Mary Ellen Schneider

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.

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, dermatology, and gastroenterology—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 neurologists, the CMS estimates that there will be a 2% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. This is a substantial economic win for neurologists and a better recognition of the importance of evaluation and management services, according to Dr. Bruce Sigsbee, a member of the medical economics and management committee of the American Academy of Neurology. AAN estimates that Medicare will pay approximately $75 million more each year for neurology services under this proposal, which will add thousands of dollars to the bottom line of most neurologists.

Other big winners under the CMS proposal were endocrinologists and primary care physicians. For endocrinologists, CMS estimates that there will be a 6% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes.

Surgeons also will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

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.

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, dermatology, and gastroenterology—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 neurologists, the CMS estimates that there will be a 2% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. This is a substantial economic win for neurologists and a better recognition of the importance of evaluation and management services, according to Dr. Bruce Sigsbee, a member of the medical economics and management committee of the American Academy of Neurology. AAN estimates that Medicare will pay approximately $75 million more each year for neurology services under this proposal, which will add thousands of dollars to the bottom line of most neurologists.

Other big winners under the CMS proposal were endocrinologists and primary care physicians. For endocrinologists, CMS estimates that there will be a 6% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes.

Surgeons also will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

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.

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, dermatology, and gastroenterology—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 neurologists, the CMS estimates that there will be a 2% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes. This is a substantial economic win for neurologists and a better recognition of the importance of evaluation and management services, according to Dr. Bruce Sigsbee, a member of the medical economics and management committee of the American Academy of Neurology. AAN estimates that Medicare will pay approximately $75 million more each year for neurology services under this proposal, which will add thousands of dollars to the bottom line of most neurologists.

Other big winners under the CMS proposal were endocrinologists and primary care physicians. For endocrinologists, CMS estimates that there will be a 6% increase in allowed Medicare charges in 2007 based on the combined impact of the work and practice expense RVU changes.

Surgeons also will see some benefit because of increases for surgical postoperative care, as well as physicians in cognitive specialties such as neurology, he said.

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

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement, physician work-flow issues, and the impact on patient involvement in their care.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, Dr. Douglas E. Henley, executive vice president for the American Academy of Family Physicians, said at a teleconference of the American Health Information Community (AHIC).

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel work on defining standards for secure messaging that will be interoperable with electronic health records.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care. AHIC also recommended that the federal government work with state agencies and professional societies to develop new licensing alternatives that address the ability to provide electronic care delivery across state lines through secure messaging systems.

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement, physician work-flow issues, and the impact on patient involvement in their care.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, Dr. Douglas E. Henley, executive vice president for the American Academy of Family Physicians, said at a teleconference of the American Health Information Community (AHIC).

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel work on defining standards for secure messaging that will be interoperable with electronic health records.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care. AHIC also recommended that the federal government work with state agencies and professional societies to develop new licensing alternatives that address the ability to provide electronic care delivery across state lines through secure messaging systems.

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement, physician work-flow issues, and the impact on patient involvement in their care.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, Dr. Douglas E. Henley, executive vice president for the American Academy of Family Physicians, said at a teleconference of the American Health Information Community (AHIC).

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel work on defining standards for secure messaging that will be interoperable with electronic health records.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care. AHIC also recommended that the federal government work with state agencies and professional societies to develop new licensing alternatives that address the ability to provide electronic care delivery across state lines through secure messaging systems.

Popularity of Biologics

Spending on injectable biologic drugs increased 34% in 2005, according to a report from Express Scripts, one of the country's largest pharmacy benefit managers. The report looked at spending through the pharmacy benefit for four injectable biologics—Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), and Remicade (inifliximab)—but excluded spending on drugs administered in physician offices. The biggest factor in the increased spending was increased use of the drugs, such as earlier treatment of rheumatoid arthritis and longer duration of treatment. Utilization in this class was up nearly 25%, according to Express Scripts. In addition, uses for other indications, such as psoriasis, also drove up the utilization and spending.

Disparities Among Children

Children with juvenile rheumatoid arthritis who were covered by Medicaid had significantly lower health-related quality of life and higher levels of disability than children with the disease who had private insurance, according to a new study. The study, which was published in the June issue of Arthritis & Rheumatism, evaluated patients with juvenile rheumatoid arthritis being treated at the Cincinnati Children's Hospital Medical Center between July 2003 and March 2004. Of the 295 juvenile rheumatoid arthritis patients treated during that time, 40 (14%) were covered by Medicaid. Children in the two groups had about the same level of health care utilization, the researchers wrote. However, children with Medicaid received significantly fewer MRIs and were nearly twice as likely to visit the emergency department. The differences in disability and health-related quality of life may be due to nonadherence and poverty since patients had similar levels of health care utilization, the researchers wrote.

Harvard Launches Stem Cell Project

Scientists at Harvard University and Children's Hospital Boston have been given the green light to begin research using somatic cell nuclear transfer in an effort to develop treatments for diabetes, blood disorders, and neurodegenerative diseases. The research, which will involve human embryonic stem cells, will be privately funded because the federal government will not provide money for research using human embryonic stem cells derived after Aug. 9, 2001. The efforts were praised by the Coalition for the Advancement of Medical Research, which advocates for federal funding of stem cell research. “In the absence of federal support for and oversight of this type of research, CAMR is pleased that institutions like Harvard have taken the necessary steps to ensure that therapeutic cloning research happens in a manner fully consistent with the ethics and scientific standards in place for all research involving human subjects and tissues,” CAMR President Sean Tipton said.

Women as Medical Subjects

More than 60% of women aged 50 years and older who have participated in a medical research study would “definitely” or “probably” do it again, according to a survey released by the Society for Women's Health Research. The group commissioned the national telephone survey of more than 1,000 women aged 50 years and older. A similar survey was conducted in 2003. Overall, 10% of women aged 50 years and older have participated in some type of medical research, the 2006 survey found, down slightly from 12% in 2003. However, a growing number of women said they aren't interested or don't believe in medical research in the 2006 survey. Nearly 16% of women surveyed cited lack of interest as a reason for not wanting to participate, compared with about 9% in the 2003 survey.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view and 37% a negative view of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argued in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15.

Popularity of Biologics

Spending on injectable biologic drugs increased 34% in 2005, according to a report from Express Scripts, one of the country's largest pharmacy benefit managers. The report looked at spending through the pharmacy benefit for four injectable biologics—Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), and Remicade (inifliximab)—but excluded spending on drugs administered in physician offices. The biggest factor in the increased spending was increased use of the drugs, such as earlier treatment of rheumatoid arthritis and longer duration of treatment. Utilization in this class was up nearly 25%, according to Express Scripts. In addition, uses for other indications, such as psoriasis, also drove up the utilization and spending.

Disparities Among Children

Children with juvenile rheumatoid arthritis who were covered by Medicaid had significantly lower health-related quality of life and higher levels of disability than children with the disease who had private insurance, according to a new study. The study, which was published in the June issue of Arthritis & Rheumatism, evaluated patients with juvenile rheumatoid arthritis being treated at the Cincinnati Children's Hospital Medical Center between July 2003 and March 2004. Of the 295 juvenile rheumatoid arthritis patients treated during that time, 40 (14%) were covered by Medicaid. Children in the two groups had about the same level of health care utilization, the researchers wrote. However, children with Medicaid received significantly fewer MRIs and were nearly twice as likely to visit the emergency department. The differences in disability and health-related quality of life may be due to nonadherence and poverty since patients had similar levels of health care utilization, the researchers wrote.

Harvard Launches Stem Cell Project

Scientists at Harvard University and Children's Hospital Boston have been given the green light to begin research using somatic cell nuclear transfer in an effort to develop treatments for diabetes, blood disorders, and neurodegenerative diseases. The research, which will involve human embryonic stem cells, will be privately funded because the federal government will not provide money for research using human embryonic stem cells derived after Aug. 9, 2001. The efforts were praised by the Coalition for the Advancement of Medical Research, which advocates for federal funding of stem cell research. “In the absence of federal support for and oversight of this type of research, CAMR is pleased that institutions like Harvard have taken the necessary steps to ensure that therapeutic cloning research happens in a manner fully consistent with the ethics and scientific standards in place for all research involving human subjects and tissues,” CAMR President Sean Tipton said.

Women as Medical Subjects

More than 60% of women aged 50 years and older who have participated in a medical research study would “definitely” or “probably” do it again, according to a survey released by the Society for Women's Health Research. The group commissioned the national telephone survey of more than 1,000 women aged 50 years and older. A similar survey was conducted in 2003. Overall, 10% of women aged 50 years and older have participated in some type of medical research, the 2006 survey found, down slightly from 12% in 2003. However, a growing number of women said they aren't interested or don't believe in medical research in the 2006 survey. Nearly 16% of women surveyed cited lack of interest as a reason for not wanting to participate, compared with about 9% in the 2003 survey.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view and 37% a negative view of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argued in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15.

Popularity of Biologics

Spending on injectable biologic drugs increased 34% in 2005, according to a report from Express Scripts, one of the country's largest pharmacy benefit managers. The report looked at spending through the pharmacy benefit for four injectable biologics—Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), and Remicade (inifliximab)—but excluded spending on drugs administered in physician offices. The biggest factor in the increased spending was increased use of the drugs, such as earlier treatment of rheumatoid arthritis and longer duration of treatment. Utilization in this class was up nearly 25%, according to Express Scripts. In addition, uses for other indications, such as psoriasis, also drove up the utilization and spending.

Disparities Among Children

Children with juvenile rheumatoid arthritis who were covered by Medicaid had significantly lower health-related quality of life and higher levels of disability than children with the disease who had private insurance, according to a new study. The study, which was published in the June issue of Arthritis & Rheumatism, evaluated patients with juvenile rheumatoid arthritis being treated at the Cincinnati Children's Hospital Medical Center between July 2003 and March 2004. Of the 295 juvenile rheumatoid arthritis patients treated during that time, 40 (14%) were covered by Medicaid. Children in the two groups had about the same level of health care utilization, the researchers wrote. However, children with Medicaid received significantly fewer MRIs and were nearly twice as likely to visit the emergency department. The differences in disability and health-related quality of life may be due to nonadherence and poverty since patients had similar levels of health care utilization, the researchers wrote.

Harvard Launches Stem Cell Project

Scientists at Harvard University and Children's Hospital Boston have been given the green light to begin research using somatic cell nuclear transfer in an effort to develop treatments for diabetes, blood disorders, and neurodegenerative diseases. The research, which will involve human embryonic stem cells, will be privately funded because the federal government will not provide money for research using human embryonic stem cells derived after Aug. 9, 2001. The efforts were praised by the Coalition for the Advancement of Medical Research, which advocates for federal funding of stem cell research. “In the absence of federal support for and oversight of this type of research, CAMR is pleased that institutions like Harvard have taken the necessary steps to ensure that therapeutic cloning research happens in a manner fully consistent with the ethics and scientific standards in place for all research involving human subjects and tissues,” CAMR President Sean Tipton said.

Women as Medical Subjects

More than 60% of women aged 50 years and older who have participated in a medical research study would “definitely” or “probably” do it again, according to a survey released by the Society for Women's Health Research. The group commissioned the national telephone survey of more than 1,000 women aged 50 years and older. A similar survey was conducted in 2003. Overall, 10% of women aged 50 years and older have participated in some type of medical research, the 2006 survey found, down slightly from 12% in 2003. However, a growing number of women said they aren't interested or don't believe in medical research in the 2006 survey. Nearly 16% of women surveyed cited lack of interest as a reason for not wanting to participate, compared with about 9% in the 2003 survey.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view and 37% a negative view of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argued in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and store-based health clinics topped the list of issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and “evidence-based” preventive health coverage.

The policy also calls for individuals and families earning less than 500% of the federal poverty level to obtain coverage once refundable tax credits and other subsidies are available.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The endorsement of an individual mandate for coverage will bring the country one step closer to universal coverage, said Dr. Donna Sweet, an ACP delegate. Creating a market for insurance has the potential to bring down the cost of coverage, said Dr. Mary T. Herald, also an ACP delegate.

But Dr. David McKalip, an alternate delegate from Florida, said the AMA should stick with its current policy of using tax credits to broaden access to health insurance without imposing a requirement. Similar requirements for auto insurance, which are in place in 47 states, have failed to achieve universal insurance coverage, with noncompliance rates of 15%–30% despite penalties, he said.

Instead, Dr. McKalip proposed monitoring the effects of the individual health insurance mandate in Massachusetts. An individual mandate is a step toward socialized medicine and a “slippery slope,” he said.

In other issues, many physicians at the House of Delegates meeting expressed dissatisfaction with the store-based health clinics that have sprung up in retail stores and pharmacies around the country and resignation that these clinics are here to stay.

In an effort to deal with that new reality, AMA delegates established principles for operating store-based health clinics, which include limiting their scope of practice, using standardized medical protocols from evidence-based guidelines, and informing patients in advance of the qualifications of those providing their care. In addition, the delegates called on the management of store-based health clinics to establish arrangements for their care providers to have direct access to and supervision by allopathic and osteopathic physicians, as consistent with state laws.

Clinic providers also should encourage patients to establish care with a primary care physician, the new AMA policy said.

In the area of direct-to-consumer advertising, AMA delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. The guidelines are a response to the frustration that many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

The policy also recommends that product-specific DTC ads should not use actors to portray health care providers who are promoting drug or device products, because this portrayal may be misleading and deceptive. If an actor is used to portray a health care provider, a disclaimer should be prominently displayed. The AMA also voted to discourage active and retired physicians from participating in advertising that endorses a particular drug or device product. If physicians do choose to participate in an ad, there should be a clear disclaimer that they are being paid for their endorsement, according to the new AMA policy.

Last year, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued voluntary “Guiding Principles” on DTC advertising that call on drug companies to spend time educating health care professionals before beginning a new DTC campaign.

In other news from the AMA House of Delegates:

▸ Scaling back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume.

▸ Obtaining organs. The delegates approved a policy that allows for public solicitation of organs from living donors as long as it adds to the overall number of available organs and does not disadvantage others who are waiting for a transplant.

This type of directed donation is acceptable as long as donors do not receive payment beyond reimbursement for travel, lodging, lost wages, and medical care associated with the donation, according to the new policy.

▸ Emphasizing electronic records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records and instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. But the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

▸ Meddling in medicine. AMA delegates voiced their opposition to the “interference of government in the practice of medicine” through the use of government-mandated recitations to patients.

▸ Interrogations and immigration. The House of Delegates adopted a set of ethical guidelines to limit physician participation in interrogation of prisoners and detainees. Under the new guidelines, physicians must not conduct or directly participate in interrogations because it undermines the role of the physician as a healer. The prohibition on direct participation includes monitoring with the intention of intervening, under the AMA guidance.

However, the guidelines spell out a role for physicians to help develop interrogation strategies that are not coercive.

On caring for illegal immigrants, delegates voted to have AMA leadership ask that when federal agencies such as the U.S. Department of Homeland Security or U.S. Customs and Border Protection have custody of an undocumented foreign national, that they assume the cost of that person's health care instead of passing it on to the physician or hospital.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and store-based health clinics topped the list of issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and “evidence-based” preventive health coverage.

The policy also calls for individuals and families earning less than 500% of the federal poverty level to obtain coverage once refundable tax credits and other subsidies are available.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The endorsement of an individual mandate for coverage will bring the country one step closer to universal coverage, said Dr. Donna Sweet, an ACP delegate. Creating a market for insurance has the potential to bring down the cost of coverage, said Dr. Mary T. Herald, also an ACP delegate.

But Dr. David McKalip, an alternate delegate from Florida, said the AMA should stick with its current policy of using tax credits to broaden access to health insurance without imposing a requirement. Similar requirements for auto insurance, which are in place in 47 states, have failed to achieve universal insurance coverage, with noncompliance rates of 15%–30% despite penalties, he said.

Instead, Dr. McKalip proposed monitoring the effects of the individual health insurance mandate in Massachusetts. An individual mandate is a step toward socialized medicine and a “slippery slope,” he said.

In other issues, many physicians at the House of Delegates meeting expressed dissatisfaction with the store-based health clinics that have sprung up in retail stores and pharmacies around the country and resignation that these clinics are here to stay.

In an effort to deal with that new reality, AMA delegates established principles for operating store-based health clinics, which include limiting their scope of practice, using standardized medical protocols from evidence-based guidelines, and informing patients in advance of the qualifications of those providing their care. In addition, the delegates called on the management of store-based health clinics to establish arrangements for their care providers to have direct access to and supervision by allopathic and osteopathic physicians, as consistent with state laws.

Clinic providers also should encourage patients to establish care with a primary care physician, the new AMA policy said.

In the area of direct-to-consumer advertising, AMA delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. The guidelines are a response to the frustration that many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

The policy also recommends that product-specific DTC ads should not use actors to portray health care providers who are promoting drug or device products, because this portrayal may be misleading and deceptive. If an actor is used to portray a health care provider, a disclaimer should be prominently displayed. The AMA also voted to discourage active and retired physicians from participating in advertising that endorses a particular drug or device product. If physicians do choose to participate in an ad, there should be a clear disclaimer that they are being paid for their endorsement, according to the new AMA policy.

Last year, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued voluntary “Guiding Principles” on DTC advertising that call on drug companies to spend time educating health care professionals before beginning a new DTC campaign.

In other news from the AMA House of Delegates:

▸ Scaling back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume.

▸ Obtaining organs. The delegates approved a policy that allows for public solicitation of organs from living donors as long as it adds to the overall number of available organs and does not disadvantage others who are waiting for a transplant.

This type of directed donation is acceptable as long as donors do not receive payment beyond reimbursement for travel, lodging, lost wages, and medical care associated with the donation, according to the new policy.

▸ Emphasizing electronic records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records and instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. But the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

▸ Meddling in medicine. AMA delegates voiced their opposition to the “interference of government in the practice of medicine” through the use of government-mandated recitations to patients.

▸ Interrogations and immigration. The House of Delegates adopted a set of ethical guidelines to limit physician participation in interrogation of prisoners and detainees. Under the new guidelines, physicians must not conduct or directly participate in interrogations because it undermines the role of the physician as a healer. The prohibition on direct participation includes monitoring with the intention of intervening, under the AMA guidance.

However, the guidelines spell out a role for physicians to help develop interrogation strategies that are not coercive.

On caring for illegal immigrants, delegates voted to have AMA leadership ask that when federal agencies such as the U.S. Department of Homeland Security or U.S. Customs and Border Protection have custody of an undocumented foreign national, that they assume the cost of that person's health care instead of passing it on to the physician or hospital.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and store-based health clinics topped the list of issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and “evidence-based” preventive health coverage.

The policy also calls for individuals and families earning less than 500% of the federal poverty level to obtain coverage once refundable tax credits and other subsidies are available.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The endorsement of an individual mandate for coverage will bring the country one step closer to universal coverage, said Dr. Donna Sweet, an ACP delegate. Creating a market for insurance has the potential to bring down the cost of coverage, said Dr. Mary T. Herald, also an ACP delegate.

But Dr. David McKalip, an alternate delegate from Florida, said the AMA should stick with its current policy of using tax credits to broaden access to health insurance without imposing a requirement. Similar requirements for auto insurance, which are in place in 47 states, have failed to achieve universal insurance coverage, with noncompliance rates of 15%–30% despite penalties, he said.

Instead, Dr. McKalip proposed monitoring the effects of the individual health insurance mandate in Massachusetts. An individual mandate is a step toward socialized medicine and a “slippery slope,” he said.

In other issues, many physicians at the House of Delegates meeting expressed dissatisfaction with the store-based health clinics that have sprung up in retail stores and pharmacies around the country and resignation that these clinics are here to stay.

In an effort to deal with that new reality, AMA delegates established principles for operating store-based health clinics, which include limiting their scope of practice, using standardized medical protocols from evidence-based guidelines, and informing patients in advance of the qualifications of those providing their care. In addition, the delegates called on the management of store-based health clinics to establish arrangements for their care providers to have direct access to and supervision by allopathic and osteopathic physicians, as consistent with state laws.

Clinic providers also should encourage patients to establish care with a primary care physician, the new AMA policy said.

In the area of direct-to-consumer advertising, AMA delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. The guidelines are a response to the frustration that many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

The policy also recommends that product-specific DTC ads should not use actors to portray health care providers who are promoting drug or device products, because this portrayal may be misleading and deceptive. If an actor is used to portray a health care provider, a disclaimer should be prominently displayed. The AMA also voted to discourage active and retired physicians from participating in advertising that endorses a particular drug or device product. If physicians do choose to participate in an ad, there should be a clear disclaimer that they are being paid for their endorsement, according to the new AMA policy.

Last year, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued voluntary “Guiding Principles” on DTC advertising that call on drug companies to spend time educating health care professionals before beginning a new DTC campaign.

In other news from the AMA House of Delegates:

▸ Scaling back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume.

▸ Obtaining organs. The delegates approved a policy that allows for public solicitation of organs from living donors as long as it adds to the overall number of available organs and does not disadvantage others who are waiting for a transplant.

This type of directed donation is acceptable as long as donors do not receive payment beyond reimbursement for travel, lodging, lost wages, and medical care associated with the donation, according to the new policy.

▸ Emphasizing electronic records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records and instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. But the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

▸ Meddling in medicine. AMA delegates voiced their opposition to the “interference of government in the practice of medicine” through the use of government-mandated recitations to patients.

▸ Interrogations and immigration. The House of Delegates adopted a set of ethical guidelines to limit physician participation in interrogation of prisoners and detainees. Under the new guidelines, physicians must not conduct or directly participate in interrogations because it undermines the role of the physician as a healer. The prohibition on direct participation includes monitoring with the intention of intervening, under the AMA guidance.

However, the guidelines spell out a role for physicians to help develop interrogation strategies that are not coercive.

On caring for illegal immigrants, delegates voted to have AMA leadership ask that when federal agencies such as the U.S. Department of Homeland Security or U.S. Customs and Border Protection have custody of an undocumented foreign national, that they assume the cost of that person's health care instead of passing it on to the physician or hospital.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and changing the public's perception of salt were among the issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level ($49,000 for individuals and $100,000 for a family of four) obtain a minimum level of catastrophic and “evidence-based” preventive health coverage. The new policy calls for using the tax structure to achieve compliance, although language about the exact tax consequences is vague.

“We've taken a bold shift here, and we want to help lead this discussion because we want to have comprehensive reform,” said Dr. Edward L. Langston, a member of the AMA Board of Trustees, during a press conference at the meeting.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. About 11% of the uninsured had incomes that were more than 500% of the federal poverty level in 2004, according to an analysis by the Department of Health and Human Services. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The American College of Cardiology does not have a formal policy position on individual health insurance mandates. “The ACC has and continues to support reforms that would make health insurance coverage more accessible and more affordable for individuals and families,” an ACC spokesperson said.

In other news from the AMA House of Delegates:

▸ Direct-to-consumer advertising. The delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. Under the AMA policy, the length of the moratorium would be determined on a product-by-product basis by the FDA in consultation with the drug or device sponsor.

The guidelines are a response to the frustration many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

▸ The need to scale back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume. Patients are often unaware of how much sodium is in their diet, cardiologist J. James Rohack, an AMA Board of Trustees member, said during a press conference. Patients with hypertension will often say they don't add salt to food, but they don't realize the high sodium content of processed meats, he said.

▸ Electronic medical records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records, and they instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. However, the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and changing the public's perception of salt were among the issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level ($49,000 for individuals and $100,000 for a family of four) obtain a minimum level of catastrophic and “evidence-based” preventive health coverage. The new policy calls for using the tax structure to achieve compliance, although language about the exact tax consequences is vague.

“We've taken a bold shift here, and we want to help lead this discussion because we want to have comprehensive reform,” said Dr. Edward L. Langston, a member of the AMA Board of Trustees, during a press conference at the meeting.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. About 11% of the uninsured had incomes that were more than 500% of the federal poverty level in 2004, according to an analysis by the Department of Health and Human Services. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The American College of Cardiology does not have a formal policy position on individual health insurance mandates. “The ACC has and continues to support reforms that would make health insurance coverage more accessible and more affordable for individuals and families,” an ACC spokesperson said.

In other news from the AMA House of Delegates:

▸ Direct-to-consumer advertising. The delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. Under the AMA policy, the length of the moratorium would be determined on a product-by-product basis by the FDA in consultation with the drug or device sponsor.

The guidelines are a response to the frustration many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

▸ The need to scale back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume. Patients are often unaware of how much sodium is in their diet, cardiologist J. James Rohack, an AMA Board of Trustees member, said during a press conference. Patients with hypertension will often say they don't add salt to food, but they don't realize the high sodium content of processed meats, he said.

▸ Electronic medical records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records, and they instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. However, the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

CHICAGO — Individual health insurance mandates, direct-to-consumer advertising, and changing the public's perception of salt were among the issues addressed at the annual meeting of the American Medical Association's House of Delegates.

On the heels of Massachusetts' new mandate that all individuals must obtain health insurance, AMA delegates voted to support a requirement that individuals and families earning more than 500% of the federal poverty level ($49,000 for individuals and $100,000 for a family of four) obtain a minimum level of catastrophic and “evidence-based” preventive health coverage. The new policy calls for using the tax structure to achieve compliance, although language about the exact tax consequences is vague.

“We've taken a bold shift here, and we want to help lead this discussion because we want to have comprehensive reform,” said Dr. Edward L. Langston, a member of the AMA Board of Trustees, during a press conference at the meeting.

The recommendation would cover only a fraction of the more than 40 million uninsured Americans. About 11% of the uninsured had incomes that were more than 500% of the federal poverty level in 2004, according to an analysis by the Department of Health and Human Services. But the delegates' action gives AMA officials another tool with which to lobby for expanding the number of people with health coverage, said AMA Board of Trustees member Dr. Ardis D. Hoven.

The American College of Cardiology does not have a formal policy position on individual health insurance mandates. “The ACC has and continues to support reforms that would make health insurance coverage more accessible and more affordable for individuals and families,” an ACC spokesperson said.

In other news from the AMA House of Delegates:

▸ Direct-to-consumer advertising. The delegates voted in favor of placing a moratorium on DTC advertising for newly approved prescription drugs and medical devices until physicians have become educated about the new products. Under the AMA policy, the length of the moratorium would be determined on a product-by-product basis by the FDA in consultation with the drug or device sponsor.

The guidelines are a response to the frustration many physicians feel when patients ask for specific drugs or devices that they have seen advertised, which may not be appropriate for them, said Dr. Ronald M. Davis, an AMA Board of Trustees member, during a press conference.

▸ The need to scale back on salt. In a series of actions, the AMA delegates voted to urge the FDA to revoke the “generally recognized as safe” status of salt, allowing the agency to develop limits on sodium in processed food and restaurant items.

The AMA called for at least a 50% reduction in the amount of sodium in processed foods, fast food products, and restaurant meals over the next decade. The delegates also instructed the AMA leadership to work with the FDA to improve labeling of foods and meals so consumers can better understand the amount of sodium they consume. Patients are often unaware of how much sodium is in their diet, cardiologist J. James Rohack, an AMA Board of Trustees member, said during a press conference. Patients with hypertension will often say they don't add salt to food, but they don't realize the high sodium content of processed meats, he said.

▸ Electronic medical records. Delegates voted for the AMA to support initiatives that minimize the financial burden to physician practices of adopting and maintaining electronic medical records, and they instructed AMA officials to get involved in efforts to define and promote standards for the interoperability of health information technology systems. However, the delegates also established as AMA policy that physicians should not be required to adopt electronic medical records by either public or private payers.

More than two dozen health information technology vendors have applied to have their electronic health record systems independently certified this summer.

The inspection process is underway and the Certification Commission for Health Information Technology (CCHIT) is expected to make the first announcement of certified products this month, according to CCHIT chair Dr. Mark Leavitt.

CCHIT was launched in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology to establish baseline criteria for EHR products and provide a seal of approval to products that meet those standards. CCHIT received a 3-year grant from the Department of Health and Human Services in September 2005.

In this first round of applications, CCHIT is evaluating products from across the spectrum, including EHR systems for the small office to those for large clinics, Dr. Leavitt said at a meeting of the American Health Information Community. This group advises HHS on health IT interoperability issues.

The more than two dozen applications received represent only a small fraction of the 200 or so vendors who have products available commercially, but it is about double what CCHIT officials had expected in the first round, Dr. Leavitt said.

Physicians have been heavily involved in the evaluation of products, Dr. Leavitt said. Of the 175 people who volunteered to evaluate products during 8-hour demonstration sessions, about 80% were practicing physicians. “I think the providers are interested in this,” he said.

“Plug and play” systems that will not require a practice to spend $50,000 on an interface compose one CCHIT goal, Dr. Leavitt said at Toward an Electronic Patient Record, an annual conference sponsored by the Medical Records Institute.

CCHIT plans to review and certify EHR products for the ambulatory setting on a quarterly basis. In 2007, the group will begin certification of EHR products for the inpatient setting, and CCHIT will tackle certification of EHR networks in the spring of 2008.

Nancy Nickell, associate editor for Practice Trends, contributed to this report.

More than two dozen health information technology vendors have applied to have their electronic health record systems independently certified this summer.

The inspection process is underway and the Certification Commission for Health Information Technology (CCHIT) is expected to make the first announcement of certified products this month, according to CCHIT chair Dr. Mark Leavitt.

CCHIT was launched in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology to establish baseline criteria for EHR products and provide a seal of approval to products that meet those standards. CCHIT received a 3-year grant from the Department of Health and Human Services in September 2005.

In this first round of applications, CCHIT is evaluating products from across the spectrum, including EHR systems for the small office to those for large clinics, Dr. Leavitt said at a meeting of the American Health Information Community. This group advises HHS on health IT interoperability issues.

The more than two dozen applications received represent only a small fraction of the 200 or so vendors who have products available commercially, but it is about double what CCHIT officials had expected in the first round, Dr. Leavitt said.

Physicians have been heavily involved in the evaluation of products, Dr. Leavitt said. Of the 175 people who volunteered to evaluate products during 8-hour demonstration sessions, about 80% were practicing physicians. “I think the providers are interested in this,” he said.

“Plug and play” systems that will not require a practice to spend $50,000 on an interface compose one CCHIT goal, Dr. Leavitt said at Toward an Electronic Patient Record, an annual conference sponsored by the Medical Records Institute.

CCHIT plans to review and certify EHR products for the ambulatory setting on a quarterly basis. In 2007, the group will begin certification of EHR products for the inpatient setting, and CCHIT will tackle certification of EHR networks in the spring of 2008.

Nancy Nickell, associate editor for Practice Trends, contributed to this report.

More than two dozen health information technology vendors have applied to have their electronic health record systems independently certified this summer.

The inspection process is underway and the Certification Commission for Health Information Technology (CCHIT) is expected to make the first announcement of certified products this month, according to CCHIT chair Dr. Mark Leavitt.

CCHIT was launched in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology to establish baseline criteria for EHR products and provide a seal of approval to products that meet those standards. CCHIT received a 3-year grant from the Department of Health and Human Services in September 2005.

In this first round of applications, CCHIT is evaluating products from across the spectrum, including EHR systems for the small office to those for large clinics, Dr. Leavitt said at a meeting of the American Health Information Community. This group advises HHS on health IT interoperability issues.

The more than two dozen applications received represent only a small fraction of the 200 or so vendors who have products available commercially, but it is about double what CCHIT officials had expected in the first round, Dr. Leavitt said.

Physicians have been heavily involved in the evaluation of products, Dr. Leavitt said. Of the 175 people who volunteered to evaluate products during 8-hour demonstration sessions, about 80% were practicing physicians. “I think the providers are interested in this,” he said.

“Plug and play” systems that will not require a practice to spend $50,000 on an interface compose one CCHIT goal, Dr. Leavitt said at Toward an Electronic Patient Record, an annual conference sponsored by the Medical Records Institute.

CCHIT plans to review and certify EHR products for the ambulatory setting on a quarterly basis. In 2007, the group will begin certification of EHR products for the inpatient setting, and CCHIT will tackle certification of EHR networks in the spring of 2008.

Nancy Nickell, associate editor for Practice Trends, contributed to this report.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Dr. Jill E. Elwing of Washington University in St. Louis and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Dr. Jill E. Elwing of Washington University in St. Louis and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Dr. Jill E. Elwing of Washington University in St. Louis and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

PHILADELPHIA – A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer–Anthem Health Plans Inc. of Connecticut–has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system–that it will eliminate transcription, cut down on needed staff positions, and improve coding–don't hold true for all physicians, he said.

PHILADELPHIA – A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer–Anthem Health Plans Inc. of Connecticut–has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system–that it will eliminate transcription, cut down on needed staff positions, and improve coding–don't hold true for all physicians, he said.

PHILADELPHIA – A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer–Anthem Health Plans Inc. of Connecticut–has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system–that it will eliminate transcription, cut down on needed staff positions, and improve coding–don't hold true for all physicians, he said.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

“For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors,” Sen. Clinton said in a statement. “Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom.”

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine.

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

But some physician leaders are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Dr. Joseph Flood, chairman of the government affairs committee for the American College of Rheumatology, said the focus on patient safety is important but that the approach outlined in the bill could have unintended consequences.

Dr. Larry S. Fields, president of the American Academy of Family Physicians, said that Sen. Clinton and Sen. Obama had their chance to vote for comprehensive liability reform back in May when the Senate defeated a motion to consider S. 22. That bill would have capped noneconomic damages at $250,000 and allowed courts to restrict the payment of attorney contingency fees. Sen. Clinton voted against the motion, and Sen. Obama did not vote.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

“For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors,” Sen. Clinton said in a statement. “Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom.”

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine.

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

But some physician leaders are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Dr. Joseph Flood, chairman of the government affairs committee for the American College of Rheumatology, said the focus on patient safety is important but that the approach outlined in the bill could have unintended consequences.

Dr. Larry S. Fields, president of the American Academy of Family Physicians, said that Sen. Clinton and Sen. Obama had their chance to vote for comprehensive liability reform back in May when the Senate defeated a motion to consider S. 22. That bill would have capped noneconomic damages at $250,000 and allowed courts to restrict the payment of attorney contingency fees. Sen. Clinton voted against the motion, and Sen. Obama did not vote.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

“For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors,” Sen. Clinton said in a statement. “Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom.”

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine.

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

But some physician leaders are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Dr. Joseph Flood, chairman of the government affairs committee for the American College of Rheumatology, said the focus on patient safety is important but that the approach outlined in the bill could have unintended consequences.

Dr. Larry S. Fields, president of the American Academy of Family Physicians, said that Sen. Clinton and Sen. Obama had their chance to vote for comprehensive liability reform back in May when the Senate defeated a motion to consider S. 22. That bill would have capped noneconomic damages at $250,000 and allowed courts to restrict the payment of attorney contingency fees. Sen. Clinton voted against the motion, and Sen. Obama did not vote.

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. In addition to the need for more geriatricians, the report points to the need for more mental health professionals, registered nurses, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. In addition to the need for more geriatricians, the report points to the need for more mental health professionals, registered nurses, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. In addition to the need for more geriatricians, the report points to the need for more mental health professionals, registered nurses, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu