Mary Ellen Schneider

NASHVILLE, TENN. — The Medicaid program needs to undergo some fundamental changes, including asking patients to share some of the costs, Tennessee Gov. Phil Bredesen said at the annual conference of the National Academy for State Health Policy.

“We have got to get control of the economics of the program,” he said.

Gov. Bredesen proposed that everyone should pay a little something for everything. “Unless and until there is some economic tension in the program—unless the users make some of the choices for themselves about how scarce resources are going to be used—the system will continue to be inefficient,” he said.

The Medicaid Commission, which is charged with recommending ways to cut costs in the program, has focused mainly on changes such as negotiating better prices with drug companies and cracking down on asset transfers by Medicaid applicants. However, the commission did tackle beneficiary cost sharing in its recommendation to give states the flexibility to increase copays for some beneficiaries on nonpreferred drugs.

The best way to do that is to let beneficiaries decide what they are willing to pay for and what they aren't, he said. “This is not about being hard-hearted.”

For example, Tennessee has a number of faith-based clinics that serve the uninsured; at these clinics, everyone pays something for their care.

Government purchasers should pay for the most important things first, he said. Not everything that can be categorized as health care is on an equal footing, he added. For example, providing prenatal care is more important than covering antihistamines.

But in Tennessee, the state spends $280 million annually on two classes of drugs—antihistamines and gastric acid reducers. These two classes of drugs account for 12% of the number of prescriptions written in the TennCare program. “We need to exercise some intelligent discretion here and prioritize what we do,” Gov. Bredesen said.

Medicaid should pay only for what works, the governor said. In 2002, the Food and Drug Administration approved 78 new drugs, of which only 7 contained any new active ingredients that were classified as improvements over existing medications.

“If we limit our oversight to a policy of buy everything but just argue about discounts, we've completely lost control,” he said.

NASHVILLE, TENN. — The Medicaid program needs to undergo some fundamental changes, including asking patients to share some of the costs, Tennessee Gov. Phil Bredesen said at the annual conference of the National Academy for State Health Policy.

“We have got to get control of the economics of the program,” he said.

Gov. Bredesen proposed that everyone should pay a little something for everything. “Unless and until there is some economic tension in the program—unless the users make some of the choices for themselves about how scarce resources are going to be used—the system will continue to be inefficient,” he said.

The Medicaid Commission, which is charged with recommending ways to cut costs in the program, has focused mainly on changes such as negotiating better prices with drug companies and cracking down on asset transfers by Medicaid applicants. However, the commission did tackle beneficiary cost sharing in its recommendation to give states the flexibility to increase copays for some beneficiaries on nonpreferred drugs.

The best way to do that is to let beneficiaries decide what they are willing to pay for and what they aren't, he said. “This is not about being hard-hearted.”

For example, Tennessee has a number of faith-based clinics that serve the uninsured; at these clinics, everyone pays something for their care.

Government purchasers should pay for the most important things first, he said. Not everything that can be categorized as health care is on an equal footing, he added. For example, providing prenatal care is more important than covering antihistamines.

But in Tennessee, the state spends $280 million annually on two classes of drugs—antihistamines and gastric acid reducers. These two classes of drugs account for 12% of the number of prescriptions written in the TennCare program. “We need to exercise some intelligent discretion here and prioritize what we do,” Gov. Bredesen said.

Medicaid should pay only for what works, the governor said. In 2002, the Food and Drug Administration approved 78 new drugs, of which only 7 contained any new active ingredients that were classified as improvements over existing medications.

“If we limit our oversight to a policy of buy everything but just argue about discounts, we've completely lost control,” he said.

NASHVILLE, TENN. — The Medicaid program needs to undergo some fundamental changes, including asking patients to share some of the costs, Tennessee Gov. Phil Bredesen said at the annual conference of the National Academy for State Health Policy.

“We have got to get control of the economics of the program,” he said.

Gov. Bredesen proposed that everyone should pay a little something for everything. “Unless and until there is some economic tension in the program—unless the users make some of the choices for themselves about how scarce resources are going to be used—the system will continue to be inefficient,” he said.

The Medicaid Commission, which is charged with recommending ways to cut costs in the program, has focused mainly on changes such as negotiating better prices with drug companies and cracking down on asset transfers by Medicaid applicants. However, the commission did tackle beneficiary cost sharing in its recommendation to give states the flexibility to increase copays for some beneficiaries on nonpreferred drugs.

The best way to do that is to let beneficiaries decide what they are willing to pay for and what they aren't, he said. “This is not about being hard-hearted.”

For example, Tennessee has a number of faith-based clinics that serve the uninsured; at these clinics, everyone pays something for their care.

Government purchasers should pay for the most important things first, he said. Not everything that can be categorized as health care is on an equal footing, he added. For example, providing prenatal care is more important than covering antihistamines.

But in Tennessee, the state spends $280 million annually on two classes of drugs—antihistamines and gastric acid reducers. These two classes of drugs account for 12% of the number of prescriptions written in the TennCare program. “We need to exercise some intelligent discretion here and prioritize what we do,” Gov. Bredesen said.

Medicaid should pay only for what works, the governor said. In 2002, the Food and Drug Administration approved 78 new drugs, of which only 7 contained any new active ingredients that were classified as improvements over existing medications.

“If we limit our oversight to a policy of buy everything but just argue about discounts, we've completely lost control,” he said.

Another FDA Resignation

The Food and Drug Administration's delay in deciding whether to approve Plan B emergency contraception for sale over the counter has cost the agency another expert. Frank Davidoff, M.D., editor emeritus of the Annals of Internal Medicine, resigned his position as a consultant with FDA's Nonprescription Drugs Advisory Committee in September. This comes after Susan F. Wood, Ph.D., the director of the FDA Office of Women's Health, also resigned in protest over agency actions on Plan B. In a letter to FDA, Dr. Davidoff said he was resigning from the committee because of the agency's move to postpone its decision on Plan B. “I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence,” he said in the letter. He added that he plans to encourage other members of FDA advisory committees to resign as well. FDA released a statement thanking Dr. Davidoff for his work on the committee. “His decision to resign as a consultant is an unfortunate loss of expertise as we work toward solving the complex policy and regulatory issues related to Plan B,” the FDA said.

Case Could Head to High Court

The court battle over the “Partial Birth Abortion Act of 2003” may be headed to the Supreme Court. The U.S. solicitor general petitioned the court on Sept. 23 to review the U.S. Court of Appeals ruling that struck down Gonzales v. Carhart, one of three challenges to the law, as unconstitutional. If the court accepts the case, it would likely be decided by next summer, according to the National Right to Life Committee. But abortion rights advocates, who have been successful so far in challenging the law, are opposing this move. In the meantime, there are two other related cases still pending in lower courts.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding said the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Court Upholds Refusal Clause

A provision of the law that withholds federal funds from government agencies that discriminate against providers and insurers for failing to provide abortion services has withstood its first legal challenge. The National Family Planning and Reproductive Health Association (NFPRHA) had filed a suit claiming the law was “unconstitutionally vague” because it didn't define the types of entities governed by it or the types of discrimination it prohibits. The group argued that following the provision would put it at odds with its obligations under Title X to provide abortion referrals upon request. The U.S. District Court judge ruled against NFPRHA and denied its request for a preliminary injunction.

Anticonvulsant Education

The Epilepsy Foundation is telling women of childbearing age who take anticonvulsant medications to talk with their doctors about their treatment options. The group issued a “call to action” in an effort to make women aware of the risks to the fetus from these drugs. Since the risks from these drugs occur early in pregnancy and about half of pregnancies in the United States are unplanned, it leaves women unprepared, according to the Epilepsy Foundation. The call to action “places a sense of urgency for all women of childbearing age to reevaluate their current drug treatment,” Eric Hargis, president of the Epilepsy Foundation, said in a statement. This call to action is part of a larger effort to education women about reducing the risks associated with anticonvulsant drugs, according to the group. More than 56 million prescriptions were written last year for anticonvulsants, making it the fifth most prescribed class of medications, according to the Epilepsy Foundation.

Another FDA Resignation

The Food and Drug Administration's delay in deciding whether to approve Plan B emergency contraception for sale over the counter has cost the agency another expert. Frank Davidoff, M.D., editor emeritus of the Annals of Internal Medicine, resigned his position as a consultant with FDA's Nonprescription Drugs Advisory Committee in September. This comes after Susan F. Wood, Ph.D., the director of the FDA Office of Women's Health, also resigned in protest over agency actions on Plan B. In a letter to FDA, Dr. Davidoff said he was resigning from the committee because of the agency's move to postpone its decision on Plan B. “I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence,” he said in the letter. He added that he plans to encourage other members of FDA advisory committees to resign as well. FDA released a statement thanking Dr. Davidoff for his work on the committee. “His decision to resign as a consultant is an unfortunate loss of expertise as we work toward solving the complex policy and regulatory issues related to Plan B,” the FDA said.

Case Could Head to High Court

The court battle over the “Partial Birth Abortion Act of 2003” may be headed to the Supreme Court. The U.S. solicitor general petitioned the court on Sept. 23 to review the U.S. Court of Appeals ruling that struck down Gonzales v. Carhart, one of three challenges to the law, as unconstitutional. If the court accepts the case, it would likely be decided by next summer, according to the National Right to Life Committee. But abortion rights advocates, who have been successful so far in challenging the law, are opposing this move. In the meantime, there are two other related cases still pending in lower courts.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding said the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Court Upholds Refusal Clause

A provision of the law that withholds federal funds from government agencies that discriminate against providers and insurers for failing to provide abortion services has withstood its first legal challenge. The National Family Planning and Reproductive Health Association (NFPRHA) had filed a suit claiming the law was “unconstitutionally vague” because it didn't define the types of entities governed by it or the types of discrimination it prohibits. The group argued that following the provision would put it at odds with its obligations under Title X to provide abortion referrals upon request. The U.S. District Court judge ruled against NFPRHA and denied its request for a preliminary injunction.

Anticonvulsant Education

The Epilepsy Foundation is telling women of childbearing age who take anticonvulsant medications to talk with their doctors about their treatment options. The group issued a “call to action” in an effort to make women aware of the risks to the fetus from these drugs. Since the risks from these drugs occur early in pregnancy and about half of pregnancies in the United States are unplanned, it leaves women unprepared, according to the Epilepsy Foundation. The call to action “places a sense of urgency for all women of childbearing age to reevaluate their current drug treatment,” Eric Hargis, president of the Epilepsy Foundation, said in a statement. This call to action is part of a larger effort to education women about reducing the risks associated with anticonvulsant drugs, according to the group. More than 56 million prescriptions were written last year for anticonvulsants, making it the fifth most prescribed class of medications, according to the Epilepsy Foundation.

Another FDA Resignation

The Food and Drug Administration's delay in deciding whether to approve Plan B emergency contraception for sale over the counter has cost the agency another expert. Frank Davidoff, M.D., editor emeritus of the Annals of Internal Medicine, resigned his position as a consultant with FDA's Nonprescription Drugs Advisory Committee in September. This comes after Susan F. Wood, Ph.D., the director of the FDA Office of Women's Health, also resigned in protest over agency actions on Plan B. In a letter to FDA, Dr. Davidoff said he was resigning from the committee because of the agency's move to postpone its decision on Plan B. “I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence,” he said in the letter. He added that he plans to encourage other members of FDA advisory committees to resign as well. FDA released a statement thanking Dr. Davidoff for his work on the committee. “His decision to resign as a consultant is an unfortunate loss of expertise as we work toward solving the complex policy and regulatory issues related to Plan B,” the FDA said.

Case Could Head to High Court

The court battle over the “Partial Birth Abortion Act of 2003” may be headed to the Supreme Court. The U.S. solicitor general petitioned the court on Sept. 23 to review the U.S. Court of Appeals ruling that struck down Gonzales v. Carhart, one of three challenges to the law, as unconstitutional. If the court accepts the case, it would likely be decided by next summer, according to the National Right to Life Committee. But abortion rights advocates, who have been successful so far in challenging the law, are opposing this move. In the meantime, there are two other related cases still pending in lower courts.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding said the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Court Upholds Refusal Clause

A provision of the law that withholds federal funds from government agencies that discriminate against providers and insurers for failing to provide abortion services has withstood its first legal challenge. The National Family Planning and Reproductive Health Association (NFPRHA) had filed a suit claiming the law was “unconstitutionally vague” because it didn't define the types of entities governed by it or the types of discrimination it prohibits. The group argued that following the provision would put it at odds with its obligations under Title X to provide abortion referrals upon request. The U.S. District Court judge ruled against NFPRHA and denied its request for a preliminary injunction.

Anticonvulsant Education

The Epilepsy Foundation is telling women of childbearing age who take anticonvulsant medications to talk with their doctors about their treatment options. The group issued a “call to action” in an effort to make women aware of the risks to the fetus from these drugs. Since the risks from these drugs occur early in pregnancy and about half of pregnancies in the United States are unplanned, it leaves women unprepared, according to the Epilepsy Foundation. The call to action “places a sense of urgency for all women of childbearing age to reevaluate their current drug treatment,” Eric Hargis, president of the Epilepsy Foundation, said in a statement. This call to action is part of a larger effort to education women about reducing the risks associated with anticonvulsant drugs, according to the group. More than 56 million prescriptions were written last year for anticonvulsants, making it the fifth most prescribed class of medications, according to the Epilepsy Foundation.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system that is used by the Department of Veterans Affairs (VA). The VA information system is used at 1,300 sites nationwide and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system that is used by the Department of Veterans Affairs (VA). The VA information system is used at 1,300 sites nationwide and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system that is used by the Department of Veterans Affairs (VA). The VA information system is used at 1,300 sites nationwide and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice. “In obesity, there's a lot of work the patients needs to do when they leave the office,” he said.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

While most carriers won't pay for interventions associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes (99212–99215) or, if the patient was referred by another provider, the physician can use the consultation codes (99241–99245). When spending extra time with a patient, physicians should use the prolonged face-to-face codes (99354–99355). The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically if physicians code accurately, they will get paid fairly, Dr. Calabrese said. And there is some movement on this issue as some insurers begin to provide payment for the obesity code, she said. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice. “In obesity, there's a lot of work the patients needs to do when they leave the office,” he said.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

While most carriers won't pay for interventions associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes (99212–99215) or, if the patient was referred by another provider, the physician can use the consultation codes (99241–99245). When spending extra time with a patient, physicians should use the prolonged face-to-face codes (99354–99355). The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically if physicians code accurately, they will get paid fairly, Dr. Calabrese said. And there is some movement on this issue as some insurers begin to provide payment for the obesity code, she said. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice. “In obesity, there's a lot of work the patients needs to do when they leave the office,” he said.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

While most carriers won't pay for interventions associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes (99212–99215) or, if the patient was referred by another provider, the physician can use the consultation codes (99241–99245). When spending extra time with a patient, physicians should use the prolonged face-to-face codes (99354–99355). The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically if physicians code accurately, they will get paid fairly, Dr. Calabrese said. And there is some movement on this issue as some insurers begin to provide payment for the obesity code, she said. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of one to seven users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

Government-sponsored pay-for-performance programs will spur adoption of EHRs, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

“All the signs are pointing the right way,” Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of one to seven users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

Government-sponsored pay-for-performance programs will spur adoption of EHRs, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

“All the signs are pointing the right way,” Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

“The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process,” CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of one to seven users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

“It's good for physicians to have more choices,” said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said.

“A beta test definitely stresses the office,” he said.

The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

Government-sponsored pay-for-performance programs will spur adoption of EHRs, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

“All the signs are pointing the right way,” Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

NASHVILLE, TENN. — States' policy makers are looking for innovative approaches to expand access to health insurance.

“There seems to be renewed interest in trying to build on [employer-sponsored insurance],” Sharon Silow-Carroll, senior vice president of the Economic and Social Research Institute in Teaneck, N.J., said at the annual conference of the National Academy for State Health Policy.

Trends that have combined to spur action in this area include the decline in employer-sponsored insurance, the financial strains on state Medicaid programs, and the rising cost of health care.

States have responded with a number of different approaches:

▸ Limited benefit plans. Some states are allowing the sale of lower-cost, limited benefit plans and other options such as health savings accounts coupled with high-deductible plans.

▸ Premium assistance. Other states are offering premium assistance through Medicaid, State Children's Health Insurance Program (SCHIP), and other public programs. For example, Rhode Island offers subsidies and wrap-around benefits to those eligible for Medicaid and other state health programs. For those individuals who earn 150% of the federal poverty level or less, the state pays the employee's share of the employer-sponsored premium.

▸ Reinsurance. There has also been a lot of interest in reinsurance through indirect subsidies to employers and workers, Ms. Silow-Carroll said. New York pays 90% of claims between $5,000 and $75,000 for eligible individuals.

▸ State-negotiated health plans. States are also using their purchasing power with or without additional subsidies to provide more affordable health insurance options.

▸ Employer mandates. State policy makers can also try to increase employer-sponsored coverage with mandates that require employers to cover workers or pay a fee to the state to arrange coverage. Such a proposal was recently defeated in California.

Such “pay-or-play” proposals “reemerge every few years in the states,” Ms. Silow-Carroll said. “If a state is very serious about boosting [employer sponsored insurance] in a big way, a pay-or-play type approach really should be on the table as one of the options considered.”

All of these strategies can stand alone but should be part of a comprehensive approach that deals with cost containment, cost issues, and quality issues, and various aspects of different uninsured populations, she said.

Strategies that build on employer-sponsored insurance have advantages for states, Ms. Silow-Carroll said, because they offer a way to expand access to coverage without the state bearing the full cost. For example, the Rhode Island premium assistance program allows the state to cover a family for half the cost under its traditional assistance programs like Medicaid.

But a key limitation, she said, is that under voluntary strategies there has historically been fairly low employer participation—especially among employers who have never offered coverage in the past.

NASHVILLE, TENN. — States' policy makers are looking for innovative approaches to expand access to health insurance.

“There seems to be renewed interest in trying to build on [employer-sponsored insurance],” Sharon Silow-Carroll, senior vice president of the Economic and Social Research Institute in Teaneck, N.J., said at the annual conference of the National Academy for State Health Policy.

Trends that have combined to spur action in this area include the decline in employer-sponsored insurance, the financial strains on state Medicaid programs, and the rising cost of health care.

States have responded with a number of different approaches:

▸ Limited benefit plans. Some states are allowing the sale of lower-cost, limited benefit plans and other options such as health savings accounts coupled with high-deductible plans.

▸ Premium assistance. Other states are offering premium assistance through Medicaid, State Children's Health Insurance Program (SCHIP), and other public programs. For example, Rhode Island offers subsidies and wrap-around benefits to those eligible for Medicaid and other state health programs. For those individuals who earn 150% of the federal poverty level or less, the state pays the employee's share of the employer-sponsored premium.

▸ Reinsurance. There has also been a lot of interest in reinsurance through indirect subsidies to employers and workers, Ms. Silow-Carroll said. New York pays 90% of claims between $5,000 and $75,000 for eligible individuals.

▸ State-negotiated health plans. States are also using their purchasing power with or without additional subsidies to provide more affordable health insurance options.

▸ Employer mandates. State policy makers can also try to increase employer-sponsored coverage with mandates that require employers to cover workers or pay a fee to the state to arrange coverage. Such a proposal was recently defeated in California.

Such “pay-or-play” proposals “reemerge every few years in the states,” Ms. Silow-Carroll said. “If a state is very serious about boosting [employer sponsored insurance] in a big way, a pay-or-play type approach really should be on the table as one of the options considered.”

All of these strategies can stand alone but should be part of a comprehensive approach that deals with cost containment, cost issues, and quality issues, and various aspects of different uninsured populations, she said.

Strategies that build on employer-sponsored insurance have advantages for states, Ms. Silow-Carroll said, because they offer a way to expand access to coverage without the state bearing the full cost. For example, the Rhode Island premium assistance program allows the state to cover a family for half the cost under its traditional assistance programs like Medicaid.

But a key limitation, she said, is that under voluntary strategies there has historically been fairly low employer participation—especially among employers who have never offered coverage in the past.

NASHVILLE, TENN. — States' policy makers are looking for innovative approaches to expand access to health insurance.

“There seems to be renewed interest in trying to build on [employer-sponsored insurance],” Sharon Silow-Carroll, senior vice president of the Economic and Social Research Institute in Teaneck, N.J., said at the annual conference of the National Academy for State Health Policy.

Trends that have combined to spur action in this area include the decline in employer-sponsored insurance, the financial strains on state Medicaid programs, and the rising cost of health care.

States have responded with a number of different approaches:

▸ Limited benefit plans. Some states are allowing the sale of lower-cost, limited benefit plans and other options such as health savings accounts coupled with high-deductible plans.

▸ Premium assistance. Other states are offering premium assistance through Medicaid, State Children's Health Insurance Program (SCHIP), and other public programs. For example, Rhode Island offers subsidies and wrap-around benefits to those eligible for Medicaid and other state health programs. For those individuals who earn 150% of the federal poverty level or less, the state pays the employee's share of the employer-sponsored premium.

▸ Reinsurance. There has also been a lot of interest in reinsurance through indirect subsidies to employers and workers, Ms. Silow-Carroll said. New York pays 90% of claims between $5,000 and $75,000 for eligible individuals.

▸ State-negotiated health plans. States are also using their purchasing power with or without additional subsidies to provide more affordable health insurance options.

▸ Employer mandates. State policy makers can also try to increase employer-sponsored coverage with mandates that require employers to cover workers or pay a fee to the state to arrange coverage. Such a proposal was recently defeated in California.

Such “pay-or-play” proposals “reemerge every few years in the states,” Ms. Silow-Carroll said. “If a state is very serious about boosting [employer sponsored insurance] in a big way, a pay-or-play type approach really should be on the table as one of the options considered.”

All of these strategies can stand alone but should be part of a comprehensive approach that deals with cost containment, cost issues, and quality issues, and various aspects of different uninsured populations, she said.

Strategies that build on employer-sponsored insurance have advantages for states, Ms. Silow-Carroll said, because they offer a way to expand access to coverage without the state bearing the full cost. For example, the Rhode Island premium assistance program allows the state to cover a family for half the cost under its traditional assistance programs like Medicaid.

But a key limitation, she said, is that under voluntary strategies there has historically been fairly low employer participation—especially among employers who have never offered coverage in the past.

Musculoskeletal Education

Medical schools should address the fragmentation of musculoskeletal education by integrating this material throughout the curriculum and explicitly identifying it, according to a report from the Association of American Medical Colleges. Medical school professors should inform their students when they are receiving musculoskeletal medicine instruction “so they begin to recognize and associate the musculoskeletal thread between disciplines,” the report said. “We are delighted with these new recommendations,” Nancy E. Lane, M.D., president of the U.S. Bone and Joint Decade, said in a statement. “With the growing responsibility of musculoskeletal diseases in our aging population, it is mandatory that we incorporate these criteria in the medical school setting.” The AAMC report is available online at

www.aamc.org/meded/msop/msop7.pdf

ACR Protests Pay Cuts

The American College of Rheumatology, the American Medical Association, and more than 100 other groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year, including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

New Lupus Foundation Leader

Marjorie S. Susman has been elected as the new chair of the board of directors for the Lupus Foundation of America. Ms. Susman has been a member of the group's board of directors since 2003 and has served as a member of the development and gala committees. She is also vice chairman of the board of trustees and a member of the executive committee of the Museum of Contemporary Art in Chicago. “I am honored to lead the [Lupus Foundation of America] and look forward to working with the scientific community, business leaders, policy makers, and our chapters around the country to advance our agenda and make a significant difference in the lives of those of us with lupus,” Ms. Susman said in a statement.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank, thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding say the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding, we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004 (up 4.6 points to 66.8%), along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, largely because of shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With a few exceptions, these plans tend not to measure or report on their performance.

von Eschenbach to Head FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time, at the age of 67, to step aside,” he said.

Musculoskeletal Education

Medical schools should address the fragmentation of musculoskeletal education by integrating this material throughout the curriculum and explicitly identifying it, according to a report from the Association of American Medical Colleges. Medical school professors should inform their students when they are receiving musculoskeletal medicine instruction “so they begin to recognize and associate the musculoskeletal thread between disciplines,” the report said. “We are delighted with these new recommendations,” Nancy E. Lane, M.D., president of the U.S. Bone and Joint Decade, said in a statement. “With the growing responsibility of musculoskeletal diseases in our aging population, it is mandatory that we incorporate these criteria in the medical school setting.” The AAMC report is available online at

www.aamc.org/meded/msop/msop7.pdf

ACR Protests Pay Cuts

The American College of Rheumatology, the American Medical Association, and more than 100 other groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year, including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

New Lupus Foundation Leader

Marjorie S. Susman has been elected as the new chair of the board of directors for the Lupus Foundation of America. Ms. Susman has been a member of the group's board of directors since 2003 and has served as a member of the development and gala committees. She is also vice chairman of the board of trustees and a member of the executive committee of the Museum of Contemporary Art in Chicago. “I am honored to lead the [Lupus Foundation of America] and look forward to working with the scientific community, business leaders, policy makers, and our chapters around the country to advance our agenda and make a significant difference in the lives of those of us with lupus,” Ms. Susman said in a statement.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank, thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding say the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding, we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004 (up 4.6 points to 66.8%), along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, largely because of shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With a few exceptions, these plans tend not to measure or report on their performance.

von Eschenbach to Head FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time, at the age of 67, to step aside,” he said.

Musculoskeletal Education

Medical schools should address the fragmentation of musculoskeletal education by integrating this material throughout the curriculum and explicitly identifying it, according to a report from the Association of American Medical Colleges. Medical school professors should inform their students when they are receiving musculoskeletal medicine instruction “so they begin to recognize and associate the musculoskeletal thread between disciplines,” the report said. “We are delighted with these new recommendations,” Nancy E. Lane, M.D., president of the U.S. Bone and Joint Decade, said in a statement. “With the growing responsibility of musculoskeletal diseases in our aging population, it is mandatory that we incorporate these criteria in the medical school setting.” The AAMC report is available online at

www.aamc.org/meded/msop/msop7.pdf

ACR Protests Pay Cuts

The American College of Rheumatology, the American Medical Association, and more than 100 other groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year, including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

New Lupus Foundation Leader

Marjorie S. Susman has been elected as the new chair of the board of directors for the Lupus Foundation of America. Ms. Susman has been a member of the group's board of directors since 2003 and has served as a member of the development and gala committees. She is also vice chairman of the board of trustees and a member of the executive committee of the Museum of Contemporary Art in Chicago. “I am honored to lead the [Lupus Foundation of America] and look forward to working with the scientific community, business leaders, policy makers, and our chapters around the country to advance our agenda and make a significant difference in the lives of those of us with lupus,” Ms. Susman said in a statement.

National Stem Cell Bank

WiCell Research Institute, a nonprofit organization headquartered at the University of Wisconsin, Madison, will be home to a new national stem cell bank, thanks to a $16.1 million grant from the National Institutes of Health. The stem cell bank will consolidate many of the human embryonic stem cell lines eligible for federal funding in one place, reduce the costs that researchers have to pay for the cells, and maintain quality control, according to NIH. “This will optimize and standardize the techniques used for comparing the properties of stem cells, a critical step for both the basic and translational research that is needed for the eventual development of potential therapies,” NIH Director Elias A. Zerhouni, M.D., said in a statement. But critics of the federal policy on stem cell research funding say the move is overdue and doesn't go far enough. “A stem cell bank is only as good as the lines in it. Without federal funding, we will simply not have the resources to develop the number and diversity of lines researchers need,” said Rep. Diana DeGette (D-Colo.), who has cosponsored legislation to expand the number of stem cell lines that will be eligible for federal funding.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004 (up 4.6 points to 66.8%), along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, largely because of shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With a few exceptions, these plans tend not to measure or report on their performance.

von Eschenbach to Head FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time, at the age of 67, to step aside,” he said.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm. At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase adoption of health information technology, said David J. Brailer, M.D., National Coordinator of Health Information Technology for HHS. But the site itself is not intended for long-term use, he said. Regarding patients relocated as a result of hurricane Rita, at press time his office was in discussions with local officials about whether they might want to utilize the site.

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm. At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase adoption of health information technology, said David J. Brailer, M.D., National Coordinator of Health Information Technology for HHS. But the site itself is not intended for long-term use, he said. Regarding patients relocated as a result of hurricane Rita, at press time his office was in discussions with local officials about whether they might want to utilize the site.

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm. At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase adoption of health information technology, said David J. Brailer, M.D., National Coordinator of Health Information Technology for HHS. But the site itself is not intended for long-term use, he said. Regarding patients relocated as a result of hurricane Rita, at press time his office was in discussions with local officials about whether they might want to utilize the site.

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

NASHVILLE — The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the approximately 460,000 or 7% of Massachusetts residents without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care-expenditure account.

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program—called Commonwealth Care—will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option—called Safety Net Care—is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

The Safety Net Care program is designed for individuals who can't afford current insurance products or Commonwealth Care but who don't qualify for Medicaid. Unless subsidized by employers, these individuals would typically be uninsured and receive “free” health care, Ms. Lischko said, at a cost of about $1 billion a year.

This program would feature private insurance with the same benefits as Commonwealth Care, but with lower copays and no deductibles. The monthly premiums would be set according to a sliding scale based on individual income.

For example, a single individual with an income at 300% of federal poverty who earns $28,710 a year would be required to pay a weekly premium of $32.31, and the weekly state subsidy would be $36.92.

Under Gov. Romney's proposal, the Safety Net Care program would be funded with existing resources of about $922 million that are currently used to pay for care for the uninsured.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

NASHVILLE — The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the approximately 460,000 or 7% of Massachusetts residents without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care-expenditure account.

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program—called Commonwealth Care—will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option—called Safety Net Care—is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

The Safety Net Care program is designed for individuals who can't afford current insurance products or Commonwealth Care but who don't qualify for Medicaid. Unless subsidized by employers, these individuals would typically be uninsured and receive “free” health care, Ms. Lischko said, at a cost of about $1 billion a year.

This program would feature private insurance with the same benefits as Commonwealth Care, but with lower copays and no deductibles. The monthly premiums would be set according to a sliding scale based on individual income.

For example, a single individual with an income at 300% of federal poverty who earns $28,710 a year would be required to pay a weekly premium of $32.31, and the weekly state subsidy would be $36.92.

Under Gov. Romney's proposal, the Safety Net Care program would be funded with existing resources of about $922 million that are currently used to pay for care for the uninsured.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

NASHVILLE — The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the approximately 460,000 or 7% of Massachusetts residents without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care-expenditure account.

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program—called Commonwealth Care—will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option—called Safety Net Care—is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

The Safety Net Care program is designed for individuals who can't afford current insurance products or Commonwealth Care but who don't qualify for Medicaid. Unless subsidized by employers, these individuals would typically be uninsured and receive “free” health care, Ms. Lischko said, at a cost of about $1 billion a year.

This program would feature private insurance with the same benefits as Commonwealth Care, but with lower copays and no deductibles. The monthly premiums would be set according to a sliding scale based on individual income.

For example, a single individual with an income at 300% of federal poverty who earns $28,710 a year would be required to pay a weekly premium of $32.31, and the weekly state subsidy would be $36.92.

Under Gov. Romney's proposal, the Safety Net Care program would be funded with existing resources of about $922 million that are currently used to pay for care for the uninsured.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

Helping Hand to Physicians

The American Medical Association Foundation is offering grants to help physicians affected by Hurricane Katrina and Rita rebuild their medical practices. The Foundation has set up the Health Care Recovery Fund, which will award grants in this and future natural and man-made disasters. Physicians are eligible for the grants if their practices were damaged or destroyed in areas declared disaster zones by the Federal Emergency Management Agency. Physicians do not need to be AMA members to receive the grants. The AMA has given $100,000 as seed money for the fund, and the AMA Foundation will accept donations by mail to the fund. Applications are available at

www.ama-assn.org

Protesting Pay Cuts

The American College of Cardiology, the Heart Rhythm Society, and more than 100 other medical specialty groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 22% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 5 points, to 67%) along with cholesterol control for people with diabetes (up 4 points, to 65%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply, and these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'Show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the last 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said.

Chronic Disease Epidemic

The World Health Organization is calling on both the public and private sectors throughout the world to help stem the trend of chronic disease deaths. In a new report, WHO outlines a global goal of reducing deaths from chronic disease by 2% each year until 2015. This would prevent 36 million deaths in the next 10 years, nearly half in people younger than 70, according to WHO. Some inexpensive and cost-effective solutions to tackle preventable risk factors include salt reduction in processed foods, improved school meals, and taxation of tobacco products, according to the WHO report. “This is a very serious situation, both for public health and for the societies and economies affected, and the toll is projected to increase,” WHO Director-General Lee Jong-wook, M.D., said in a statement. “The cost of inaction is clear and unacceptable. It is vital that countries review and implement the health actions we know will reduce premature death from chronic diseases.”

Helping Hand to Physicians

The American Medical Association Foundation is offering grants to help physicians affected by Hurricane Katrina and Rita rebuild their medical practices. The Foundation has set up the Health Care Recovery Fund, which will award grants in this and future natural and man-made disasters. Physicians are eligible for the grants if their practices were damaged or destroyed in areas declared disaster zones by the Federal Emergency Management Agency. Physicians do not need to be AMA members to receive the grants. The AMA has given $100,000 as seed money for the fund, and the AMA Foundation will accept donations by mail to the fund. Applications are available at

www.ama-assn.org

Protesting Pay Cuts

The American College of Cardiology, the Heart Rhythm Society, and more than 100 other medical specialty groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 22% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 5 points, to 67%) along with cholesterol control for people with diabetes (up 4 points, to 65%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply, and these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'Show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the last 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said.

Chronic Disease Epidemic

The World Health Organization is calling on both the public and private sectors throughout the world to help stem the trend of chronic disease deaths. In a new report, WHO outlines a global goal of reducing deaths from chronic disease by 2% each year until 2015. This would prevent 36 million deaths in the next 10 years, nearly half in people younger than 70, according to WHO. Some inexpensive and cost-effective solutions to tackle preventable risk factors include salt reduction in processed foods, improved school meals, and taxation of tobacco products, according to the WHO report. “This is a very serious situation, both for public health and for the societies and economies affected, and the toll is projected to increase,” WHO Director-General Lee Jong-wook, M.D., said in a statement. “The cost of inaction is clear and unacceptable. It is vital that countries review and implement the health actions we know will reduce premature death from chronic diseases.”

Helping Hand to Physicians

The American Medical Association Foundation is offering grants to help physicians affected by Hurricane Katrina and Rita rebuild their medical practices. The Foundation has set up the Health Care Recovery Fund, which will award grants in this and future natural and man-made disasters. Physicians are eligible for the grants if their practices were damaged or destroyed in areas declared disaster zones by the Federal Emergency Management Agency. Physicians do not need to be AMA members to receive the grants. The AMA has given $100,000 as seed money for the fund, and the AMA Foundation will accept donations by mail to the fund. Applications are available at

www.ama-assn.org

Protesting Pay Cuts

The American College of Cardiology, the Heart Rhythm Society, and more than 100 other medical specialty groups are urging Congress to step in to stop expected cuts in the Medicare physician payments for 2006. Physicians will face a 4.4% pay cut on Jan. 1, 2006, unless Congress acts to impose a fix. In a letter to congressional leaders, the group pointed out that other health care providers and institutions will get pay increases next year including home health providers (2.5% increase), hospitals (3.7%), and nursing homes (3.1%). “Only physicians are subject to the flawed Sustainable Growth Rate (SGR) formula, which produces negative updates because it is tied to the ups and downs of the national economy, specifically the Gross Domestic Product (GDP)—and not to the health care needs of seniors and disabled patients or the cost of providing care to them,” the groups said in the letter.

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 22% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures, although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 5 points, to 67%) along with cholesterol control for people with diabetes (up 4 points, to 65%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply, and these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'Show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the last 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said.

Chronic Disease Epidemic

The World Health Organization is calling on both the public and private sectors throughout the world to help stem the trend of chronic disease deaths. In a new report, WHO outlines a global goal of reducing deaths from chronic disease by 2% each year until 2015. This would prevent 36 million deaths in the next 10 years, nearly half in people younger than 70, according to WHO. Some inexpensive and cost-effective solutions to tackle preventable risk factors include salt reduction in processed foods, improved school meals, and taxation of tobacco products, according to the WHO report. “This is a very serious situation, both for public health and for the societies and economies affected, and the toll is projected to increase,” WHO Director-General Lee Jong-wook, M.D., said in a statement. “The cost of inaction is clear and unacceptable. It is vital that countries review and implement the health actions we know will reduce premature death from chronic diseases.”