Mary Ellen Schneider

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations. Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products. The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards. Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said. That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, he said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, he said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians should not do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems. In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

Dr. Mark Leavitt, CCHIT chair (right) and HHS Secretary Mike Leavitt (left) discuss the importance of certifying EHR products. John Whitman/CCHIT

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations. Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products. The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards. Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said. That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, he said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, he said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians should not do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems. In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

Dr. Mark Leavitt, CCHIT chair (right) and HHS Secretary Mike Leavitt (left) discuss the importance of certifying EHR products. John Whitman/CCHIT

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations. Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products. The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards. Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said. That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, he said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, he said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians should not do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems. In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

Dr. Mark Leavitt, CCHIT chair (right) and HHS Secretary Mike Leavitt (left) discuss the importance of certifying EHR products. John Whitman/CCHIT

Each year, patients in the United States experience at least 1.5 million preventable injuries due to medication errors, according to the findings of an Institute of Medicine analysis.

The report, released in July, estimated that these preventable adverse drug events would add up to about $3.5 billion in additional hospitalization costs this year, excluding the economic burden of lost wages and productivity.

The expert panel convened by the Institute of Medicine (IOM) called on physicians to do their part in reducing medication errors by improving communication with patients about medication safety and adopting electronic prescribing technology.

“Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems,” J. Lyle Bootman, Ph.D., cochair of the IOM committee and dean of the college of pharmacy at the University of Arizona, Tucson, said in a statement.

The IOM committee set a 2010 deadline for physicians to implement e-prescribing for all prescriptions. Physicians and hospitals should have plans in place by 2008 to implement the necessary technology, the IOM report said. The e-prescribing technology should also be able to provide physicians with real-time clinical decision support tools.

The report, which was written at the request of Congress, underscores for lawmakers the importance of electronic health records (EHRs) in improving safety, said Hedy Cohen, R.N., vice president of the Institute for Safe Medication Practices. There have already been discussions within Congress about how to support the adoption of this technology, she said, and over time, prices for the systems should decrease.

The American Medical Association pointed out that while there is great interest among physicians to adopt health IT, they face a dizzying array of choices, without much basis for objective comparison, and high adoption costs. Just days before the release of the IOM report, the Certification Commission for Healthcare Information Technology (CCHIT) released the first list of ambulatory EHR products that had been certified as meeting baseline criteria for functionality, interoperability, and security.

“We're encouraged by these first, solid steps to help physicians make purchasing decisions, but there is much more work to be done before the majority of physicians have the capability to do e-prescribing in a comprehensive way that includes safety and security capabilities,” Dr. Cecil B. Wilson, AMA Board Chair, said in a statement.

And while health IT will help to eliminate some of the errors in prescribing, such as errors from handwriting, it will inevitably introduce new errors to the process, Frances Griffin, a director at the Institute for Healthcare Improvement, said in an interview.

The IOM committee also recommended that physicians do a better job of counseling patients about their medications. Physicians should educate patients and family members by providing information on side effects, contraindications, how to handle adverse reactions, and where to get good information. And patients should be better informed about their medications at the point of prescribing, at hospital discharge, and at the pharmacy, the report said.

One of the factors that can lead to patients' problems with self-management of medication is the use of free samples, the IOM report noted. Free drug samples can pose problems when a patient is switched to a medication based on the drug's availability rather than on clinical appropriateness.

Also, there is generally poor documentation in the medical record when samples are used and adverse events may not be reported, the IOM report noted. The committee recommended that the Agency for Healthcare Research and Quality fund studies evaluating the impact of free samples on overall patient safety as well as on prescribing practice and patient adherence.

Other recommendations from the report include the following suggestions:

▸ Patients or their caregivers should keep an active list of all prescription drugs, over-the-counter drugs, and dietary supplements that they take, why they are taking them, and any known allergies. Physicians should have access to this list.

▸ Government agencies should standardize pharmacy medication information, improve online medication resources, and establish a national drug information telephone help line.

▸ The Food and Drug Administration and the pharmaceutical industry should work together to develop common drug nomenclature with standard abbreviations, acronyms, and terms.

▸ States should attempt to remove barriers to e-prescribing and enact legislation that is consistent with the Medicare Modernization Act's e-prescribing provisions. Under the act, drug plans that participate in the Medicare Part D program were required to support e-prescribing by January 2006. E-prescribing is optional for physicians and pharmacists under the final rule issued by CMS last year.

The IOM report is available online at www.nap.edu

Each year, patients in the United States experience at least 1.5 million preventable injuries due to medication errors, according to the findings of an Institute of Medicine analysis.

The report, released in July, estimated that these preventable adverse drug events would add up to about $3.5 billion in additional hospitalization costs this year, excluding the economic burden of lost wages and productivity.

The expert panel convened by the Institute of Medicine (IOM) called on physicians to do their part in reducing medication errors by improving communication with patients about medication safety and adopting electronic prescribing technology.

“Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems,” J. Lyle Bootman, Ph.D., cochair of the IOM committee and dean of the college of pharmacy at the University of Arizona, Tucson, said in a statement.

The IOM committee set a 2010 deadline for physicians to implement e-prescribing for all prescriptions. Physicians and hospitals should have plans in place by 2008 to implement the necessary technology, the IOM report said. The e-prescribing technology should also be able to provide physicians with real-time clinical decision support tools.

The report, which was written at the request of Congress, underscores for lawmakers the importance of electronic health records (EHRs) in improving safety, said Hedy Cohen, R.N., vice president of the Institute for Safe Medication Practices. There have already been discussions within Congress about how to support the adoption of this technology, she said, and over time, prices for the systems should decrease.

The American Medical Association pointed out that while there is great interest among physicians to adopt health IT, they face a dizzying array of choices, without much basis for objective comparison, and high adoption costs. Just days before the release of the IOM report, the Certification Commission for Healthcare Information Technology (CCHIT) released the first list of ambulatory EHR products that had been certified as meeting baseline criteria for functionality, interoperability, and security.

“We're encouraged by these first, solid steps to help physicians make purchasing decisions, but there is much more work to be done before the majority of physicians have the capability to do e-prescribing in a comprehensive way that includes safety and security capabilities,” Dr. Cecil B. Wilson, AMA Board Chair, said in a statement.

And while health IT will help to eliminate some of the errors in prescribing, such as errors from handwriting, it will inevitably introduce new errors to the process, Frances Griffin, a director at the Institute for Healthcare Improvement, said in an interview.

The IOM committee also recommended that physicians do a better job of counseling patients about their medications. Physicians should educate patients and family members by providing information on side effects, contraindications, how to handle adverse reactions, and where to get good information. And patients should be better informed about their medications at the point of prescribing, at hospital discharge, and at the pharmacy, the report said.

One of the factors that can lead to patients' problems with self-management of medication is the use of free samples, the IOM report noted. Free drug samples can pose problems when a patient is switched to a medication based on the drug's availability rather than on clinical appropriateness.

Also, there is generally poor documentation in the medical record when samples are used and adverse events may not be reported, the IOM report noted. The committee recommended that the Agency for Healthcare Research and Quality fund studies evaluating the impact of free samples on overall patient safety as well as on prescribing practice and patient adherence.

Other recommendations from the report include the following suggestions:

▸ Patients or their caregivers should keep an active list of all prescription drugs, over-the-counter drugs, and dietary supplements that they take, why they are taking them, and any known allergies. Physicians should have access to this list.

▸ Government agencies should standardize pharmacy medication information, improve online medication resources, and establish a national drug information telephone help line.

▸ The Food and Drug Administration and the pharmaceutical industry should work together to develop common drug nomenclature with standard abbreviations, acronyms, and terms.

▸ States should attempt to remove barriers to e-prescribing and enact legislation that is consistent with the Medicare Modernization Act's e-prescribing provisions. Under the act, drug plans that participate in the Medicare Part D program were required to support e-prescribing by January 2006. E-prescribing is optional for physicians and pharmacists under the final rule issued by CMS last year.

The IOM report is available online at www.nap.edu

Each year, patients in the United States experience at least 1.5 million preventable injuries due to medication errors, according to the findings of an Institute of Medicine analysis.

The report, released in July, estimated that these preventable adverse drug events would add up to about $3.5 billion in additional hospitalization costs this year, excluding the economic burden of lost wages and productivity.

The expert panel convened by the Institute of Medicine (IOM) called on physicians to do their part in reducing medication errors by improving communication with patients about medication safety and adopting electronic prescribing technology.

“Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems,” J. Lyle Bootman, Ph.D., cochair of the IOM committee and dean of the college of pharmacy at the University of Arizona, Tucson, said in a statement.

The IOM committee set a 2010 deadline for physicians to implement e-prescribing for all prescriptions. Physicians and hospitals should have plans in place by 2008 to implement the necessary technology, the IOM report said. The e-prescribing technology should also be able to provide physicians with real-time clinical decision support tools.

The report, which was written at the request of Congress, underscores for lawmakers the importance of electronic health records (EHRs) in improving safety, said Hedy Cohen, R.N., vice president of the Institute for Safe Medication Practices. There have already been discussions within Congress about how to support the adoption of this technology, she said, and over time, prices for the systems should decrease.

The American Medical Association pointed out that while there is great interest among physicians to adopt health IT, they face a dizzying array of choices, without much basis for objective comparison, and high adoption costs. Just days before the release of the IOM report, the Certification Commission for Healthcare Information Technology (CCHIT) released the first list of ambulatory EHR products that had been certified as meeting baseline criteria for functionality, interoperability, and security.

“We're encouraged by these first, solid steps to help physicians make purchasing decisions, but there is much more work to be done before the majority of physicians have the capability to do e-prescribing in a comprehensive way that includes safety and security capabilities,” Dr. Cecil B. Wilson, AMA Board Chair, said in a statement.

And while health IT will help to eliminate some of the errors in prescribing, such as errors from handwriting, it will inevitably introduce new errors to the process, Frances Griffin, a director at the Institute for Healthcare Improvement, said in an interview.

The IOM committee also recommended that physicians do a better job of counseling patients about their medications. Physicians should educate patients and family members by providing information on side effects, contraindications, how to handle adverse reactions, and where to get good information. And patients should be better informed about their medications at the point of prescribing, at hospital discharge, and at the pharmacy, the report said.

One of the factors that can lead to patients' problems with self-management of medication is the use of free samples, the IOM report noted. Free drug samples can pose problems when a patient is switched to a medication based on the drug's availability rather than on clinical appropriateness.

Also, there is generally poor documentation in the medical record when samples are used and adverse events may not be reported, the IOM report noted. The committee recommended that the Agency for Healthcare Research and Quality fund studies evaluating the impact of free samples on overall patient safety as well as on prescribing practice and patient adherence.

Other recommendations from the report include the following suggestions:

▸ Patients or their caregivers should keep an active list of all prescription drugs, over-the-counter drugs, and dietary supplements that they take, why they are taking them, and any known allergies. Physicians should have access to this list.

▸ Government agencies should standardize pharmacy medication information, improve online medication resources, and establish a national drug information telephone help line.

▸ The Food and Drug Administration and the pharmaceutical industry should work together to develop common drug nomenclature with standard abbreviations, acronyms, and terms.

▸ States should attempt to remove barriers to e-prescribing and enact legislation that is consistent with the Medicare Modernization Act's e-prescribing provisions. Under the act, drug plans that participate in the Medicare Part D program were required to support e-prescribing by January 2006. E-prescribing is optional for physicians and pharmacists under the final rule issued by CMS last year.

The IOM report is available online at www.nap.edu

PHILADELPHIA — The effect that any future Medicare-run pay-for-performance program would have on physicians is still up in the air, experts said at the annual meeting of the American College of Physicians.

Medicare currently has no pay-for-performance programs in effect, and—although the agency has various demonstrations and pilots underway to look at this issue—the real effect of such a program is still a matter of speculation, said Dr. John Tooker, ACP's executive vice president and chief executive officer.

But Dr. Tooker urged physicians to consider participating in what may be a precursor to a Medicare pay-for-performance program: the Physician Voluntary Reporting Program. The initiative, launched earlier this year by officials at the Centers for Medicare and Medicaid Services, asks physicians to report on a core starter set of 16 quality measures. There is no funding attached to the program at this point.

“It's a good way to begin to learn how to do this in your practice,” Dr. Tooker said. “But most importantly, I think it's really a matter of learning to change the culture of a practice.”

If done right, pay-for-performance programs could result in higher quality patient care and increased physician and patient satisfaction, commented Dr. C. Anderson Hedberg, ACP's immediate past president.

But the ACP is concerned that such programs could also lead to increased paperwork burdens, higher expenses, less revenue, and time taken away from patient care, he said. And there could be unintended consequences for sicker and noncompliant patients.

Much will depend on what measures are used, how quickly they are phased in, how data will be collected, the type of public reporting involved, and the incentives applied, he said.

ACP officials aren't the only physicians who have questions about how pay-for-performance programs—whether through Medicare or private insurers—will affect their practices.

At the ACP's town hall meeting on the issue, Dr. Emily R. Transue, an internist in a group practice in Seattle, said there is still not a set of consistent and appropriate quality measures that everyone has agreed to use.

For example, she received two reports on her performance from two different companies. In one report she was rated as a high performer, and in the other her quality of care was considered below average. “Clearly there's something that isn't fitting together,” she said.

If physicians can't come up with appropriate quality measures, these programs will end up just being another set of hoops that physicians have to jump through, she added.

Dr. Barry M. Straube, acting director of the Office of Clinical Standards and Quality at CMS, acknowledged that some of the measures the agency has been focused on may not be relevant to older Medicare patients. Officials at CMS have been discussing how to assess quality care in special populations, he said.

But the ongoing quality work is being done in collaboration with Medicaid and commercial health plans, so for now the focus is on measures that apply to a broad population, Dr. Straube said.

One program that has been a pioneer in this area was formulated by the Bridges to Excellence coalition, which was founded by a number of larger employers and offers incentives to physicians who demonstrate quality care.

To date, the program has shown that in communities where incentives are available, there has not been patient dumping, said Francois deBrantes, national coordinator of the program. “That's not how good performance is achieved.” In fact, after physicians devoted time to reengineering their practices, they generally sought out more patients, he said.

Officials with the program have also found that the financial incentives are effective, and that the size of the incentive has a direct relationship to whether physicians are willing to go through an expensive and time-consuming overhaul of their practices. Asking a physician to make these changes for $1,000 a year is an insult, Mr. deBrantes said. Incentivizing physicians to provide higher quality care has also paid off for payers, he said. They have found that patients who are managed for their chronic conditions have more office visits and fewer hospital stays, which produces an average 10% payer savings.

But setting up incentive programs is not a small task, Mr. deBrantes said. Because incentives need to be large enough to encourage physicians to make significant practice changes, it's hard for any one employer or health plan to set up rewards programs. It's also a major undertaking for physicians and their staffs, especially given the cost and complexity of electronic health record systems. (See box.)

The transition from a paper-based practice to something more systematic generally takes about a year and a half, Mr. deBrantes said—and that's with outside help.

Investing Wisely in Health Technology

One of the barriers to systematically measuring quality for physicians, especially those in small practices, is the cost of electronic health records and other technology.

“Don't waste a lot of time and money on high-tech solutions,” advised Dr. Kevin B. Weiss, professor of medicine at Northwestern University, Chicago, and chair of the ACP's performance measurement subcommittee.

Dr. Weiss, who said he considers himself a believer in health information technology, cautioned that many of the first- and second-generation EHRs were not designed for population-based medicine, which is essential for participation in pay-for-performance programs. Instead, the systems were built to mimic paper records and to work with individual patients.

Consider investing in EHRs that have population-based care functionality, or look into cheaper alternatives.

A lower-cost option is to use patient registries, he said. Patient registry software allows physicians to track their management of patients with chronic health conditions and to report on process and outcomes data that may be required by pay-for-performance programs.

One way to get ready for the pay-for-performance movement that does not involve any technology is to get in the habit of having weekly discussions with staff on quality issues, Dr. Weiss said. Physicians can also consider investing in team-oriented continuing medical education courses, he said.

PHILADELPHIA — The effect that any future Medicare-run pay-for-performance program would have on physicians is still up in the air, experts said at the annual meeting of the American College of Physicians.

Medicare currently has no pay-for-performance programs in effect, and—although the agency has various demonstrations and pilots underway to look at this issue—the real effect of such a program is still a matter of speculation, said Dr. John Tooker, ACP's executive vice president and chief executive officer.

But Dr. Tooker urged physicians to consider participating in what may be a precursor to a Medicare pay-for-performance program: the Physician Voluntary Reporting Program. The initiative, launched earlier this year by officials at the Centers for Medicare and Medicaid Services, asks physicians to report on a core starter set of 16 quality measures. There is no funding attached to the program at this point.

“It's a good way to begin to learn how to do this in your practice,” Dr. Tooker said. “But most importantly, I think it's really a matter of learning to change the culture of a practice.”

If done right, pay-for-performance programs could result in higher quality patient care and increased physician and patient satisfaction, commented Dr. C. Anderson Hedberg, ACP's immediate past president.

But the ACP is concerned that such programs could also lead to increased paperwork burdens, higher expenses, less revenue, and time taken away from patient care, he said. And there could be unintended consequences for sicker and noncompliant patients.

Much will depend on what measures are used, how quickly they are phased in, how data will be collected, the type of public reporting involved, and the incentives applied, he said.

ACP officials aren't the only physicians who have questions about how pay-for-performance programs—whether through Medicare or private insurers—will affect their practices.

At the ACP's town hall meeting on the issue, Dr. Emily R. Transue, an internist in a group practice in Seattle, said there is still not a set of consistent and appropriate quality measures that everyone has agreed to use.

For example, she received two reports on her performance from two different companies. In one report she was rated as a high performer, and in the other her quality of care was considered below average. “Clearly there's something that isn't fitting together,” she said.

If physicians can't come up with appropriate quality measures, these programs will end up just being another set of hoops that physicians have to jump through, she added.

Dr. Barry M. Straube, acting director of the Office of Clinical Standards and Quality at CMS, acknowledged that some of the measures the agency has been focused on may not be relevant to older Medicare patients. Officials at CMS have been discussing how to assess quality care in special populations, he said.

But the ongoing quality work is being done in collaboration with Medicaid and commercial health plans, so for now the focus is on measures that apply to a broad population, Dr. Straube said.

One program that has been a pioneer in this area was formulated by the Bridges to Excellence coalition, which was founded by a number of larger employers and offers incentives to physicians who demonstrate quality care.

To date, the program has shown that in communities where incentives are available, there has not been patient dumping, said Francois deBrantes, national coordinator of the program. “That's not how good performance is achieved.” In fact, after physicians devoted time to reengineering their practices, they generally sought out more patients, he said.

Officials with the program have also found that the financial incentives are effective, and that the size of the incentive has a direct relationship to whether physicians are willing to go through an expensive and time-consuming overhaul of their practices. Asking a physician to make these changes for $1,000 a year is an insult, Mr. deBrantes said. Incentivizing physicians to provide higher quality care has also paid off for payers, he said. They have found that patients who are managed for their chronic conditions have more office visits and fewer hospital stays, which produces an average 10% payer savings.

But setting up incentive programs is not a small task, Mr. deBrantes said. Because incentives need to be large enough to encourage physicians to make significant practice changes, it's hard for any one employer or health plan to set up rewards programs. It's also a major undertaking for physicians and their staffs, especially given the cost and complexity of electronic health record systems. (See box.)

The transition from a paper-based practice to something more systematic generally takes about a year and a half, Mr. deBrantes said—and that's with outside help.

Investing Wisely in Health Technology

One of the barriers to systematically measuring quality for physicians, especially those in small practices, is the cost of electronic health records and other technology.

“Don't waste a lot of time and money on high-tech solutions,” advised Dr. Kevin B. Weiss, professor of medicine at Northwestern University, Chicago, and chair of the ACP's performance measurement subcommittee.

Dr. Weiss, who said he considers himself a believer in health information technology, cautioned that many of the first- and second-generation EHRs were not designed for population-based medicine, which is essential for participation in pay-for-performance programs. Instead, the systems were built to mimic paper records and to work with individual patients.

Consider investing in EHRs that have population-based care functionality, or look into cheaper alternatives.

A lower-cost option is to use patient registries, he said. Patient registry software allows physicians to track their management of patients with chronic health conditions and to report on process and outcomes data that may be required by pay-for-performance programs.

One way to get ready for the pay-for-performance movement that does not involve any technology is to get in the habit of having weekly discussions with staff on quality issues, Dr. Weiss said. Physicians can also consider investing in team-oriented continuing medical education courses, he said.

PHILADELPHIA — The effect that any future Medicare-run pay-for-performance program would have on physicians is still up in the air, experts said at the annual meeting of the American College of Physicians.

Medicare currently has no pay-for-performance programs in effect, and—although the agency has various demonstrations and pilots underway to look at this issue—the real effect of such a program is still a matter of speculation, said Dr. John Tooker, ACP's executive vice president and chief executive officer.

But Dr. Tooker urged physicians to consider participating in what may be a precursor to a Medicare pay-for-performance program: the Physician Voluntary Reporting Program. The initiative, launched earlier this year by officials at the Centers for Medicare and Medicaid Services, asks physicians to report on a core starter set of 16 quality measures. There is no funding attached to the program at this point.

“It's a good way to begin to learn how to do this in your practice,” Dr. Tooker said. “But most importantly, I think it's really a matter of learning to change the culture of a practice.”

If done right, pay-for-performance programs could result in higher quality patient care and increased physician and patient satisfaction, commented Dr. C. Anderson Hedberg, ACP's immediate past president.

But the ACP is concerned that such programs could also lead to increased paperwork burdens, higher expenses, less revenue, and time taken away from patient care, he said. And there could be unintended consequences for sicker and noncompliant patients.

Much will depend on what measures are used, how quickly they are phased in, how data will be collected, the type of public reporting involved, and the incentives applied, he said.

ACP officials aren't the only physicians who have questions about how pay-for-performance programs—whether through Medicare or private insurers—will affect their practices.

At the ACP's town hall meeting on the issue, Dr. Emily R. Transue, an internist in a group practice in Seattle, said there is still not a set of consistent and appropriate quality measures that everyone has agreed to use.

For example, she received two reports on her performance from two different companies. In one report she was rated as a high performer, and in the other her quality of care was considered below average. “Clearly there's something that isn't fitting together,” she said.

If physicians can't come up with appropriate quality measures, these programs will end up just being another set of hoops that physicians have to jump through, she added.

Dr. Barry M. Straube, acting director of the Office of Clinical Standards and Quality at CMS, acknowledged that some of the measures the agency has been focused on may not be relevant to older Medicare patients. Officials at CMS have been discussing how to assess quality care in special populations, he said.

But the ongoing quality work is being done in collaboration with Medicaid and commercial health plans, so for now the focus is on measures that apply to a broad population, Dr. Straube said.

One program that has been a pioneer in this area was formulated by the Bridges to Excellence coalition, which was founded by a number of larger employers and offers incentives to physicians who demonstrate quality care.

To date, the program has shown that in communities where incentives are available, there has not been patient dumping, said Francois deBrantes, national coordinator of the program. “That's not how good performance is achieved.” In fact, after physicians devoted time to reengineering their practices, they generally sought out more patients, he said.

Officials with the program have also found that the financial incentives are effective, and that the size of the incentive has a direct relationship to whether physicians are willing to go through an expensive and time-consuming overhaul of their practices. Asking a physician to make these changes for $1,000 a year is an insult, Mr. deBrantes said. Incentivizing physicians to provide higher quality care has also paid off for payers, he said. They have found that patients who are managed for their chronic conditions have more office visits and fewer hospital stays, which produces an average 10% payer savings.

But setting up incentive programs is not a small task, Mr. deBrantes said. Because incentives need to be large enough to encourage physicians to make significant practice changes, it's hard for any one employer or health plan to set up rewards programs. It's also a major undertaking for physicians and their staffs, especially given the cost and complexity of electronic health record systems. (See box.)

The transition from a paper-based practice to something more systematic generally takes about a year and a half, Mr. deBrantes said—and that's with outside help.

Investing Wisely in Health Technology

One of the barriers to systematically measuring quality for physicians, especially those in small practices, is the cost of electronic health records and other technology.

“Don't waste a lot of time and money on high-tech solutions,” advised Dr. Kevin B. Weiss, professor of medicine at Northwestern University, Chicago, and chair of the ACP's performance measurement subcommittee.

Dr. Weiss, who said he considers himself a believer in health information technology, cautioned that many of the first- and second-generation EHRs were not designed for population-based medicine, which is essential for participation in pay-for-performance programs. Instead, the systems were built to mimic paper records and to work with individual patients.

Consider investing in EHRs that have population-based care functionality, or look into cheaper alternatives.

A lower-cost option is to use patient registries, he said. Patient registry software allows physicians to track their management of patients with chronic health conditions and to report on process and outcomes data that may be required by pay-for-performance programs.

One way to get ready for the pay-for-performance movement that does not involve any technology is to get in the habit of having weekly discussions with staff on quality issues, Dr. Weiss said. Physicians can also consider investing in team-oriented continuing medical education courses, he said.

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according to the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health in July. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Latest Vioxx Ruling

Merck has collected another win in its defense of Vioxx. A jury last month rejected the charge that the company was liable for a New Jersey woman's heart attack after nearly 3 years of taking Vioxx. Elaine Doherty of Lawrenceville said she took Vioxx daily from June 2001 until her heart attack in January 2004 at age 65, and then continued on the medication until it was withdrawn from the market in September 2004. But Merck attorneys countered that she had multiple risk factors for heart disease, such as high cholesterol, diabetes, high blood pressure, and obesity. “The company acted responsibly, the science was on our side, and the jury agreed,” Jim Fitzpatrick of Hughes Hubbard and Reed, a member of the Merck defense team in the case, said in a statement. “Mrs. Doherty would have suffered a heart attack whether she was taking Vioxx or not.” This is Merck's third courtroom victory. The company lost two other cases and was handed a split verdict in the case of two New Jersey plaintiffs in April. Next up: another Vioxx case ongoing in Los Angeles.

Translating Research to Prevention

Officials at the Department of Health and Human Services are spending about $15 million in an effort to bring new evidence-based approaches for managing chronic illnesses and preventing injuries to seniors. “Simply put, this collaboration will put the results of our research investments into the hands of older people so they can use it to improve the quality of their lives,” HHS Secretary Mike Leavitt said in a statement. The money will be used to fund community-level programs in 12 states over 3 years, focusing on conditions such as arthritis, diabetes, and heart disease, as well as injury prevention. Thirty or more of these programs are expected to be operational within a year, according to HHS.

Postmarketing Study Failure

The Food and Drug Administration is doing a poor job of ensuring that pharmaceutical companies live up to postmarketing study commitments, according to a new report released by the Department of Health and Human Services' Office of Inspector General. The IG reviewed new drug applications from 1990 to 2004; 48% of those applications had at least one postmarketing study commitment. Drug makers are required to submit annual status reports. The IG found that 35% of the reports that should have been submitted in fiscal 2004 were missing or had no information on the study commitments. The IG noted that the FDA has limited enforcement power in this area, but suggested that the agency require more, and more relevant, information from drug makers. In response, FDA said it could not do that without additional regulations, but agreed that it needed to do more to improve its monitoring and to ensure that commitments are honored and that annual status reports are thorough.

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according to the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health in July. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Latest Vioxx Ruling

Merck has collected another win in its defense of Vioxx. A jury last month rejected the charge that the company was liable for a New Jersey woman's heart attack after nearly 3 years of taking Vioxx. Elaine Doherty of Lawrenceville said she took Vioxx daily from June 2001 until her heart attack in January 2004 at age 65, and then continued on the medication until it was withdrawn from the market in September 2004. But Merck attorneys countered that she had multiple risk factors for heart disease, such as high cholesterol, diabetes, high blood pressure, and obesity. “The company acted responsibly, the science was on our side, and the jury agreed,” Jim Fitzpatrick of Hughes Hubbard and Reed, a member of the Merck defense team in the case, said in a statement. “Mrs. Doherty would have suffered a heart attack whether she was taking Vioxx or not.” This is Merck's third courtroom victory. The company lost two other cases and was handed a split verdict in the case of two New Jersey plaintiffs in April. Next up: another Vioxx case ongoing in Los Angeles.

Translating Research to Prevention

Officials at the Department of Health and Human Services are spending about $15 million in an effort to bring new evidence-based approaches for managing chronic illnesses and preventing injuries to seniors. “Simply put, this collaboration will put the results of our research investments into the hands of older people so they can use it to improve the quality of their lives,” HHS Secretary Mike Leavitt said in a statement. The money will be used to fund community-level programs in 12 states over 3 years, focusing on conditions such as arthritis, diabetes, and heart disease, as well as injury prevention. Thirty or more of these programs are expected to be operational within a year, according to HHS.

Postmarketing Study Failure

The Food and Drug Administration is doing a poor job of ensuring that pharmaceutical companies live up to postmarketing study commitments, according to a new report released by the Department of Health and Human Services' Office of Inspector General. The IG reviewed new drug applications from 1990 to 2004; 48% of those applications had at least one postmarketing study commitment. Drug makers are required to submit annual status reports. The IG found that 35% of the reports that should have been submitted in fiscal 2004 were missing or had no information on the study commitments. The IG noted that the FDA has limited enforcement power in this area, but suggested that the agency require more, and more relevant, information from drug makers. In response, FDA said it could not do that without additional regulations, but agreed that it needed to do more to improve its monitoring and to ensure that commitments are honored and that annual status reports are thorough.

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according to the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health in July. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Latest Vioxx Ruling

Merck has collected another win in its defense of Vioxx. A jury last month rejected the charge that the company was liable for a New Jersey woman's heart attack after nearly 3 years of taking Vioxx. Elaine Doherty of Lawrenceville said she took Vioxx daily from June 2001 until her heart attack in January 2004 at age 65, and then continued on the medication until it was withdrawn from the market in September 2004. But Merck attorneys countered that she had multiple risk factors for heart disease, such as high cholesterol, diabetes, high blood pressure, and obesity. “The company acted responsibly, the science was on our side, and the jury agreed,” Jim Fitzpatrick of Hughes Hubbard and Reed, a member of the Merck defense team in the case, said in a statement. “Mrs. Doherty would have suffered a heart attack whether she was taking Vioxx or not.” This is Merck's third courtroom victory. The company lost two other cases and was handed a split verdict in the case of two New Jersey plaintiffs in April. Next up: another Vioxx case ongoing in Los Angeles.

Translating Research to Prevention

Officials at the Department of Health and Human Services are spending about $15 million in an effort to bring new evidence-based approaches for managing chronic illnesses and preventing injuries to seniors. “Simply put, this collaboration will put the results of our research investments into the hands of older people so they can use it to improve the quality of their lives,” HHS Secretary Mike Leavitt said in a statement. The money will be used to fund community-level programs in 12 states over 3 years, focusing on conditions such as arthritis, diabetes, and heart disease, as well as injury prevention. Thirty or more of these programs are expected to be operational within a year, according to HHS.

Postmarketing Study Failure

The Food and Drug Administration is doing a poor job of ensuring that pharmaceutical companies live up to postmarketing study commitments, according to a new report released by the Department of Health and Human Services' Office of Inspector General. The IG reviewed new drug applications from 1990 to 2004; 48% of those applications had at least one postmarketing study commitment. Drug makers are required to submit annual status reports. The IG found that 35% of the reports that should have been submitted in fiscal 2004 were missing or had no information on the study commitments. The IG noted that the FDA has limited enforcement power in this area, but suggested that the agency require more, and more relevant, information from drug makers. In response, FDA said it could not do that without additional regulations, but agreed that it needed to do more to improve its monitoring and to ensure that commitments are honored and that annual status reports are thorough.

A new proposal from the Centers for Medicare and Medicaid Services could result in a better bottom line next year for physicians who spend a lot of time on evaluation and management services but is expected to mean a slight cut in payments for cardiologists.

CMS officials are seeking to increase the work component for relative value units (RVUs) for a number of evaluation and management service codes. For example, Medicare is proposing to increase the work RVUs for the commonly used established office visit codes 99213 and 99214. The proposed changes, which are the result of a mandatory 5-year review by the CMS, would take effect in January 2007.

The proposed rule, issued on June 29, also calls for changes in the practice expense methodology that would involve the use of practice expense survey data from eight specialties, including cardiology, to better calculate the costs incurred by physicians. These changes would begin in January but would be phased in over 4 years.

To pay for the proposed increases in reimbursement, the CMS is required to impose across-the-board cuts in work RVUs. This could mean payment cuts for physicians who provide fewer evaluation and management services.

Moreover, the expected increase for primary care physicians could be offset by the end of the year if physicians are unable to get a temporary fix to the sustainable growth rate formula, which is expected to cut physician payments under Medicare by nearly 5%.

“The CMS proposal reinforces the urgent need for Congress to act to stop the Medicare physician payment cuts and ensure that payments keep up to practice costs,” Dr. Cecil Wilson, AMA board chair, said in a statement.

For cardiologists, CMS estimates that there will be a 1% drop in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. By 2010, when the practice expensive methodology changes are fully implemented, the cut will be about 4% compared with allowed charges in 2006.

This proposed cut will mean that physicians will put off acquiring new technology such as electronic medical records and that they will be looking for ways to cut costs, said Dr. James Blankenship, who serves as the American College of Cardiology representative on the Relative Value Update Committee (RUC) of the American Medical Association. The RUC is a 29-member multispecialty committee that makes recommendations to the CMS annually on payment issues.

However, the impact could be more dramatic if cuts are coupled with the planned 4.6% Medicare payment cut that all physicians are expected to face at the beginning of 2007 if changes are not made to the Sustainable Growth Rate formula. In addition, under the Deficit Reduction Act of 2005, physicians who perform imaging services in their offices are facing additional payment cuts under Medicare. If all of these cuts go into effect, cardiologists may consider early retirement and Medicare patients may face decreased access, Dr. Blankenship said.

Despite the gloomy outlook for Medicare payments in 2007, things could have been worse, Dr. Blankenship said. Without the ACC commissioned survey of cardiologist practice expenses, which is being used by CMS in determining payments, the cuts could have been even deeper, he said.

The CMS proposal was praised by primary care groups, which stand to benefit from the changes. Dr. J. Leonard Lichtenfeld said the proposed changes to evaluation and management services would help address the underfunding of primary care. Dr. Lichtenfeld, a medical oncologist, is the American College of Physicians' representative on the RUC.

But although these changes go a long way in helping struggling physicians, it's not a complete solution, Dr. Lichtenfeld said, because it doesn't solve the underlying problem of inadequate funds in Medicare.

“Someone's got to be there to be the captain of the ship,” he said.

Primary care physicians aren't the only ones who will benefit from the increases for evaluation and management codes, he noted. Surgeons will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

For Dr. Douglas Leahy, an alternate delegate to the RUC for the ACP and a general internist, the proposed increases would mean the chance to spend more time with patients. Dr. Leahy, who works in a large multispecialty practice in Knoxville, Tenn., said that with better reimbursement for evaluation and management services, he could devote more time to important areas such as diabetes prevention or counseling family members of an Alzheimer's patient.

Although the increased payments for evaluation and management services and surgical postoperative care are needed, they are accompanied by an average 5% across-the-board cut in payments, according to the AMA.

That cut is the result of the budget neutrality adjustment that the CMS is required by law to make whenever changes in RVUs cause an increase or decrease in overall physician fee schedule outlays of more than $20 million. The proposed work RVU changes are estimated to increase expenditures by about $4 billion, according to the CMS.

The proposal was published in the June 29 issue of the Federal Register. The CMS is accepting comments until Aug. 21.

The proposed rule is available online at www.cms.hhs.gov/PhysicianFeeSched

A new proposal from the Centers for Medicare and Medicaid Services could result in a better bottom line next year for physicians who spend a lot of time on evaluation and management services but is expected to mean a slight cut in payments for cardiologists.

CMS officials are seeking to increase the work component for relative value units (RVUs) for a number of evaluation and management service codes. For example, Medicare is proposing to increase the work RVUs for the commonly used established office visit codes 99213 and 99214. The proposed changes, which are the result of a mandatory 5-year review by the CMS, would take effect in January 2007.

The proposed rule, issued on June 29, also calls for changes in the practice expense methodology that would involve the use of practice expense survey data from eight specialties, including cardiology, to better calculate the costs incurred by physicians. These changes would begin in January but would be phased in over 4 years.

To pay for the proposed increases in reimbursement, the CMS is required to impose across-the-board cuts in work RVUs. This could mean payment cuts for physicians who provide fewer evaluation and management services.

Moreover, the expected increase for primary care physicians could be offset by the end of the year if physicians are unable to get a temporary fix to the sustainable growth rate formula, which is expected to cut physician payments under Medicare by nearly 5%.

“The CMS proposal reinforces the urgent need for Congress to act to stop the Medicare physician payment cuts and ensure that payments keep up to practice costs,” Dr. Cecil Wilson, AMA board chair, said in a statement.

For cardiologists, CMS estimates that there will be a 1% drop in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. By 2010, when the practice expensive methodology changes are fully implemented, the cut will be about 4% compared with allowed charges in 2006.

This proposed cut will mean that physicians will put off acquiring new technology such as electronic medical records and that they will be looking for ways to cut costs, said Dr. James Blankenship, who serves as the American College of Cardiology representative on the Relative Value Update Committee (RUC) of the American Medical Association. The RUC is a 29-member multispecialty committee that makes recommendations to the CMS annually on payment issues.

However, the impact could be more dramatic if cuts are coupled with the planned 4.6% Medicare payment cut that all physicians are expected to face at the beginning of 2007 if changes are not made to the Sustainable Growth Rate formula. In addition, under the Deficit Reduction Act of 2005, physicians who perform imaging services in their offices are facing additional payment cuts under Medicare. If all of these cuts go into effect, cardiologists may consider early retirement and Medicare patients may face decreased access, Dr. Blankenship said.

Despite the gloomy outlook for Medicare payments in 2007, things could have been worse, Dr. Blankenship said. Without the ACC commissioned survey of cardiologist practice expenses, which is being used by CMS in determining payments, the cuts could have been even deeper, he said.

The CMS proposal was praised by primary care groups, which stand to benefit from the changes. Dr. J. Leonard Lichtenfeld said the proposed changes to evaluation and management services would help address the underfunding of primary care. Dr. Lichtenfeld, a medical oncologist, is the American College of Physicians' representative on the RUC.

But although these changes go a long way in helping struggling physicians, it's not a complete solution, Dr. Lichtenfeld said, because it doesn't solve the underlying problem of inadequate funds in Medicare.

“Someone's got to be there to be the captain of the ship,” he said.

Primary care physicians aren't the only ones who will benefit from the increases for evaluation and management codes, he noted. Surgeons will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

For Dr. Douglas Leahy, an alternate delegate to the RUC for the ACP and a general internist, the proposed increases would mean the chance to spend more time with patients. Dr. Leahy, who works in a large multispecialty practice in Knoxville, Tenn., said that with better reimbursement for evaluation and management services, he could devote more time to important areas such as diabetes prevention or counseling family members of an Alzheimer's patient.

Although the increased payments for evaluation and management services and surgical postoperative care are needed, they are accompanied by an average 5% across-the-board cut in payments, according to the AMA.

That cut is the result of the budget neutrality adjustment that the CMS is required by law to make whenever changes in RVUs cause an increase or decrease in overall physician fee schedule outlays of more than $20 million. The proposed work RVU changes are estimated to increase expenditures by about $4 billion, according to the CMS.

The proposal was published in the June 29 issue of the Federal Register. The CMS is accepting comments until Aug. 21.

The proposed rule is available online at www.cms.hhs.gov/PhysicianFeeSched

A new proposal from the Centers for Medicare and Medicaid Services could result in a better bottom line next year for physicians who spend a lot of time on evaluation and management services but is expected to mean a slight cut in payments for cardiologists.

CMS officials are seeking to increase the work component for relative value units (RVUs) for a number of evaluation and management service codes. For example, Medicare is proposing to increase the work RVUs for the commonly used established office visit codes 99213 and 99214. The proposed changes, which are the result of a mandatory 5-year review by the CMS, would take effect in January 2007.

The proposed rule, issued on June 29, also calls for changes in the practice expense methodology that would involve the use of practice expense survey data from eight specialties, including cardiology, to better calculate the costs incurred by physicians. These changes would begin in January but would be phased in over 4 years.

To pay for the proposed increases in reimbursement, the CMS is required to impose across-the-board cuts in work RVUs. This could mean payment cuts for physicians who provide fewer evaluation and management services.

Moreover, the expected increase for primary care physicians could be offset by the end of the year if physicians are unable to get a temporary fix to the sustainable growth rate formula, which is expected to cut physician payments under Medicare by nearly 5%.

“The CMS proposal reinforces the urgent need for Congress to act to stop the Medicare physician payment cuts and ensure that payments keep up to practice costs,” Dr. Cecil Wilson, AMA board chair, said in a statement.

For cardiologists, CMS estimates that there will be a 1% drop in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. By 2010, when the practice expensive methodology changes are fully implemented, the cut will be about 4% compared with allowed charges in 2006.

This proposed cut will mean that physicians will put off acquiring new technology such as electronic medical records and that they will be looking for ways to cut costs, said Dr. James Blankenship, who serves as the American College of Cardiology representative on the Relative Value Update Committee (RUC) of the American Medical Association. The RUC is a 29-member multispecialty committee that makes recommendations to the CMS annually on payment issues.

However, the impact could be more dramatic if cuts are coupled with the planned 4.6% Medicare payment cut that all physicians are expected to face at the beginning of 2007 if changes are not made to the Sustainable Growth Rate formula. In addition, under the Deficit Reduction Act of 2005, physicians who perform imaging services in their offices are facing additional payment cuts under Medicare. If all of these cuts go into effect, cardiologists may consider early retirement and Medicare patients may face decreased access, Dr. Blankenship said.

Despite the gloomy outlook for Medicare payments in 2007, things could have been worse, Dr. Blankenship said. Without the ACC commissioned survey of cardiologist practice expenses, which is being used by CMS in determining payments, the cuts could have been even deeper, he said.

The CMS proposal was praised by primary care groups, which stand to benefit from the changes. Dr. J. Leonard Lichtenfeld said the proposed changes to evaluation and management services would help address the underfunding of primary care. Dr. Lichtenfeld, a medical oncologist, is the American College of Physicians' representative on the RUC.

But although these changes go a long way in helping struggling physicians, it's not a complete solution, Dr. Lichtenfeld said, because it doesn't solve the underlying problem of inadequate funds in Medicare.

“Someone's got to be there to be the captain of the ship,” he said.

Primary care physicians aren't the only ones who will benefit from the increases for evaluation and management codes, he noted. Surgeons will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

For Dr. Douglas Leahy, an alternate delegate to the RUC for the ACP and a general internist, the proposed increases would mean the chance to spend more time with patients. Dr. Leahy, who works in a large multispecialty practice in Knoxville, Tenn., said that with better reimbursement for evaluation and management services, he could devote more time to important areas such as diabetes prevention or counseling family members of an Alzheimer's patient.

Although the increased payments for evaluation and management services and surgical postoperative care are needed, they are accompanied by an average 5% across-the-board cut in payments, according to the AMA.

That cut is the result of the budget neutrality adjustment that the CMS is required by law to make whenever changes in RVUs cause an increase or decrease in overall physician fee schedule outlays of more than $20 million. The proposed work RVU changes are estimated to increase expenditures by about $4 billion, according to the CMS.

The proposal was published in the June 29 issue of the Federal Register. The CMS is accepting comments until Aug. 21.

The proposed rule is available online at www.cms.hhs.gov/PhysicianFeeSched

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations.

Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products.

The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards.

Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said.

That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, Dr. Leavitt said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, Dr. Leavitt said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some of the risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians shouldn't do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems.

In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of the commission's certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations.

Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products.

The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards.

Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said.

That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, Dr. Leavitt said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, Dr. Leavitt said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some of the risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians shouldn't do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems.

In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of the commission's certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

The Certification Commission for Healthcare Information Technology has unveiled an initial list of 22 ambulatory electronic health record products that meet its standards for functionality, interoperability, and security.

CCHIT was formed in 2004 by three leading health IT management and technology industry associations.

Since last fall, CCHIT has been under contract to the federal government to develop certification criteria for EHRs and evaluate products.

The CCHIT process has also been endorsed by the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics.

In this first round, CCHIT officials gave their seal of approval to 22 products that met all certification standards.

Going forward, CCHIT officials will evaluate ambulatory EHR products on a quarterly basis, and are expected to make the next announcement about newly certified EHR systems in late October. In the meantime, the group will begin work on certification for inpatient EHRs and for the network systems that support information exchange between physicians and health care institutions.

The certified products are designed to serve the spectrum of physician practices, Dr. Mark Leavitt, CCHIT chair, said during a press conference. Vendors whose products were certified in this first round received a CCHIT seal of approval that the product met 2006 standards, Dr. Leavitt said.

That certification is good for up to 3 years or vendors can come back to CCHIT each year to be certified under the updated standards, Dr. Leavitt said.

This year's standards included some baseline interoperability functionality related to receiving lab results, but the bulk of the interoperability criteria will be applied starting next year, once standards in this area have been harmonized, Dr. Leavitt said.

“This certification process provides folks with a short list, if you will,” Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians, said in an interview.

Having a list of certified products reduces some of the risk for physicians buying EHR systems, Dr. Barr said. But it does not mean that physicians shouldn't do their homework when it comes to buying a system, since every practice will be looking for different types of functionality, he said.

“This is just a first step along a long, long path,” Health and Human Services Secretary Mike Leavitt said during the press conference.

Leaders in health IT are quickly approaching the time when they will no longer have to sell people on the benefits of EHRs, he said, but there is a need to continue to talk about the importance of the interoperability of these systems.

In the long term, interoperable systems will become a condition of doing business with the federal government, said Mr. Leavitt, who is not related to Dr. Leavitt.

In an effort to aid physician adoption of EHRs, Mr. Leavitt said HHS will soon publish a final regulation creating safe harbors in the federal antikickback statute and physician self-referral law (Stark laws) that would allow hospital systems and other large provider groups to donate health IT products to physicians in certain cases. HHS issued the proposed rule last October.

The full list of the commission's certified products is available at www.cchit.org/certified/2006/CCHIT+Certified+Products+by+Product.htm

Providing telephone counseling and targeted educational materials to the siblings of recently diagnosed melanoma patients can help improve the rate and quality of skin self-screening, according to the results of new research.

In a randomized controlled trial that included 494 siblings of melanoma patients, those who received the study intervention were more likely to examine all of their moles, including those on the back, compared with siblings who had received usual care (odds ratio 1.76). Those receiving targeted education also were more likely to compare all of their moles to see if one stood out (odds ratio 2.20).

The study, which will appear in the print issue of the journal Cancer on Aug. 15, was published online July 10.

Alan C. Geller, R.N., of Boston University, and his colleagues contacted 667 siblings of recently diagnosed melanoma patients. Of this group, 494 consented to participate in the study and completed a baseline survey. The siblings were randomized to receive either the study intervention or usual care, which in the study was a suggestion by the dermatologist that siblings be screened for melanoma. A total of 314 siblings completed the 12-month survey.

The intervention included a motivational telephone session with a health educator, tailored print materials at various points in the first 6 months, three additional telephone counseling sessions, and information about free screening programs. The calls and materials were customized to the particular needs or concerns of the siblings. Study participants who said they had difficulty checking for moles on their back, for example, were given information on how to include that as part of their self-exam.

The researchers assessed the efficacy of the intervention by whether the siblings had a skin cancer screening exam by a dermatologist within 12 months of completing the baseline survey, whether they conducted a personal skin self-exam within 12 months, and whether they had always or often used sunscreen with SPF 15 or more during the past summer when spending more than 15 minutes in the sun.

Although the siblings in the intervention arm showed greater improvement in self-screening, both arms showed similar results in terms of obtaining an exam from a dermatologist within a year and routinely using sunscreen. At baseline, about 28% of participants in both groups had been to a dermatologist for an exam in the last year. That figure rose to about 68% after 12 months. About 56% of participants in both groups reported routinely using sunscreen at baseline and that figure rose to 66% for the usual-care group and 67% for the intervention group after 12 months.

Dr. June K. Robinson of Chicago, editor of the Archives of Dermatology, praised the study. Teaching skin self-examination to those who recognize their personal risk can help to improve the performance and quality of the exam, she said in an interview.

The lesson for clinicians making a diagnosis of melanoma is to ask patients to inform their first-degree relatives so they can be examined by a dermatologist. “One of the most important motivators for the patient is for the physician to tell them to do something,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

Providing telephone counseling and targeted educational materials to the siblings of recently diagnosed melanoma patients can help improve the rate and quality of skin self-screening, according to the results of new research.

In a randomized controlled trial that included 494 siblings of melanoma patients, those who received the study intervention were more likely to examine all of their moles, including those on the back, compared with siblings who had received usual care (odds ratio 1.76). Those receiving targeted education also were more likely to compare all of their moles to see if one stood out (odds ratio 2.20).

The study, which will appear in the print issue of the journal Cancer on Aug. 15, was published online July 10.

Alan C. Geller, R.N., of Boston University, and his colleagues contacted 667 siblings of recently diagnosed melanoma patients. Of this group, 494 consented to participate in the study and completed a baseline survey. The siblings were randomized to receive either the study intervention or usual care, which in the study was a suggestion by the dermatologist that siblings be screened for melanoma. A total of 314 siblings completed the 12-month survey.

The intervention included a motivational telephone session with a health educator, tailored print materials at various points in the first 6 months, three additional telephone counseling sessions, and information about free screening programs. The calls and materials were customized to the particular needs or concerns of the siblings. Study participants who said they had difficulty checking for moles on their back, for example, were given information on how to include that as part of their self-exam.

The researchers assessed the efficacy of the intervention by whether the siblings had a skin cancer screening exam by a dermatologist within 12 months of completing the baseline survey, whether they conducted a personal skin self-exam within 12 months, and whether they had always or often used sunscreen with SPF 15 or more during the past summer when spending more than 15 minutes in the sun.

Although the siblings in the intervention arm showed greater improvement in self-screening, both arms showed similar results in terms of obtaining an exam from a dermatologist within a year and routinely using sunscreen. At baseline, about 28% of participants in both groups had been to a dermatologist for an exam in the last year. That figure rose to about 68% after 12 months. About 56% of participants in both groups reported routinely using sunscreen at baseline and that figure rose to 66% for the usual-care group and 67% for the intervention group after 12 months.

Dr. June K. Robinson of Chicago, editor of the Archives of Dermatology, praised the study. Teaching skin self-examination to those who recognize their personal risk can help to improve the performance and quality of the exam, she said in an interview.

The lesson for clinicians making a diagnosis of melanoma is to ask patients to inform their first-degree relatives so they can be examined by a dermatologist. “One of the most important motivators for the patient is for the physician to tell them to do something,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

Providing telephone counseling and targeted educational materials to the siblings of recently diagnosed melanoma patients can help improve the rate and quality of skin self-screening, according to the results of new research.

In a randomized controlled trial that included 494 siblings of melanoma patients, those who received the study intervention were more likely to examine all of their moles, including those on the back, compared with siblings who had received usual care (odds ratio 1.76). Those receiving targeted education also were more likely to compare all of their moles to see if one stood out (odds ratio 2.20).

The study, which will appear in the print issue of the journal Cancer on Aug. 15, was published online July 10.

Alan C. Geller, R.N., of Boston University, and his colleagues contacted 667 siblings of recently diagnosed melanoma patients. Of this group, 494 consented to participate in the study and completed a baseline survey. The siblings were randomized to receive either the study intervention or usual care, which in the study was a suggestion by the dermatologist that siblings be screened for melanoma. A total of 314 siblings completed the 12-month survey.

The intervention included a motivational telephone session with a health educator, tailored print materials at various points in the first 6 months, three additional telephone counseling sessions, and information about free screening programs. The calls and materials were customized to the particular needs or concerns of the siblings. Study participants who said they had difficulty checking for moles on their back, for example, were given information on how to include that as part of their self-exam.

The researchers assessed the efficacy of the intervention by whether the siblings had a skin cancer screening exam by a dermatologist within 12 months of completing the baseline survey, whether they conducted a personal skin self-exam within 12 months, and whether they had always or often used sunscreen with SPF 15 or more during the past summer when spending more than 15 minutes in the sun.

Although the siblings in the intervention arm showed greater improvement in self-screening, both arms showed similar results in terms of obtaining an exam from a dermatologist within a year and routinely using sunscreen. At baseline, about 28% of participants in both groups had been to a dermatologist for an exam in the last year. That figure rose to about 68% after 12 months. About 56% of participants in both groups reported routinely using sunscreen at baseline and that figure rose to 66% for the usual-care group and 67% for the intervention group after 12 months.

Dr. June K. Robinson of Chicago, editor of the Archives of Dermatology, praised the study. Teaching skin self-examination to those who recognize their personal risk can help to improve the performance and quality of the exam, she said in an interview.

The lesson for clinicians making a diagnosis of melanoma is to ask patients to inform their first-degree relatives so they can be examined by a dermatologist. “One of the most important motivators for the patient is for the physician to tell them to do something,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

Louisiana Passes Abortion Ban

Louisiana Gov. Kathleen Blanco (D) last month signed into law a bill that would ban most abortions in the state in the event that the U.S. Supreme Court overturns Roe v. Wade or the U.S. Constitution is amended giving states the right to outlaw abortion. The new law would make exceptions in order to save the life of the mother or to prevent “substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant women.” However, the law does not allow for abortions in the case of rape or incest. If Roe v. Wade were overturned or the constitution amended, the ban would go into effect, and physicians who performed abortions would face 1–10 years of prison with hard labor and fines of $10,000–$100,000. “I, along with many other pro-life legislators, had hoped this bill would include special protections for women in cases of rape and incest,” Gov. Blanco said in a statement. “In the end, these exceptions did not pass, but the central provision of the bill supports and reflects my personal beliefs.”

Crisis Pregnancy Centers

Abortion advocates are accusing operators of crisis pregnancy centers of using bait-and-switch tactics in an effort to keep women from obtaining abortions. A recent report from the National Abortion Federation said that these centers, which exist to offer women alternatives to abortion, often choose names that are similar to existing reproductive health facilities and open their offices near abortion providers, giving women the false impression that they offer family planning and abortion services. Currently, pending federal legislation would authorize the Federal Trade Commission to regulate the advertising practices of crisis pregnancy centers to ensure they are not confused with abortion providers. The bill (H.R. 5052) was introduced by Rep. Carolyn Maloney (D-N.Y.) in March.

Physician Income Drops

The average physician net income dropped by about 7% from 1995 to 2003 after adjusting for inflation, even as incomes for other professionals increased, according to a survey conducted by the Center for Studying Health System Change (HSC). Primary care physicians have experienced the biggest decline with average net incomes dropping 10.2% after adjusting for inflation. Surgical specialists also saw a significant decrease in inflation-adjusted earnings, with an 8.2% drop in net income from 1995 to 2003. Medical specialists had a 2.1% drop but the change was not statistically significant. The major driver of this drop in real incomes is flat or declining payments from both Medicare and Medicaid, and from private payers, according to the HSC analysis.

Stalking Prevalence

Stalking is a significant public health issue, especially for women, according to an analysis published in the August issue of the American Journal of Preventive Medicine. The results of a random-digit-dial telephone survey of more than 9,600 adults show that about 10 million adults in the United States report having been stalked at some point in their lifetime. More women reported having been the victim of stalking than men, with about 7% of women and 2% of men reporting they had been a victim of stalking behavior that they perceived as somewhat dangerous or life threatening. Overall, 1 in 50 men and 1 in 14 women will be victims of stalking behavior at some point in their lifetime, according to the study, which was conducted by researchers from the Centers for Disease Control and Prevention. Adults under age 55, whites, and unmarried individuals are also more likely to be victims of stalking, the researchers wrote.

Rapid Response Teams Cut Deaths

An 18-month campaign to get hospitals to adopt quality control measures has saved more than 100,000 lives. That's according to estimates by the Institute for Healthcare Improvement, the Cambridge, Mass.- based nonprofit organization behind the campaign. IHI based its estimates on raw mortality data from inpatient admissions only, which is submitted to the organization by participating hospitals. The data are compared with mortality data from each facility's “baseline” in 2004, and risk adjusted. So far, at least 3,000 hospitals have signed up to be part of the effort. They agreed to implement some or all of a checklist of six quality improvement initiatives, including establishing rapid response teams that are activated when a patient's condition is deemed to be worsening. The facilities also agree to prevent medication errors by closely tracking and reconciling inpatient records; follow evidence-based guidelines for heart attack care; institute programs to prevent central line infections and postsurgical infections; and keep ventilator-dependent patients from developing pneumonia.

Louisiana Passes Abortion Ban

Louisiana Gov. Kathleen Blanco (D) last month signed into law a bill that would ban most abortions in the state in the event that the U.S. Supreme Court overturns Roe v. Wade or the U.S. Constitution is amended giving states the right to outlaw abortion. The new law would make exceptions in order to save the life of the mother or to prevent “substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant women.” However, the law does not allow for abortions in the case of rape or incest. If Roe v. Wade were overturned or the constitution amended, the ban would go into effect, and physicians who performed abortions would face 1–10 years of prison with hard labor and fines of $10,000–$100,000. “I, along with many other pro-life legislators, had hoped this bill would include special protections for women in cases of rape and incest,” Gov. Blanco said in a statement. “In the end, these exceptions did not pass, but the central provision of the bill supports and reflects my personal beliefs.”

Crisis Pregnancy Centers

Abortion advocates are accusing operators of crisis pregnancy centers of using bait-and-switch tactics in an effort to keep women from obtaining abortions. A recent report from the National Abortion Federation said that these centers, which exist to offer women alternatives to abortion, often choose names that are similar to existing reproductive health facilities and open their offices near abortion providers, giving women the false impression that they offer family planning and abortion services. Currently, pending federal legislation would authorize the Federal Trade Commission to regulate the advertising practices of crisis pregnancy centers to ensure they are not confused with abortion providers. The bill (H.R. 5052) was introduced by Rep. Carolyn Maloney (D-N.Y.) in March.

Physician Income Drops

The average physician net income dropped by about 7% from 1995 to 2003 after adjusting for inflation, even as incomes for other professionals increased, according to a survey conducted by the Center for Studying Health System Change (HSC). Primary care physicians have experienced the biggest decline with average net incomes dropping 10.2% after adjusting for inflation. Surgical specialists also saw a significant decrease in inflation-adjusted earnings, with an 8.2% drop in net income from 1995 to 2003. Medical specialists had a 2.1% drop but the change was not statistically significant. The major driver of this drop in real incomes is flat or declining payments from both Medicare and Medicaid, and from private payers, according to the HSC analysis.

Stalking Prevalence

Stalking is a significant public health issue, especially for women, according to an analysis published in the August issue of the American Journal of Preventive Medicine. The results of a random-digit-dial telephone survey of more than 9,600 adults show that about 10 million adults in the United States report having been stalked at some point in their lifetime. More women reported having been the victim of stalking than men, with about 7% of women and 2% of men reporting they had been a victim of stalking behavior that they perceived as somewhat dangerous or life threatening. Overall, 1 in 50 men and 1 in 14 women will be victims of stalking behavior at some point in their lifetime, according to the study, which was conducted by researchers from the Centers for Disease Control and Prevention. Adults under age 55, whites, and unmarried individuals are also more likely to be victims of stalking, the researchers wrote.

Rapid Response Teams Cut Deaths

An 18-month campaign to get hospitals to adopt quality control measures has saved more than 100,000 lives. That's according to estimates by the Institute for Healthcare Improvement, the Cambridge, Mass.- based nonprofit organization behind the campaign. IHI based its estimates on raw mortality data from inpatient admissions only, which is submitted to the organization by participating hospitals. The data are compared with mortality data from each facility's “baseline” in 2004, and risk adjusted. So far, at least 3,000 hospitals have signed up to be part of the effort. They agreed to implement some or all of a checklist of six quality improvement initiatives, including establishing rapid response teams that are activated when a patient's condition is deemed to be worsening. The facilities also agree to prevent medication errors by closely tracking and reconciling inpatient records; follow evidence-based guidelines for heart attack care; institute programs to prevent central line infections and postsurgical infections; and keep ventilator-dependent patients from developing pneumonia.

Louisiana Passes Abortion Ban

Louisiana Gov. Kathleen Blanco (D) last month signed into law a bill that would ban most abortions in the state in the event that the U.S. Supreme Court overturns Roe v. Wade or the U.S. Constitution is amended giving states the right to outlaw abortion. The new law would make exceptions in order to save the life of the mother or to prevent “substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant women.” However, the law does not allow for abortions in the case of rape or incest. If Roe v. Wade were overturned or the constitution amended, the ban would go into effect, and physicians who performed abortions would face 1–10 years of prison with hard labor and fines of $10,000–$100,000. “I, along with many other pro-life legislators, had hoped this bill would include special protections for women in cases of rape and incest,” Gov. Blanco said in a statement. “In the end, these exceptions did not pass, but the central provision of the bill supports and reflects my personal beliefs.”

Crisis Pregnancy Centers

Abortion advocates are accusing operators of crisis pregnancy centers of using bait-and-switch tactics in an effort to keep women from obtaining abortions. A recent report from the National Abortion Federation said that these centers, which exist to offer women alternatives to abortion, often choose names that are similar to existing reproductive health facilities and open their offices near abortion providers, giving women the false impression that they offer family planning and abortion services. Currently, pending federal legislation would authorize the Federal Trade Commission to regulate the advertising practices of crisis pregnancy centers to ensure they are not confused with abortion providers. The bill (H.R. 5052) was introduced by Rep. Carolyn Maloney (D-N.Y.) in March.

Physician Income Drops

The average physician net income dropped by about 7% from 1995 to 2003 after adjusting for inflation, even as incomes for other professionals increased, according to a survey conducted by the Center for Studying Health System Change (HSC). Primary care physicians have experienced the biggest decline with average net incomes dropping 10.2% after adjusting for inflation. Surgical specialists also saw a significant decrease in inflation-adjusted earnings, with an 8.2% drop in net income from 1995 to 2003. Medical specialists had a 2.1% drop but the change was not statistically significant. The major driver of this drop in real incomes is flat or declining payments from both Medicare and Medicaid, and from private payers, according to the HSC analysis.

Stalking Prevalence

Stalking is a significant public health issue, especially for women, according to an analysis published in the August issue of the American Journal of Preventive Medicine. The results of a random-digit-dial telephone survey of more than 9,600 adults show that about 10 million adults in the United States report having been stalked at some point in their lifetime. More women reported having been the victim of stalking than men, with about 7% of women and 2% of men reporting they had been a victim of stalking behavior that they perceived as somewhat dangerous or life threatening. Overall, 1 in 50 men and 1 in 14 women will be victims of stalking behavior at some point in their lifetime, according to the study, which was conducted by researchers from the Centers for Disease Control and Prevention. Adults under age 55, whites, and unmarried individuals are also more likely to be victims of stalking, the researchers wrote.

Rapid Response Teams Cut Deaths

An 18-month campaign to get hospitals to adopt quality control measures has saved more than 100,000 lives. That's according to estimates by the Institute for Healthcare Improvement, the Cambridge, Mass.- based nonprofit organization behind the campaign. IHI based its estimates on raw mortality data from inpatient admissions only, which is submitted to the organization by participating hospitals. The data are compared with mortality data from each facility's “baseline” in 2004, and risk adjusted. So far, at least 3,000 hospitals have signed up to be part of the effort. They agreed to implement some or all of a checklist of six quality improvement initiatives, including establishing rapid response teams that are activated when a patient's condition is deemed to be worsening. The facilities also agree to prevent medication errors by closely tracking and reconciling inpatient records; follow evidence-based guidelines for heart attack care; institute programs to prevent central line infections and postsurgical infections; and keep ventilator-dependent patients from developing pneumonia.

Nationwide use of performance measures related to just two clinical areas—coronary artery bypass graft surgery and pneumonia—could have saved hospitals as much as $1 billion in 2004.

That conclusion is part of an analysis from Premier Inc., an alliance of not-for-profit hospitals and health care systems. Officials at Premier also estimated that use of the same performance measures would have improved quality of care in hospitals resulting in about 3,000 fewer deaths, 6,000 fewer complications, 6,000 fewer readmissions, and 500,000 fewer days in the hospital nationwide over 1 year.

The analysis is an extrapolation of the first-year results of a Medicare pay-for-performance demonstration project that involved more than 250 Premier member hospitals in 38 states. As part of the demonstration project, which began in October 2003, Premier collected information on the use of quality indicators across five clinical conditions—myocardial infarction, coronary artery bypass graft (CABG), pneumonia, heart failure, and hip and knee replacement.

The Centers for Medicare and Medicaid Services offered incentive payments to hospitals based on their performance on the quality indicators. The 3-year project is still ongoing but the first-year results showed improvements in all clinical categories.

As part of its national analysis, Premier concentrated on two high-volume diagnoses—pneumonia and CABG—and extrapolated outcomes for the use of seven pneumonia measures and four CABG measures.

The predictions on cost savings and quality improvement are based on all pneumonia and CABG patients receiving 76% of more of the recommended performance measures.

“Improving patient care in these two clinical areas … can be proven statistically to reduce readmissions, and to shorten length of stay,” Richard A. Norling, president and CEO of Premier, said during a teleconference to announce the results of the analysis.

For more information on the Premier analysis of the impact of performance measures, go to www.premierinc.com/p4p/press

Nationwide use of performance measures related to just two clinical areas—coronary artery bypass graft surgery and pneumonia—could have saved hospitals as much as $1 billion in 2004.

That conclusion is part of an analysis from Premier Inc., an alliance of not-for-profit hospitals and health care systems. Officials at Premier also estimated that use of the same performance measures would have improved quality of care in hospitals resulting in about 3,000 fewer deaths, 6,000 fewer complications, 6,000 fewer readmissions, and 500,000 fewer days in the hospital nationwide over 1 year.

The analysis is an extrapolation of the first-year results of a Medicare pay-for-performance demonstration project that involved more than 250 Premier member hospitals in 38 states. As part of the demonstration project, which began in October 2003, Premier collected information on the use of quality indicators across five clinical conditions—myocardial infarction, coronary artery bypass graft (CABG), pneumonia, heart failure, and hip and knee replacement.

The Centers for Medicare and Medicaid Services offered incentive payments to hospitals based on their performance on the quality indicators. The 3-year project is still ongoing but the first-year results showed improvements in all clinical categories.

As part of its national analysis, Premier concentrated on two high-volume diagnoses—pneumonia and CABG—and extrapolated outcomes for the use of seven pneumonia measures and four CABG measures.

The predictions on cost savings and quality improvement are based on all pneumonia and CABG patients receiving 76% of more of the recommended performance measures.

“Improving patient care in these two clinical areas … can be proven statistically to reduce readmissions, and to shorten length of stay,” Richard A. Norling, president and CEO of Premier, said during a teleconference to announce the results of the analysis.

For more information on the Premier analysis of the impact of performance measures, go to www.premierinc.com/p4p/press

Nationwide use of performance measures related to just two clinical areas—coronary artery bypass graft surgery and pneumonia—could have saved hospitals as much as $1 billion in 2004.

That conclusion is part of an analysis from Premier Inc., an alliance of not-for-profit hospitals and health care systems. Officials at Premier also estimated that use of the same performance measures would have improved quality of care in hospitals resulting in about 3,000 fewer deaths, 6,000 fewer complications, 6,000 fewer readmissions, and 500,000 fewer days in the hospital nationwide over 1 year.

The analysis is an extrapolation of the first-year results of a Medicare pay-for-performance demonstration project that involved more than 250 Premier member hospitals in 38 states. As part of the demonstration project, which began in October 2003, Premier collected information on the use of quality indicators across five clinical conditions—myocardial infarction, coronary artery bypass graft (CABG), pneumonia, heart failure, and hip and knee replacement.

The Centers for Medicare and Medicaid Services offered incentive payments to hospitals based on their performance on the quality indicators. The 3-year project is still ongoing but the first-year results showed improvements in all clinical categories.

As part of its national analysis, Premier concentrated on two high-volume diagnoses—pneumonia and CABG—and extrapolated outcomes for the use of seven pneumonia measures and four CABG measures.

The predictions on cost savings and quality improvement are based on all pneumonia and CABG patients receiving 76% of more of the recommended performance measures.

“Improving patient care in these two clinical areas … can be proven statistically to reduce readmissions, and to shorten length of stay,” Richard A. Norling, president and CEO of Premier, said during a teleconference to announce the results of the analysis.

For more information on the Premier analysis of the impact of performance measures, go to www.premierinc.com/p4p/press

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and other admissions, and by fall, similar information on outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005. Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing. “They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system.”

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers. And in the fall, the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said. For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician.

However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released in June includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations. Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and other admissions, and by fall, similar information on outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005. Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing. “They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system.”

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers. And in the fall, the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said. For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician.

However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released in June includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations. Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and other admissions, and by fall, similar information on outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005. Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing. “They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system.”

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers. And in the fall, the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said. For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician.

However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released in June includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations. Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit