Mary Ellen Schneider

Grading the Cervical Cancer Fight

Most U.S. states have improved their efforts to eliminate cervical cancer, but state officials are still missing critical screening opportunities, according to Women in Government's second annual report, “The 'State' of Cervical Cancer Prevention in America.” A total of 20 states and the District of Columbia improved their grades over last year but no state received an “excellent” grade, according to the report. The assessment is based on data concerning screening rates, rates of uninsured women, public insurance coverage of advanced screening technology, and legislative focus on the issue. “Our country has made significant progress in the effort to eliminate cervical cancer,” Women in Government President Susan Crosby said in a statement. “However, our findings still show that too many women remain unscreened or underscreened for cervical cancer and too many screening programs rely on the Pap test alone, while [a Food and Drug Administration-approved] test for the human papillomavirus, the cause of cervical cancer, is available and can better identify women needing intervention.” The report is available online at

www.womeningovernment.org/prevention

Revisiting Parental Notice on Abortion

The U.S. Supreme Court has returned to the lower court a case involving New Hampshire's law requiring parental notification prior to an abortion. Ayotte v. Planned Parenthood of Northern New England was sent back to the lower court so the court could reconsider its original decision that the parental notification law is unconstitutional because it does not include an exception to allow an abortion in a medical emergency without parental notification. The Supreme Court, in a unanimous opinion, instructed the lower court to consider the legislative intent of the statute and determine if the court could prohibit the unconstitutional application of the law without striking it down completely. Both supporters and opponents of abortion rights claimed victory for their sides. The Center for Reproductive Rights called the decision a “recognition of its precedent that abortion laws must protect women's health and safety.” The group said it expects that the lower court will strike down the law entirely. But the Christian Medical Association praised the decision and said they hoped that the lower court upon reconsideration would reaffirm the law.

Youth Health Trends Brighten

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners.

Minority Women and HIV/AIDS

Federal officials need to take a closer look at the growing rates of HIV infection among minority women in the United States, women's health advocates said at a Capitol Hill briefing last month. The rates of HIV infection among women of color are disproportionate to the population. For example, African American, Hispanic, Native American, and Asian and Pacific Islander women represent about 29% of the U.S. female population, but account for 84% of female AIDS cases, according to the Society for Women's Health Research and Women's Policy Inc., one sponsor of the briefing. More information about HIV/AIDS and sexual health should be directed toward women and girls, including comprehensive sex education in schools and increased health services for immigrants, the speakers said. In addition, more funding is needed to improve the diagnosis and treatment of sexually transmitted diseases.

Infertility Treatment Coverage Sought

RESOLVE: The National Infertility Association is renewing its call for increased insurance coverage for medically necessary infertility treatment. Currently, only 15 U.S. states offer some level of insurance reimbursement for infertility treatment and many patients cannot afford treatments, according to Joseph C. Isaacs, president of RESOLVE. The group discourages the acquisition of prescription medicines from sources other than pharmaceutical distributors licensed by the Food and Drug Administration. “The real crime here is that millions of American women and men are denied the opportunity to have a family because insurance companies are unwilling to cover treatment,” Mr. Isaacs said in a statement.

Grading the Cervical Cancer Fight

Most U.S. states have improved their efforts to eliminate cervical cancer, but state officials are still missing critical screening opportunities, according to Women in Government's second annual report, “The 'State' of Cervical Cancer Prevention in America.” A total of 20 states and the District of Columbia improved their grades over last year but no state received an “excellent” grade, according to the report. The assessment is based on data concerning screening rates, rates of uninsured women, public insurance coverage of advanced screening technology, and legislative focus on the issue. “Our country has made significant progress in the effort to eliminate cervical cancer,” Women in Government President Susan Crosby said in a statement. “However, our findings still show that too many women remain unscreened or underscreened for cervical cancer and too many screening programs rely on the Pap test alone, while [a Food and Drug Administration-approved] test for the human papillomavirus, the cause of cervical cancer, is available and can better identify women needing intervention.” The report is available online at

www.womeningovernment.org/prevention

Revisiting Parental Notice on Abortion

The U.S. Supreme Court has returned to the lower court a case involving New Hampshire's law requiring parental notification prior to an abortion. Ayotte v. Planned Parenthood of Northern New England was sent back to the lower court so the court could reconsider its original decision that the parental notification law is unconstitutional because it does not include an exception to allow an abortion in a medical emergency without parental notification. The Supreme Court, in a unanimous opinion, instructed the lower court to consider the legislative intent of the statute and determine if the court could prohibit the unconstitutional application of the law without striking it down completely. Both supporters and opponents of abortion rights claimed victory for their sides. The Center for Reproductive Rights called the decision a “recognition of its precedent that abortion laws must protect women's health and safety.” The group said it expects that the lower court will strike down the law entirely. But the Christian Medical Association praised the decision and said they hoped that the lower court upon reconsideration would reaffirm the law.

Youth Health Trends Brighten

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners.

Minority Women and HIV/AIDS

Federal officials need to take a closer look at the growing rates of HIV infection among minority women in the United States, women's health advocates said at a Capitol Hill briefing last month. The rates of HIV infection among women of color are disproportionate to the population. For example, African American, Hispanic, Native American, and Asian and Pacific Islander women represent about 29% of the U.S. female population, but account for 84% of female AIDS cases, according to the Society for Women's Health Research and Women's Policy Inc., one sponsor of the briefing. More information about HIV/AIDS and sexual health should be directed toward women and girls, including comprehensive sex education in schools and increased health services for immigrants, the speakers said. In addition, more funding is needed to improve the diagnosis and treatment of sexually transmitted diseases.

Infertility Treatment Coverage Sought

RESOLVE: The National Infertility Association is renewing its call for increased insurance coverage for medically necessary infertility treatment. Currently, only 15 U.S. states offer some level of insurance reimbursement for infertility treatment and many patients cannot afford treatments, according to Joseph C. Isaacs, president of RESOLVE. The group discourages the acquisition of prescription medicines from sources other than pharmaceutical distributors licensed by the Food and Drug Administration. “The real crime here is that millions of American women and men are denied the opportunity to have a family because insurance companies are unwilling to cover treatment,” Mr. Isaacs said in a statement.

Grading the Cervical Cancer Fight

Most U.S. states have improved their efforts to eliminate cervical cancer, but state officials are still missing critical screening opportunities, according to Women in Government's second annual report, “The 'State' of Cervical Cancer Prevention in America.” A total of 20 states and the District of Columbia improved their grades over last year but no state received an “excellent” grade, according to the report. The assessment is based on data concerning screening rates, rates of uninsured women, public insurance coverage of advanced screening technology, and legislative focus on the issue. “Our country has made significant progress in the effort to eliminate cervical cancer,” Women in Government President Susan Crosby said in a statement. “However, our findings still show that too many women remain unscreened or underscreened for cervical cancer and too many screening programs rely on the Pap test alone, while [a Food and Drug Administration-approved] test for the human papillomavirus, the cause of cervical cancer, is available and can better identify women needing intervention.” The report is available online at

www.womeningovernment.org/prevention

Revisiting Parental Notice on Abortion

The U.S. Supreme Court has returned to the lower court a case involving New Hampshire's law requiring parental notification prior to an abortion. Ayotte v. Planned Parenthood of Northern New England was sent back to the lower court so the court could reconsider its original decision that the parental notification law is unconstitutional because it does not include an exception to allow an abortion in a medical emergency without parental notification. The Supreme Court, in a unanimous opinion, instructed the lower court to consider the legislative intent of the statute and determine if the court could prohibit the unconstitutional application of the law without striking it down completely. Both supporters and opponents of abortion rights claimed victory for their sides. The Center for Reproductive Rights called the decision a “recognition of its precedent that abortion laws must protect women's health and safety.” The group said it expects that the lower court will strike down the law entirely. But the Christian Medical Association praised the decision and said they hoped that the lower court upon reconsideration would reaffirm the law.

Youth Health Trends Brighten

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners.

Minority Women and HIV/AIDS

Federal officials need to take a closer look at the growing rates of HIV infection among minority women in the United States, women's health advocates said at a Capitol Hill briefing last month. The rates of HIV infection among women of color are disproportionate to the population. For example, African American, Hispanic, Native American, and Asian and Pacific Islander women represent about 29% of the U.S. female population, but account for 84% of female AIDS cases, according to the Society for Women's Health Research and Women's Policy Inc., one sponsor of the briefing. More information about HIV/AIDS and sexual health should be directed toward women and girls, including comprehensive sex education in schools and increased health services for immigrants, the speakers said. In addition, more funding is needed to improve the diagnosis and treatment of sexually transmitted diseases.

Infertility Treatment Coverage Sought

RESOLVE: The National Infertility Association is renewing its call for increased insurance coverage for medically necessary infertility treatment. Currently, only 15 U.S. states offer some level of insurance reimbursement for infertility treatment and many patients cannot afford treatments, according to Joseph C. Isaacs, president of RESOLVE. The group discourages the acquisition of prescription medicines from sources other than pharmaceutical distributors licensed by the Food and Drug Administration. “The real crime here is that millions of American women and men are denied the opportunity to have a family because insurance companies are unwilling to cover treatment,” Mr. Isaacs said in a statement.

Wisconsin physicians are continuing to push for the reinstatement of a medical liability damage cap despite recent legal and legislative setbacks.

“I think our legislature clearly understands that something has to be done,” said Dr. Susan Turney, executive vice president and CEO of the Wisconsin Medical Society.

Last summer, the Wisconsin Supreme Court struck down the state's $445,775 cap on noneconomic damages as unconstitutional because it was set “unreasonably low.”

The state legislature acted quickly to pass legislation that enacted a $450,000 cap for adults age 18 and older and a $550,000 cap for those under 18.

But Gov. Jim Doyle (D) vetoed the bill last December, saying that legislators had passed virtually the same cap and ignored the concerns of the court.

“Legal experts agree that a court which found a $445,775 cap unconstitutional would most certainly strike down a cap not even $5,000 higher,” Gov. Doyle said in his veto message. “Approving a law that would be quickly overturned doesn't do anyone any good. Instead, I encourage all the interested parties on all sides of this issue to get together and figure out a responsible and lasting solution that has a real chance of being upheld by the Wisconsin Supreme Court.”

An attempt to override the governor's veto failed in January.

Dr. Turney said she and her colleagues at the Wisconsin Medical Society are “concerned that the absence of caps” will hurt the state's “historically stable medical liability environment” and drive physicians out of state.

The Wisconsin Hospital Association reported that since the state Supreme Court struck down the cap last July, hospitals have had “greater difficulty recruiting physicians” and that damage awards and lawsuits have begun to rise.

In addition, officials at the state's Injured Patients and Families Compensation Fund, which is funded through mandatory premiums from hospitals and physicians, have proposed a 25% increase in annual fees. The proposal is under consideration, and if it is approved, would go into effect on July 1.

But Dr. Turney said she is optimistic that the state legislature will pass new legislation addressing the cap issue this spring. “Both Democrats and Republicans clearly want to see this issue resolved,” she said.

Wisconsin physicians are continuing to push for the reinstatement of a medical liability damage cap despite recent legal and legislative setbacks.

“I think our legislature clearly understands that something has to be done,” said Dr. Susan Turney, executive vice president and CEO of the Wisconsin Medical Society.

Last summer, the Wisconsin Supreme Court struck down the state's $445,775 cap on noneconomic damages as unconstitutional because it was set “unreasonably low.”

The state legislature acted quickly to pass legislation that enacted a $450,000 cap for adults age 18 and older and a $550,000 cap for those under 18.

But Gov. Jim Doyle (D) vetoed the bill last December, saying that legislators had passed virtually the same cap and ignored the concerns of the court.

“Legal experts agree that a court which found a $445,775 cap unconstitutional would most certainly strike down a cap not even $5,000 higher,” Gov. Doyle said in his veto message. “Approving a law that would be quickly overturned doesn't do anyone any good. Instead, I encourage all the interested parties on all sides of this issue to get together and figure out a responsible and lasting solution that has a real chance of being upheld by the Wisconsin Supreme Court.”

An attempt to override the governor's veto failed in January.

Dr. Turney said she and her colleagues at the Wisconsin Medical Society are “concerned that the absence of caps” will hurt the state's “historically stable medical liability environment” and drive physicians out of state.

The Wisconsin Hospital Association reported that since the state Supreme Court struck down the cap last July, hospitals have had “greater difficulty recruiting physicians” and that damage awards and lawsuits have begun to rise.

In addition, officials at the state's Injured Patients and Families Compensation Fund, which is funded through mandatory premiums from hospitals and physicians, have proposed a 25% increase in annual fees. The proposal is under consideration, and if it is approved, would go into effect on July 1.

But Dr. Turney said she is optimistic that the state legislature will pass new legislation addressing the cap issue this spring. “Both Democrats and Republicans clearly want to see this issue resolved,” she said.

Wisconsin physicians are continuing to push for the reinstatement of a medical liability damage cap despite recent legal and legislative setbacks.

“I think our legislature clearly understands that something has to be done,” said Dr. Susan Turney, executive vice president and CEO of the Wisconsin Medical Society.

Last summer, the Wisconsin Supreme Court struck down the state's $445,775 cap on noneconomic damages as unconstitutional because it was set “unreasonably low.”

The state legislature acted quickly to pass legislation that enacted a $450,000 cap for adults age 18 and older and a $550,000 cap for those under 18.

But Gov. Jim Doyle (D) vetoed the bill last December, saying that legislators had passed virtually the same cap and ignored the concerns of the court.

“Legal experts agree that a court which found a $445,775 cap unconstitutional would most certainly strike down a cap not even $5,000 higher,” Gov. Doyle said in his veto message. “Approving a law that would be quickly overturned doesn't do anyone any good. Instead, I encourage all the interested parties on all sides of this issue to get together and figure out a responsible and lasting solution that has a real chance of being upheld by the Wisconsin Supreme Court.”

An attempt to override the governor's veto failed in January.

Dr. Turney said she and her colleagues at the Wisconsin Medical Society are “concerned that the absence of caps” will hurt the state's “historically stable medical liability environment” and drive physicians out of state.

The Wisconsin Hospital Association reported that since the state Supreme Court struck down the cap last July, hospitals have had “greater difficulty recruiting physicians” and that damage awards and lawsuits have begun to rise.

In addition, officials at the state's Injured Patients and Families Compensation Fund, which is funded through mandatory premiums from hospitals and physicians, have proposed a 25% increase in annual fees. The proposal is under consideration, and if it is approved, would go into effect on July 1.

But Dr. Turney said she is optimistic that the state legislature will pass new legislation addressing the cap issue this spring. “Both Democrats and Republicans clearly want to see this issue resolved,” she said.

As Medicare beneficiaries grapple with the new prescription drug benefit that went into effect on Jan. 1, physicians report that they are spending valuable clinical time explaining the benefit, rewriting prescriptions, and navigating drug company Web sites.

“It's taking up a disproportionate amount of our time,” said Dr. Maurice Wright, medical director and staff internist of the So Others Might Eat Medical Clinic in Washington, a group that provides primary care services to needy patients, including Medicare beneficiaries.

Physicians weren't armed with the necessary information to properly advise patients about the new Medicare Part D benefit, Dr. Wright said.

And even after exploring the Medicare and drug plan Web sites, Dr. Wright said he still has unanswered questions about how to help his low-income Medicare patients apply for the “extra help” subsidy.

That low-income subsidy is especially important for his Medicare patients who do not qualify for Medicaid, he said. And without information about how to enroll, they can't choose a drug plan because they don't know how much it will cost, he said.

Dr. Wright has also noted problems among his patients who are dually eligible for Medicare and Medicaid. These patients were automatically enrolled in a Part D drug plan before the beginning of the year.

But some technical glitches in transmitting that enrollment information from Medicare to the drug plans means that for some patients there is either no record of their enrollment when they show up at the pharmacy or they are asked to pay higher prices.

Dual-eligible beneficiaries are also facing other problems as a result of automatic enrollment, Dr. Wright said.

For example, these patients may be signed up for plans that don't cover their medications. Alhough they can switch plans, figuring out the formulary list for the various plans can be difficult for patients, Dr. Wright said.

As of Jan. 13, the Department of Health and Human Services reported that 14.3 million Medicare beneficiaries have been enrolled in a Part D drug plan. The bulk of those enrolled—6.2 million—are beneficiaries who are dually eligible for Medicare and Medicaid and were assigned to Part D plans.

In addition, 4.5 million have enrolled in Medicare Advantage plans, which include drug coverage, and 3.6 million have signed up for stand-alone drug plans under Medicare.

AARP—which sponsors a prescription drug plan for AARP members—reports that overall the benefit implementation is going well. George Keleman, campaign manager for the AARP Medicare Rx Outreach Campaign, said the problems reported relate to communication systems between Medicare, the drug plans, and the pharmacies that have mainly affected dual-eligible beneficiaries.

Dr. Donna E. Sweet, an internist in Wichita, Kan., and chair of the board of regents for the American College of Physicians, has seen those problems firsthand in her practice. The biggest problem has been among her dual-eligible patients with AIDS who are on a three- or four-drug regimen that must be taken to keep from developing resistance. “They are leaving the pharmacy without medications,” she said.

The problem isn't that the drugs aren't covered by the participating drug plans but that the patient is either not in the system or is listed incorrectly and thus asked to pay a high copay or deductible.

Among her other patients, she's noticed that the very elderly—those aged 90 years and older—are opting out of the process entirely. For those patients who have selected a Medicare drug plan, Dr. Sweet has spent a lot of time reviewing medications and figuring out which ones can be switched to better correspond with the patient's formulary list. “It's a tremendous amount of staff and physician time,” she said.

But Dr. Sweet said that in the long run, the program will likely be an asset for most seniors.

Physicians can also expect to see a spike in the number of requests they receive for prior authorizations as a result of the Part D benefit, said Dr. Yul D. Ejnes, an internist in Cranston, R.I., and chair elect of the ACP board of governors.

Although most of the drugs requiring prior authorization are approved, Dr. Ejnes noted that prior authorization is being required by many plans for standard medications such as statin drugs or proton pump inhibitors.

He advised physicians to have patience and to make their patients aware that the plan they have selected requires this level of administrative hassle.

Many of his Medicare patients have also been receiving letters from their drug plan saying that the medication they have been prescribed is limited to a certain number of doses per month.

In most cases the quantity limits have no impact, he said, but it has caused confusion among patients and he has spent a lot of time explaining it.

States to Recoup Emergency Drug $

The federal government and private drug plan sponsors will reimburse states that have provided drug coverage to Medicare beneficiaries since the Medicare Part D prescription drug benefit went into effect on Jan. 1.

Twenty-five states and the District of Columbia have been paying for prescription drugs on an emergency basis for beneficiaries who are dually eligible for Medicare and Medicaid but have had difficulty getting their medications.

Starting on Jan. 1, people who were eligible for both Medicare and Medicaid had their drug coverage transferred from the states to a Medicare prescription drug plan.

At the end of January, officials at the Centers for Medicare and Medicaid Services announced that they would begin a demonstration project that will allow them to ensure that states are fully reimbursed for their costs from the first date that the state paid claims until Feb. 15.

The states will be reimbursed by the prescription drug plan sponsors for contracted costs, and Medicare will pay any remaining drug costs. CMS will reimburse states for their administrative costs.

The move came just days after a group of senators introduced legislation—the Medicare State Reimbursement Act (S. 2181)—that would require the federal government to reimburse states for all of their costs plus interest.

Sen. Frank R. Lautenberg (D-N.J.), the chief sponsor of the legislation, said the CMS plan does not change the need for legislation.

“This is no solution,” he said in a statement. “It is simply more red tape from the Bush Administration.”

Sen. Lautenberg said the CMS plan will put a greater burden on the states by forcing them to act as bill collectors.

As Medicare beneficiaries grapple with the new prescription drug benefit that went into effect on Jan. 1, physicians report that they are spending valuable clinical time explaining the benefit, rewriting prescriptions, and navigating drug company Web sites.

“It's taking up a disproportionate amount of our time,” said Dr. Maurice Wright, medical director and staff internist of the So Others Might Eat Medical Clinic in Washington, a group that provides primary care services to needy patients, including Medicare beneficiaries.

Physicians weren't armed with the necessary information to properly advise patients about the new Medicare Part D benefit, Dr. Wright said.

And even after exploring the Medicare and drug plan Web sites, Dr. Wright said he still has unanswered questions about how to help his low-income Medicare patients apply for the “extra help” subsidy.

That low-income subsidy is especially important for his Medicare patients who do not qualify for Medicaid, he said. And without information about how to enroll, they can't choose a drug plan because they don't know how much it will cost, he said.

Dr. Wright has also noted problems among his patients who are dually eligible for Medicare and Medicaid. These patients were automatically enrolled in a Part D drug plan before the beginning of the year.

But some technical glitches in transmitting that enrollment information from Medicare to the drug plans means that for some patients there is either no record of their enrollment when they show up at the pharmacy or they are asked to pay higher prices.

Dual-eligible beneficiaries are also facing other problems as a result of automatic enrollment, Dr. Wright said.

For example, these patients may be signed up for plans that don't cover their medications. Alhough they can switch plans, figuring out the formulary list for the various plans can be difficult for patients, Dr. Wright said.

As of Jan. 13, the Department of Health and Human Services reported that 14.3 million Medicare beneficiaries have been enrolled in a Part D drug plan. The bulk of those enrolled—6.2 million—are beneficiaries who are dually eligible for Medicare and Medicaid and were assigned to Part D plans.

In addition, 4.5 million have enrolled in Medicare Advantage plans, which include drug coverage, and 3.6 million have signed up for stand-alone drug plans under Medicare.

AARP—which sponsors a prescription drug plan for AARP members—reports that overall the benefit implementation is going well. George Keleman, campaign manager for the AARP Medicare Rx Outreach Campaign, said the problems reported relate to communication systems between Medicare, the drug plans, and the pharmacies that have mainly affected dual-eligible beneficiaries.

Dr. Donna E. Sweet, an internist in Wichita, Kan., and chair of the board of regents for the American College of Physicians, has seen those problems firsthand in her practice. The biggest problem has been among her dual-eligible patients with AIDS who are on a three- or four-drug regimen that must be taken to keep from developing resistance. “They are leaving the pharmacy without medications,” she said.

The problem isn't that the drugs aren't covered by the participating drug plans but that the patient is either not in the system or is listed incorrectly and thus asked to pay a high copay or deductible.

Among her other patients, she's noticed that the very elderly—those aged 90 years and older—are opting out of the process entirely. For those patients who have selected a Medicare drug plan, Dr. Sweet has spent a lot of time reviewing medications and figuring out which ones can be switched to better correspond with the patient's formulary list. “It's a tremendous amount of staff and physician time,” she said.

But Dr. Sweet said that in the long run, the program will likely be an asset for most seniors.

Physicians can also expect to see a spike in the number of requests they receive for prior authorizations as a result of the Part D benefit, said Dr. Yul D. Ejnes, an internist in Cranston, R.I., and chair elect of the ACP board of governors.

Although most of the drugs requiring prior authorization are approved, Dr. Ejnes noted that prior authorization is being required by many plans for standard medications such as statin drugs or proton pump inhibitors.

He advised physicians to have patience and to make their patients aware that the plan they have selected requires this level of administrative hassle.

Many of his Medicare patients have also been receiving letters from their drug plan saying that the medication they have been prescribed is limited to a certain number of doses per month.

In most cases the quantity limits have no impact, he said, but it has caused confusion among patients and he has spent a lot of time explaining it.

States to Recoup Emergency Drug $

The federal government and private drug plan sponsors will reimburse states that have provided drug coverage to Medicare beneficiaries since the Medicare Part D prescription drug benefit went into effect on Jan. 1.

Twenty-five states and the District of Columbia have been paying for prescription drugs on an emergency basis for beneficiaries who are dually eligible for Medicare and Medicaid but have had difficulty getting their medications.

Starting on Jan. 1, people who were eligible for both Medicare and Medicaid had their drug coverage transferred from the states to a Medicare prescription drug plan.

At the end of January, officials at the Centers for Medicare and Medicaid Services announced that they would begin a demonstration project that will allow them to ensure that states are fully reimbursed for their costs from the first date that the state paid claims until Feb. 15.

The states will be reimbursed by the prescription drug plan sponsors for contracted costs, and Medicare will pay any remaining drug costs. CMS will reimburse states for their administrative costs.

The move came just days after a group of senators introduced legislation—the Medicare State Reimbursement Act (S. 2181)—that would require the federal government to reimburse states for all of their costs plus interest.

Sen. Frank R. Lautenberg (D-N.J.), the chief sponsor of the legislation, said the CMS plan does not change the need for legislation.

“This is no solution,” he said in a statement. “It is simply more red tape from the Bush Administration.”

Sen. Lautenberg said the CMS plan will put a greater burden on the states by forcing them to act as bill collectors.

As Medicare beneficiaries grapple with the new prescription drug benefit that went into effect on Jan. 1, physicians report that they are spending valuable clinical time explaining the benefit, rewriting prescriptions, and navigating drug company Web sites.

“It's taking up a disproportionate amount of our time,” said Dr. Maurice Wright, medical director and staff internist of the So Others Might Eat Medical Clinic in Washington, a group that provides primary care services to needy patients, including Medicare beneficiaries.

Physicians weren't armed with the necessary information to properly advise patients about the new Medicare Part D benefit, Dr. Wright said.

And even after exploring the Medicare and drug plan Web sites, Dr. Wright said he still has unanswered questions about how to help his low-income Medicare patients apply for the “extra help” subsidy.

That low-income subsidy is especially important for his Medicare patients who do not qualify for Medicaid, he said. And without information about how to enroll, they can't choose a drug plan because they don't know how much it will cost, he said.

Dr. Wright has also noted problems among his patients who are dually eligible for Medicare and Medicaid. These patients were automatically enrolled in a Part D drug plan before the beginning of the year.

But some technical glitches in transmitting that enrollment information from Medicare to the drug plans means that for some patients there is either no record of their enrollment when they show up at the pharmacy or they are asked to pay higher prices.

Dual-eligible beneficiaries are also facing other problems as a result of automatic enrollment, Dr. Wright said.

For example, these patients may be signed up for plans that don't cover their medications. Alhough they can switch plans, figuring out the formulary list for the various plans can be difficult for patients, Dr. Wright said.

As of Jan. 13, the Department of Health and Human Services reported that 14.3 million Medicare beneficiaries have been enrolled in a Part D drug plan. The bulk of those enrolled—6.2 million—are beneficiaries who are dually eligible for Medicare and Medicaid and were assigned to Part D plans.

In addition, 4.5 million have enrolled in Medicare Advantage plans, which include drug coverage, and 3.6 million have signed up for stand-alone drug plans under Medicare.

AARP—which sponsors a prescription drug plan for AARP members—reports that overall the benefit implementation is going well. George Keleman, campaign manager for the AARP Medicare Rx Outreach Campaign, said the problems reported relate to communication systems between Medicare, the drug plans, and the pharmacies that have mainly affected dual-eligible beneficiaries.

Dr. Donna E. Sweet, an internist in Wichita, Kan., and chair of the board of regents for the American College of Physicians, has seen those problems firsthand in her practice. The biggest problem has been among her dual-eligible patients with AIDS who are on a three- or four-drug regimen that must be taken to keep from developing resistance. “They are leaving the pharmacy without medications,” she said.

The problem isn't that the drugs aren't covered by the participating drug plans but that the patient is either not in the system or is listed incorrectly and thus asked to pay a high copay or deductible.

Among her other patients, she's noticed that the very elderly—those aged 90 years and older—are opting out of the process entirely. For those patients who have selected a Medicare drug plan, Dr. Sweet has spent a lot of time reviewing medications and figuring out which ones can be switched to better correspond with the patient's formulary list. “It's a tremendous amount of staff and physician time,” she said.

But Dr. Sweet said that in the long run, the program will likely be an asset for most seniors.

Physicians can also expect to see a spike in the number of requests they receive for prior authorizations as a result of the Part D benefit, said Dr. Yul D. Ejnes, an internist in Cranston, R.I., and chair elect of the ACP board of governors.

Although most of the drugs requiring prior authorization are approved, Dr. Ejnes noted that prior authorization is being required by many plans for standard medications such as statin drugs or proton pump inhibitors.

He advised physicians to have patience and to make their patients aware that the plan they have selected requires this level of administrative hassle.

Many of his Medicare patients have also been receiving letters from their drug plan saying that the medication they have been prescribed is limited to a certain number of doses per month.

In most cases the quantity limits have no impact, he said, but it has caused confusion among patients and he has spent a lot of time explaining it.

States to Recoup Emergency Drug $

The federal government and private drug plan sponsors will reimburse states that have provided drug coverage to Medicare beneficiaries since the Medicare Part D prescription drug benefit went into effect on Jan. 1.

Twenty-five states and the District of Columbia have been paying for prescription drugs on an emergency basis for beneficiaries who are dually eligible for Medicare and Medicaid but have had difficulty getting their medications.

Starting on Jan. 1, people who were eligible for both Medicare and Medicaid had their drug coverage transferred from the states to a Medicare prescription drug plan.

At the end of January, officials at the Centers for Medicare and Medicaid Services announced that they would begin a demonstration project that will allow them to ensure that states are fully reimbursed for their costs from the first date that the state paid claims until Feb. 15.

The states will be reimbursed by the prescription drug plan sponsors for contracted costs, and Medicare will pay any remaining drug costs. CMS will reimburse states for their administrative costs.

The move came just days after a group of senators introduced legislation—the Medicare State Reimbursement Act (S. 2181)—that would require the federal government to reimburse states for all of their costs plus interest.

Sen. Frank R. Lautenberg (D-N.J.), the chief sponsor of the legislation, said the CMS plan does not change the need for legislation.

“This is no solution,” he said in a statement. “It is simply more red tape from the Bush Administration.”

Sen. Lautenberg said the CMS plan will put a greater burden on the states by forcing them to act as bill collectors.

Wrongful Death Lawsuit

Ortho-McNeil Pharmaceuticals Inc. and Johnson & Johnson, makers of the Ortho Evra contraceptive patch, are facing a nearly $150 million lawsuit in the 2003 death of 17-year-old Ashley Lewis. The lawsuit, filed in the 22nd Judicial Circuit Court of Missouri in St.Louis, alleges that the companies failed to adequately warn the public and health care providers about the increased risk of thromboembolitic events with the patch. Ms. Lewis's doctors are also being sued for allegedly failing to advise her to discontinue use of the patch and failing to properly diagnose and treat her when she repeatedly reported symptoms of adverse reactions to the patch. Ortho-McNeil and the Food and Drug Administration recently updated the product's warning section to say that the patch has a higher steady-state concentration and a lower peak concentration than oral contraceptives. The steady-state concentration for ethinyl estradiol is about 60% higher for the patch, according to the new prescribing information. Spokesman Michael J. Beckerich said the companies would not comment on the litigation.

Sexual Assault Treatment Guidelines

The U.S. Department of Justice is once again under fire for its 2004 guidelines for the treatment of sexual assault survivors. Planned Parenthood Federation of America and the American Civil Liberties Union criticized the Justice Department for refusing to release certain records related to the development of the guidelines. Reproductive rights groups had previously slammed the national protocol for failing to address the use of emergency contraceptives for sexual assault victims. A coalition of these groups submitted a request for documents to the Justice Department in an attempt to figure out why emergency contraception was not included in the protocol. Although the Justice Department provided a set of documents used to develop the preliminary protocol, it did not release earlier drafts. Eric Holland, a Justice Department spokesman, said that he would not comment on the document request but said that there was a “victim-centered approach” at the heart of the national protocol and that physicians were encouraged to discuss all appropriate treatment options with patients.

Challenge to Illinois Contraceptive Rule

The Illinois regulation mandating that pharmacies that carry contraceptives must dispense all valid prescriptions for contraceptives, including emergency contraception, is being challenged in court. The American Center for Law and Justice filed a lawsuit in the U.S. District Court for the Central District of Illinois in Springfield, in December saying that the regulation infringes on the rights of pharmacists under the religious liberty provisions of the First Amendment and violates other state laws. The group represents five pharmacists who have been fired or suspended and two others. Illinois Gov. Rod R. Blagojevich (D) issued an emergency regulation last April; it was made permanent in August. The governor plans to vigorously defend the rule and a woman's right to access valid prescription drugs, according to his spokesperson, Abby Ottenhoff. Pharmacies that sell contraceptives have an obligation to fill the prescriptions without lecture and without delay, she said.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644), was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Wrongful Death Lawsuit

Ortho-McNeil Pharmaceuticals Inc. and Johnson & Johnson, makers of the Ortho Evra contraceptive patch, are facing a nearly $150 million lawsuit in the 2003 death of 17-year-old Ashley Lewis. The lawsuit, filed in the 22nd Judicial Circuit Court of Missouri in St.Louis, alleges that the companies failed to adequately warn the public and health care providers about the increased risk of thromboembolitic events with the patch. Ms. Lewis's doctors are also being sued for allegedly failing to advise her to discontinue use of the patch and failing to properly diagnose and treat her when she repeatedly reported symptoms of adverse reactions to the patch. Ortho-McNeil and the Food and Drug Administration recently updated the product's warning section to say that the patch has a higher steady-state concentration and a lower peak concentration than oral contraceptives. The steady-state concentration for ethinyl estradiol is about 60% higher for the patch, according to the new prescribing information. Spokesman Michael J. Beckerich said the companies would not comment on the litigation.

Sexual Assault Treatment Guidelines

The U.S. Department of Justice is once again under fire for its 2004 guidelines for the treatment of sexual assault survivors. Planned Parenthood Federation of America and the American Civil Liberties Union criticized the Justice Department for refusing to release certain records related to the development of the guidelines. Reproductive rights groups had previously slammed the national protocol for failing to address the use of emergency contraceptives for sexual assault victims. A coalition of these groups submitted a request for documents to the Justice Department in an attempt to figure out why emergency contraception was not included in the protocol. Although the Justice Department provided a set of documents used to develop the preliminary protocol, it did not release earlier drafts. Eric Holland, a Justice Department spokesman, said that he would not comment on the document request but said that there was a “victim-centered approach” at the heart of the national protocol and that physicians were encouraged to discuss all appropriate treatment options with patients.

Challenge to Illinois Contraceptive Rule

The Illinois regulation mandating that pharmacies that carry contraceptives must dispense all valid prescriptions for contraceptives, including emergency contraception, is being challenged in court. The American Center for Law and Justice filed a lawsuit in the U.S. District Court for the Central District of Illinois in Springfield, in December saying that the regulation infringes on the rights of pharmacists under the religious liberty provisions of the First Amendment and violates other state laws. The group represents five pharmacists who have been fired or suspended and two others. Illinois Gov. Rod R. Blagojevich (D) issued an emergency regulation last April; it was made permanent in August. The governor plans to vigorously defend the rule and a woman's right to access valid prescription drugs, according to his spokesperson, Abby Ottenhoff. Pharmacies that sell contraceptives have an obligation to fill the prescriptions without lecture and without delay, she said.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644), was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Wrongful Death Lawsuit

Ortho-McNeil Pharmaceuticals Inc. and Johnson & Johnson, makers of the Ortho Evra contraceptive patch, are facing a nearly $150 million lawsuit in the 2003 death of 17-year-old Ashley Lewis. The lawsuit, filed in the 22nd Judicial Circuit Court of Missouri in St.Louis, alleges that the companies failed to adequately warn the public and health care providers about the increased risk of thromboembolitic events with the patch. Ms. Lewis's doctors are also being sued for allegedly failing to advise her to discontinue use of the patch and failing to properly diagnose and treat her when she repeatedly reported symptoms of adverse reactions to the patch. Ortho-McNeil and the Food and Drug Administration recently updated the product's warning section to say that the patch has a higher steady-state concentration and a lower peak concentration than oral contraceptives. The steady-state concentration for ethinyl estradiol is about 60% higher for the patch, according to the new prescribing information. Spokesman Michael J. Beckerich said the companies would not comment on the litigation.

Sexual Assault Treatment Guidelines

The U.S. Department of Justice is once again under fire for its 2004 guidelines for the treatment of sexual assault survivors. Planned Parenthood Federation of America and the American Civil Liberties Union criticized the Justice Department for refusing to release certain records related to the development of the guidelines. Reproductive rights groups had previously slammed the national protocol for failing to address the use of emergency contraceptives for sexual assault victims. A coalition of these groups submitted a request for documents to the Justice Department in an attempt to figure out why emergency contraception was not included in the protocol. Although the Justice Department provided a set of documents used to develop the preliminary protocol, it did not release earlier drafts. Eric Holland, a Justice Department spokesman, said that he would not comment on the document request but said that there was a “victim-centered approach” at the heart of the national protocol and that physicians were encouraged to discuss all appropriate treatment options with patients.

Challenge to Illinois Contraceptive Rule

The Illinois regulation mandating that pharmacies that carry contraceptives must dispense all valid prescriptions for contraceptives, including emergency contraception, is being challenged in court. The American Center for Law and Justice filed a lawsuit in the U.S. District Court for the Central District of Illinois in Springfield, in December saying that the regulation infringes on the rights of pharmacists under the religious liberty provisions of the First Amendment and violates other state laws. The group represents five pharmacists who have been fired or suspended and two others. Illinois Gov. Rod R. Blagojevich (D) issued an emergency regulation last April; it was made permanent in August. The governor plans to vigorously defend the rule and a woman's right to access valid prescription drugs, according to his spokesperson, Abby Ottenhoff. Pharmacies that sell contraceptives have an obligation to fill the prescriptions without lecture and without delay, she said.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644), was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

There was a slight uptick in the number of abortions reported in 2002, according to figures published by the Centers for Disease Control and Prevention.

The number of abortions increased by 637 to 854,122 between 2001 and 2002. But the abortion rate—16 per 1,000 women—has remained constant since 2000. The figures are based on data reported from 47 states, the District of Columbia, and New York City. The analysis does not include information from Alaska, California, and New Hampshire.

The 0.1% increase follows 5 years of decline in the number of abortions from 1997 through 2001, researchers reported in the CDC's Morbidity and Mortality Weekly Report (MMWR Surveillance Summaries 2005;54[SS07]:1–31).

The CDC findings conflict with an analysis released in May 2005 by the Guttmacher Institute that showed that the number of abortions performed in the United States fell from 2001 to 2002. Their analysis showed that the number of abortions had declined from 1.30 million in 2001 to 1.29 million in 2002. The discrepancy may be due to differences in methodology. The Guttmacher Institute analysis used CDC data and figures collected for state health departments to project changes from a 2000 survey of all known abortion providers.

Regardless of the precise figures, there is still a lot of work to be done, said Rachel Jones, senior research associate with the Guttmacher Institute. Women need increased access to contraception and better information about pregnancy prevention, she said.

Most of the abortions (87%) reported to the CDC were performed at less than 13 weeks' gestation. Only 4% of abortions occurred between 16 and 20 weeks, and 1.4% of abortions were reported to have occurred after 21 weeks.

The CDC also reported a jump in the number of medical abortions between 2001 and 2002. Medical abortions accounted for about 5% of all procedures in 2002, with 36,297 medical abortion procedures reported. This is approximately a 77% increase from 2001 in the 31 areas that reported medical abortion information in both years. About 94% of medical abortions were performed at 8 weeks' gestation or earlier.

There was a slight uptick in the number of abortions reported in 2002, according to figures published by the Centers for Disease Control and Prevention.

The number of abortions increased by 637 to 854,122 between 2001 and 2002. But the abortion rate—16 per 1,000 women—has remained constant since 2000. The figures are based on data reported from 47 states, the District of Columbia, and New York City. The analysis does not include information from Alaska, California, and New Hampshire.

The 0.1% increase follows 5 years of decline in the number of abortions from 1997 through 2001, researchers reported in the CDC's Morbidity and Mortality Weekly Report (MMWR Surveillance Summaries 2005;54[SS07]:1–31).

The CDC findings conflict with an analysis released in May 2005 by the Guttmacher Institute that showed that the number of abortions performed in the United States fell from 2001 to 2002. Their analysis showed that the number of abortions had declined from 1.30 million in 2001 to 1.29 million in 2002. The discrepancy may be due to differences in methodology. The Guttmacher Institute analysis used CDC data and figures collected for state health departments to project changes from a 2000 survey of all known abortion providers.

Regardless of the precise figures, there is still a lot of work to be done, said Rachel Jones, senior research associate with the Guttmacher Institute. Women need increased access to contraception and better information about pregnancy prevention, she said.

Most of the abortions (87%) reported to the CDC were performed at less than 13 weeks' gestation. Only 4% of abortions occurred between 16 and 20 weeks, and 1.4% of abortions were reported to have occurred after 21 weeks.

The CDC also reported a jump in the number of medical abortions between 2001 and 2002. Medical abortions accounted for about 5% of all procedures in 2002, with 36,297 medical abortion procedures reported. This is approximately a 77% increase from 2001 in the 31 areas that reported medical abortion information in both years. About 94% of medical abortions were performed at 8 weeks' gestation or earlier.

There was a slight uptick in the number of abortions reported in 2002, according to figures published by the Centers for Disease Control and Prevention.

The number of abortions increased by 637 to 854,122 between 2001 and 2002. But the abortion rate—16 per 1,000 women—has remained constant since 2000. The figures are based on data reported from 47 states, the District of Columbia, and New York City. The analysis does not include information from Alaska, California, and New Hampshire.

The 0.1% increase follows 5 years of decline in the number of abortions from 1997 through 2001, researchers reported in the CDC's Morbidity and Mortality Weekly Report (MMWR Surveillance Summaries 2005;54[SS07]:1–31).

The CDC findings conflict with an analysis released in May 2005 by the Guttmacher Institute that showed that the number of abortions performed in the United States fell from 2001 to 2002. Their analysis showed that the number of abortions had declined from 1.30 million in 2001 to 1.29 million in 2002. The discrepancy may be due to differences in methodology. The Guttmacher Institute analysis used CDC data and figures collected for state health departments to project changes from a 2000 survey of all known abortion providers.

Regardless of the precise figures, there is still a lot of work to be done, said Rachel Jones, senior research associate with the Guttmacher Institute. Women need increased access to contraception and better information about pregnancy prevention, she said.

Most of the abortions (87%) reported to the CDC were performed at less than 13 weeks' gestation. Only 4% of abortions occurred between 16 and 20 weeks, and 1.4% of abortions were reported to have occurred after 21 weeks.

The CDC also reported a jump in the number of medical abortions between 2001 and 2002. Medical abortions accounted for about 5% of all procedures in 2002, with 36,297 medical abortion procedures reported. This is approximately a 77% increase from 2001 in the 31 areas that reported medical abortion information in both years. About 94% of medical abortions were performed at 8 weeks' gestation or earlier.

Physicians and individuals with 9 or more years of education are at an increased risk of developing Parkinson's disease, according to a study by Dr. Roberta Frigerio of the Mayo Clinic in Rochester, Minn., and her colleagues.

Dr. Frigerio conducted the research at Mayo while on leave from the University of Milano-Bicocca, Monza, Italy.

Individuals such as construction and extractive workers, production workers, metal workers, and engineers who have more physically demanding jobs are at a reduced risk for the disease, the researchers found (Neurology 2005; 65:1575–83).

The researchers examined the education levels and occupations of 202 individuals in Olmsted County, Minn., who developed Parkinson's disease from 1976 through 1995.

Each case was matched by age and sex to a general population control who was free of Parkinson's disease and living in the same county. Of those individuals, they were able to obtain medical records for 196 cases and 196 controls. In addition, they obtained data from telephone interviews available for 149 cases and 129 controls.

But the findings should not be a cause for alarm among physicians or those with higher levels of education, said Dr. Demetrius Maraganore, a professor of neurology at the Mayo Clinic and one of the study authors, in an interview.

The number of physicians in the study was small and therefore the effect size is unstable.

“Parkinson's disease is a thousand-piece puzzle,” Dr. Maraganore said.

More research is needed to figure out what these findings mean. For example, the findings could mean that being a physician is an indirect marker for other environmental factors.

Or it could be that being a physician or having more education are not risk factors at all, he said.

Instead, additional years of schooling and becoming a physician could be early manifestations of the disease, which affects personality and behavior.

A deficiency of dopamine could shape personality in a way that makes a person more inclined to sit at a desk and study, he said.

Physicians and individuals with 9 or more years of education are at an increased risk of developing Parkinson's disease, according to a study by Dr. Roberta Frigerio of the Mayo Clinic in Rochester, Minn., and her colleagues.

Dr. Frigerio conducted the research at Mayo while on leave from the University of Milano-Bicocca, Monza, Italy.

Individuals such as construction and extractive workers, production workers, metal workers, and engineers who have more physically demanding jobs are at a reduced risk for the disease, the researchers found (Neurology 2005; 65:1575–83).

The researchers examined the education levels and occupations of 202 individuals in Olmsted County, Minn., who developed Parkinson's disease from 1976 through 1995.

Each case was matched by age and sex to a general population control who was free of Parkinson's disease and living in the same county. Of those individuals, they were able to obtain medical records for 196 cases and 196 controls. In addition, they obtained data from telephone interviews available for 149 cases and 129 controls.

But the findings should not be a cause for alarm among physicians or those with higher levels of education, said Dr. Demetrius Maraganore, a professor of neurology at the Mayo Clinic and one of the study authors, in an interview.

The number of physicians in the study was small and therefore the effect size is unstable.

“Parkinson's disease is a thousand-piece puzzle,” Dr. Maraganore said.

More research is needed to figure out what these findings mean. For example, the findings could mean that being a physician is an indirect marker for other environmental factors.

Or it could be that being a physician or having more education are not risk factors at all, he said.

Instead, additional years of schooling and becoming a physician could be early manifestations of the disease, which affects personality and behavior.

A deficiency of dopamine could shape personality in a way that makes a person more inclined to sit at a desk and study, he said.

Physicians and individuals with 9 or more years of education are at an increased risk of developing Parkinson's disease, according to a study by Dr. Roberta Frigerio of the Mayo Clinic in Rochester, Minn., and her colleagues.

Dr. Frigerio conducted the research at Mayo while on leave from the University of Milano-Bicocca, Monza, Italy.

Individuals such as construction and extractive workers, production workers, metal workers, and engineers who have more physically demanding jobs are at a reduced risk for the disease, the researchers found (Neurology 2005; 65:1575–83).

The researchers examined the education levels and occupations of 202 individuals in Olmsted County, Minn., who developed Parkinson's disease from 1976 through 1995.

Each case was matched by age and sex to a general population control who was free of Parkinson's disease and living in the same county. Of those individuals, they were able to obtain medical records for 196 cases and 196 controls. In addition, they obtained data from telephone interviews available for 149 cases and 129 controls.

But the findings should not be a cause for alarm among physicians or those with higher levels of education, said Dr. Demetrius Maraganore, a professor of neurology at the Mayo Clinic and one of the study authors, in an interview.

The number of physicians in the study was small and therefore the effect size is unstable.

“Parkinson's disease is a thousand-piece puzzle,” Dr. Maraganore said.

More research is needed to figure out what these findings mean. For example, the findings could mean that being a physician is an indirect marker for other environmental factors.

Or it could be that being a physician or having more education are not risk factors at all, he said.

Instead, additional years of schooling and becoming a physician could be early manifestations of the disease, which affects personality and behavior.

A deficiency of dopamine could shape personality in a way that makes a person more inclined to sit at a desk and study, he said.

ACR Research Agenda

More research is needed not only to improve treatments for rheumatologic diseases, but also to gain a better understanding of the pathophysiology and disease mechanisms related to rheumatologic conditions, according to the American College of Rheumatology's research agenda. The document, which was developed by the ACR's Committee on Research, calls for research to investigate the regulation of immune and inflammatory pathways and their involvement in disease mechanism as well as identifying mechanisms underlying pain. On the treatment side, ACR pointed out the need to investigate innovative methods of drug delivery, including cell-based methods and gene therapy. The college also called for investigating theory-driven nonpharmacologic interventions to reduce pain and disability and to improve quality of life. But more money and government support are needed to make this possible, according to ACR. The group called for an increase in government and private funding and an increase in the number of early career investigators in all areas of research. The ACR research agenda is available online at

www.rheumatology.org

Psoriasis Advocates

The patient advocacy group Psoriasis Cure Now has honored three members of Congress for increasing funding for psoriasis research. Sen. Arlen Specter (R-Pa.), Rep. Rosa DeLauro (D-Conn.), and Rep. Ralph Regula (R-Ohio) were given the group's 2005 Health Care Advocates of the Year award. “These leaders took up our cause without fanfare and recognized how research on psoriasis will help not just the millions of Americans with the disease, but may also help us better understand other challenging diseases,” Michael Paranzino, president of Psoriasis Cure Now, said in a statement.

Advances in Arthritis

The Food and Drug Administration approval of abatacept, a costimulation modulator, for the treatment of moderate to severe rheumatoid arthritis, is among the top 10 advances of last year according to the Arthritis Foundation. Also topping the list are a recent study showing that febuxostat is effective for treatment of gout; a Medicare demonstration project that allowed nearly 16,000 arthritis patients to gain coverage for self-injectable drugs; research showing that weight loss and exercise can reduce arthritis pain and improve function; and findings from research showing that a once-monthly osteoporosis treatment is effective at increasing bone mineral density.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting late last year. Physicians who elect to participate in the CAP program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the U.S. Department of Health and Human Services should allow an exception to these delivery rules for rural satellite offices of providers.

ACR Research Agenda

More research is needed not only to improve treatments for rheumatologic diseases, but also to gain a better understanding of the pathophysiology and disease mechanisms related to rheumatologic conditions, according to the American College of Rheumatology's research agenda. The document, which was developed by the ACR's Committee on Research, calls for research to investigate the regulation of immune and inflammatory pathways and their involvement in disease mechanism as well as identifying mechanisms underlying pain. On the treatment side, ACR pointed out the need to investigate innovative methods of drug delivery, including cell-based methods and gene therapy. The college also called for investigating theory-driven nonpharmacologic interventions to reduce pain and disability and to improve quality of life. But more money and government support are needed to make this possible, according to ACR. The group called for an increase in government and private funding and an increase in the number of early career investigators in all areas of research. The ACR research agenda is available online at

www.rheumatology.org

Psoriasis Advocates

The patient advocacy group Psoriasis Cure Now has honored three members of Congress for increasing funding for psoriasis research. Sen. Arlen Specter (R-Pa.), Rep. Rosa DeLauro (D-Conn.), and Rep. Ralph Regula (R-Ohio) were given the group's 2005 Health Care Advocates of the Year award. “These leaders took up our cause without fanfare and recognized how research on psoriasis will help not just the millions of Americans with the disease, but may also help us better understand other challenging diseases,” Michael Paranzino, president of Psoriasis Cure Now, said in a statement.

Advances in Arthritis

The Food and Drug Administration approval of abatacept, a costimulation modulator, for the treatment of moderate to severe rheumatoid arthritis, is among the top 10 advances of last year according to the Arthritis Foundation. Also topping the list are a recent study showing that febuxostat is effective for treatment of gout; a Medicare demonstration project that allowed nearly 16,000 arthritis patients to gain coverage for self-injectable drugs; research showing that weight loss and exercise can reduce arthritis pain and improve function; and findings from research showing that a once-monthly osteoporosis treatment is effective at increasing bone mineral density.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting late last year. Physicians who elect to participate in the CAP program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the U.S. Department of Health and Human Services should allow an exception to these delivery rules for rural satellite offices of providers.

ACR Research Agenda

More research is needed not only to improve treatments for rheumatologic diseases, but also to gain a better understanding of the pathophysiology and disease mechanisms related to rheumatologic conditions, according to the American College of Rheumatology's research agenda. The document, which was developed by the ACR's Committee on Research, calls for research to investigate the regulation of immune and inflammatory pathways and their involvement in disease mechanism as well as identifying mechanisms underlying pain. On the treatment side, ACR pointed out the need to investigate innovative methods of drug delivery, including cell-based methods and gene therapy. The college also called for investigating theory-driven nonpharmacologic interventions to reduce pain and disability and to improve quality of life. But more money and government support are needed to make this possible, according to ACR. The group called for an increase in government and private funding and an increase in the number of early career investigators in all areas of research. The ACR research agenda is available online at

www.rheumatology.org

Psoriasis Advocates

The patient advocacy group Psoriasis Cure Now has honored three members of Congress for increasing funding for psoriasis research. Sen. Arlen Specter (R-Pa.), Rep. Rosa DeLauro (D-Conn.), and Rep. Ralph Regula (R-Ohio) were given the group's 2005 Health Care Advocates of the Year award. “These leaders took up our cause without fanfare and recognized how research on psoriasis will help not just the millions of Americans with the disease, but may also help us better understand other challenging diseases,” Michael Paranzino, president of Psoriasis Cure Now, said in a statement.

Advances in Arthritis

The Food and Drug Administration approval of abatacept, a costimulation modulator, for the treatment of moderate to severe rheumatoid arthritis, is among the top 10 advances of last year according to the Arthritis Foundation. Also topping the list are a recent study showing that febuxostat is effective for treatment of gout; a Medicare demonstration project that allowed nearly 16,000 arthritis patients to gain coverage for self-injectable drugs; research showing that weight loss and exercise can reduce arthritis pain and improve function; and findings from research showing that a once-monthly osteoporosis treatment is effective at increasing bone mineral density.

Rural Access to Part B Drugs

Access problems may prevent rural providers from participating in the new Competitive Acquisition Program (CAP) for Part B drugs and biologicals, Joan Sokolovsky, a senior analyst with the Medicare Payment Advisory Commission (MedPAC), said at a commission meeting late last year. Physicians who elect to participate in the CAP program will obtain drugs from a preselected list of vendors, who in turn will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. Under CAP rules, drugs must be delivered to the facility where they will be administered. Chemotherapy in rural areas, however, is delivered through satellite facilities, where “sometimes drugs cannot be mixed,” Ms. Sokolovsky said. In a recommendation, MedPAC said that the U.S. Department of Health and Human Services should allow an exception to these delivery rules for rural satellite offices of providers.

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department, said at a meeting of the American Health Information Community.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting. The American Health Information Community is an advisory committee to the Health and Human Services department. “There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Biosurveillance activities are underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program which is aimed at supporting the connection of clinical care to public health and supporting “situational awareness” at the national level. A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems. In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise.

Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But there are major needs that must be addressed to reach the goal of a nationwide system, Dr. John Loonsk of the federal Office of the National Coordinator for Health Information Technology said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality must be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said.

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department, said at a meeting of the American Health Information Community.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting. The American Health Information Community is an advisory committee to the Health and Human Services department. “There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Biosurveillance activities are underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program which is aimed at supporting the connection of clinical care to public health and supporting “situational awareness” at the national level. A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems. In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise.

Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But there are major needs that must be addressed to reach the goal of a nationwide system, Dr. John Loonsk of the federal Office of the National Coordinator for Health Information Technology said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality must be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said.

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department, said at a meeting of the American Health Information Community.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting. The American Health Information Community is an advisory committee to the Health and Human Services department. “There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Biosurveillance activities are underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program which is aimed at supporting the connection of clinical care to public health and supporting “situational awareness” at the national level. A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems. In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise.

Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But there are major needs that must be addressed to reach the goal of a nationwide system, Dr. John Loonsk of the federal Office of the National Coordinator for Health Information Technology said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality must be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said.

Top Research Advances

Using a heart attack patient's own bone marrow to repair their heart was among the Top 10 research advances in heart disease and stroke last year, according to the American Health Association. This process, known as cell recycling, showed improvement in the heart's ability to pump, compared with placebo, in a randomized controlled trial. Other highlights of 2005 include promising results in using varenicline to help smokers quit, the American Heart Association's scientific statement on childhood obesity, benefits from treatment with drug-eluting stents compared with bare metal stents, and efforts to highlight disparities in cardiovascular disease. The American Heart Association also highlighted a finding from the Framingham Heart Study that showed a prehypertensive patient is more likely to have a heart attack and heart disease than a person with normal blood pressure.

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), or heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue.

Treatment Awareness

Only about 55% of women over age 35 years said they believe they understand how to treat heart disease, according to a survey sponsored by the Cordis Corp., maker of the CYPHER sirolimus-eluting coronary stent, and the National Women's Health Resource Center. For example, 43% of women surveyed said they did not know if stent placement was a good option for women even after the technology was explained. Hispanic and African American women were more likely than white women to say that they did not know any treatments for heart disease. These findings are in contrast to survey respondents' greater awareness of heart disease prevention: 73% of respondents said that they knew how to prevent heart disease.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to the reults of a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in the period 2000–2001 to 65% in the period 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” commented HSC President Paul B. Ginsburg, Ph.D.

Targeting Health Disparities

The Department of Health and Human Services' National Center on Minority Health and Health Disparities (NCMHD) is awarding more than $56 million in grants to advance the elimination of health disparities among racial and ethic minorities and in medically underserved communities. The grant awards include $12 million that will go to 25 institutions for community-based research programs and $10.7 million that will go to 244 health professionals in the form of loan repayment. The grants will also support research into cancer, cardiovascular diseases, child health improvement, diabetes, HIV/AIDS, and obesity.

Top Research Advances

Using a heart attack patient's own bone marrow to repair their heart was among the Top 10 research advances in heart disease and stroke last year, according to the American Health Association. This process, known as cell recycling, showed improvement in the heart's ability to pump, compared with placebo, in a randomized controlled trial. Other highlights of 2005 include promising results in using varenicline to help smokers quit, the American Heart Association's scientific statement on childhood obesity, benefits from treatment with drug-eluting stents compared with bare metal stents, and efforts to highlight disparities in cardiovascular disease. The American Heart Association also highlighted a finding from the Framingham Heart Study that showed a prehypertensive patient is more likely to have a heart attack and heart disease than a person with normal blood pressure.

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), or heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue.

Treatment Awareness

Only about 55% of women over age 35 years said they believe they understand how to treat heart disease, according to a survey sponsored by the Cordis Corp., maker of the CYPHER sirolimus-eluting coronary stent, and the National Women's Health Resource Center. For example, 43% of women surveyed said they did not know if stent placement was a good option for women even after the technology was explained. Hispanic and African American women were more likely than white women to say that they did not know any treatments for heart disease. These findings are in contrast to survey respondents' greater awareness of heart disease prevention: 73% of respondents said that they knew how to prevent heart disease.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to the reults of a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in the period 2000–2001 to 65% in the period 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” commented HSC President Paul B. Ginsburg, Ph.D.

Targeting Health Disparities

The Department of Health and Human Services' National Center on Minority Health and Health Disparities (NCMHD) is awarding more than $56 million in grants to advance the elimination of health disparities among racial and ethic minorities and in medically underserved communities. The grant awards include $12 million that will go to 25 institutions for community-based research programs and $10.7 million that will go to 244 health professionals in the form of loan repayment. The grants will also support research into cancer, cardiovascular diseases, child health improvement, diabetes, HIV/AIDS, and obesity.

Top Research Advances

Using a heart attack patient's own bone marrow to repair their heart was among the Top 10 research advances in heart disease and stroke last year, according to the American Health Association. This process, known as cell recycling, showed improvement in the heart's ability to pump, compared with placebo, in a randomized controlled trial. Other highlights of 2005 include promising results in using varenicline to help smokers quit, the American Heart Association's scientific statement on childhood obesity, benefits from treatment with drug-eluting stents compared with bare metal stents, and efforts to highlight disparities in cardiovascular disease. The American Heart Association also highlighted a finding from the Framingham Heart Study that showed a prehypertensive patient is more likely to have a heart attack and heart disease than a person with normal blood pressure.

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), or heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue.

Treatment Awareness

Only about 55% of women over age 35 years said they believe they understand how to treat heart disease, according to a survey sponsored by the Cordis Corp., maker of the CYPHER sirolimus-eluting coronary stent, and the National Women's Health Resource Center. For example, 43% of women surveyed said they did not know if stent placement was a good option for women even after the technology was explained. Hispanic and African American women were more likely than white women to say that they did not know any treatments for heart disease. These findings are in contrast to survey respondents' greater awareness of heart disease prevention: 73% of respondents said that they knew how to prevent heart disease.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to the reults of a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in the period 2000–2001 to 65% in the period 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” commented HSC President Paul B. Ginsburg, Ph.D.

Targeting Health Disparities

The Department of Health and Human Services' National Center on Minority Health and Health Disparities (NCMHD) is awarding more than $56 million in grants to advance the elimination of health disparities among racial and ethic minorities and in medically underserved communities. The grant awards include $12 million that will go to 25 institutions for community-based research programs and $10.7 million that will go to 244 health professionals in the form of loan repayment. The grants will also support research into cancer, cardiovascular diseases, child health improvement, diabetes, HIV/AIDS, and obesity.

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

One of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group. Others include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer pre-populated personal health records. “We're not starting with a blank slate.”

Providing medication history electronically to patients is something that could be done quickly, he said. The Markle Foundation helped spearhead efforts to do just that with www.katrinahealth.org

It's helpful that the public already recognizes the value of using this type of information in emergencies, Dr. Lansky said.

Providing electronic access to general demographic data or registration information holds the potential for increasing convenience for patients and improving accuracy when sharing information. But privacy issues would need to be addressed and there is the potential for replicating errors, he said.

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

One of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group. Others include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer pre-populated personal health records. “We're not starting with a blank slate.”

Providing medication history electronically to patients is something that could be done quickly, he said. The Markle Foundation helped spearhead efforts to do just that with www.katrinahealth.org

It's helpful that the public already recognizes the value of using this type of information in emergencies, Dr. Lansky said.

Providing electronic access to general demographic data or registration information holds the potential for increasing convenience for patients and improving accuracy when sharing information. But privacy issues would need to be addressed and there is the potential for replicating errors, he said.

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

One of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group. Others include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer pre-populated personal health records. “We're not starting with a blank slate.”

Providing medication history electronically to patients is something that could be done quickly, he said. The Markle Foundation helped spearhead efforts to do just that with www.katrinahealth.org

It's helpful that the public already recognizes the value of using this type of information in emergencies, Dr. Lansky said.

Providing electronic access to general demographic data or registration information holds the potential for increasing convenience for patients and improving accuracy when sharing information. But privacy issues would need to be addressed and there is the potential for replicating errors, he said.