervention group were 49.2 at baseline, 43 after the 4-month intervention, and 41.9 at 1 year after baseline.

The researchers also evaluated relaxation using heart rate variability. The control group children did not show an increase in their ability to relax. The intervention group showed an increase in heart rate variability from baseline to 4 months and a statistically significant improvement between baseline and 1 year.

The intervention did not appear to have any impact on academic performance, which was measured using math test grades and proficiency scores, Dr. Bothe said.

The researchers also collected qualitative data from the teacher and students who participated in the intervention class. The teacher said the intervention helped to settle the children and helped them to relax. The teacher also reported that after the 10-minute intervention, the children seemed ready to return to work. And some of the children used the breathing exercises before the test, Dr. Bothe said.

Students also reported benefits from the daily stress management intervention. Nearly all the students (13 of 15) said it helped them during the school day, and 12 of 15 said they used the techniques outside of school.