Mary Ellen Schneider

NASHVILLE, TENN. — Integrating mental health and primary care has the potential to reduce medication mistakes and improve communication among providers, experts said at the annual conference of the National Academy for State Health Policy.

“This is a medical error reduction opportunity as well as a quality and cost opportunity,” said Joseph J. Parks Jr., M.D., a psychiatrist and medical director for the Missouri Department of Mental Health.

The status quo isn't working, he said. Individuals with mental illness have increased or early mortality, have high rates of medical comorbidity, and receive inadequate and poorly coordinated health care.

Mental illness also predicts underutilization of medical services. A study of older patients with psychiatric disorders found that individuals with diabetes were less likely to receive more than one medical visit if they also had schizophrenia, bipolar disorder, or posttraumatic stress disorder. Patients with hypertension and any psychiatric disorder were also less likely to have more than one medical visit (Psychiatr. Serv. 2002;53:874–8).

There are several models for integrated mental health and physical care, including embedding primary care in a mental health program, creating a unified primary care/mental health program with common administration and financing, and improving collaboration between mental health and medical providers.

Evidence seems to show that trying to create linkage is difficult, Dr. Parks said. “Collaboration is basically an unnatural act between separate organizations,” he said. While this model is easier to set up initially, it is harder to make successful over the long run.

Models where primary care is embedded in mental health clinics or primary care and mental health programs are unified are harder to set up initially but easier to operate day to day, he said.

In general, the colocation of services is popular with both patients and providers. On the provider side, it allows physicians and other providers to have a more accurate understanding of one another's incentives, methods, and constraints, Dr. Parks said. Colocation also allows physicians to maintain a single clinical record, which requires less time and creates less potential for errors.

For patients, it breaks down some of the barriers to care, said Susan C. Braun, a nurse practitioner and project director of the Center for Integrated Health Care at the University of Illinois at Chicago.

She runs a program that brings primary care services into an established psychiatric rehabilitation program. That setup allows mentally ill patients to access medical services without going to a large medical center. Instead, they are cared for in a familiar setting, she said.

Providers at Cherokee Health Systems Inc. in Talbott, Tenn., have taken the opposite approach. There, a behavioral health consultant is embedded with the primary care team.

For example, a behaviorist is involved in all well-child visits, said Dennis Freeman, Ph.D., chief executive officer of Cherokee Health Systems. Behaviorists also manage the psychosocial aspects of chronic and acute diseases, address lifestyle and health risk issues, and comanage treatment of mental disorders.

Dr. Freeman said that state regulators and policy makers should reject carved out payments for mental health services because the majority of these services will continue to be delivered by primary care physicians. And he encouraged more payers to implement the Health and Behavior Assessment/Intervention CPT codes 96150 through 96155 that were issued in 2002. The codes are for use by nonphysicians for services involving the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems.

Contractual requirements and financial incentives through state Medicaid programs will also help encourage integration of services, Dr. Parks said.

“People will start doing things because it's the right thing to do, but people don't always keep doing things once the excitement dies down,” he said.

NASHVILLE, TENN. — Integrating mental health and primary care has the potential to reduce medication mistakes and improve communication among providers, experts said at the annual conference of the National Academy for State Health Policy.

“This is a medical error reduction opportunity as well as a quality and cost opportunity,” said Joseph J. Parks Jr., M.D., a psychiatrist and medical director for the Missouri Department of Mental Health.

The status quo isn't working, he said. Individuals with mental illness have increased or early mortality, have high rates of medical comorbidity, and receive inadequate and poorly coordinated health care.

Mental illness also predicts underutilization of medical services. A study of older patients with psychiatric disorders found that individuals with diabetes were less likely to receive more than one medical visit if they also had schizophrenia, bipolar disorder, or posttraumatic stress disorder. Patients with hypertension and any psychiatric disorder were also less likely to have more than one medical visit (Psychiatr. Serv. 2002;53:874–8).

There are several models for integrated mental health and physical care, including embedding primary care in a mental health program, creating a unified primary care/mental health program with common administration and financing, and improving collaboration between mental health and medical providers.

Evidence seems to show that trying to create linkage is difficult, Dr. Parks said. “Collaboration is basically an unnatural act between separate organizations,” he said. While this model is easier to set up initially, it is harder to make successful over the long run.

Models where primary care is embedded in mental health clinics or primary care and mental health programs are unified are harder to set up initially but easier to operate day to day, he said.

In general, the colocation of services is popular with both patients and providers. On the provider side, it allows physicians and other providers to have a more accurate understanding of one another's incentives, methods, and constraints, Dr. Parks said. Colocation also allows physicians to maintain a single clinical record, which requires less time and creates less potential for errors.

For patients, it breaks down some of the barriers to care, said Susan C. Braun, a nurse practitioner and project director of the Center for Integrated Health Care at the University of Illinois at Chicago.

She runs a program that brings primary care services into an established psychiatric rehabilitation program. That setup allows mentally ill patients to access medical services without going to a large medical center. Instead, they are cared for in a familiar setting, she said.

Providers at Cherokee Health Systems Inc. in Talbott, Tenn., have taken the opposite approach. There, a behavioral health consultant is embedded with the primary care team.

For example, a behaviorist is involved in all well-child visits, said Dennis Freeman, Ph.D., chief executive officer of Cherokee Health Systems. Behaviorists also manage the psychosocial aspects of chronic and acute diseases, address lifestyle and health risk issues, and comanage treatment of mental disorders.

Dr. Freeman said that state regulators and policy makers should reject carved out payments for mental health services because the majority of these services will continue to be delivered by primary care physicians. And he encouraged more payers to implement the Health and Behavior Assessment/Intervention CPT codes 96150 through 96155 that were issued in 2002. The codes are for use by nonphysicians for services involving the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems.

Contractual requirements and financial incentives through state Medicaid programs will also help encourage integration of services, Dr. Parks said.

“People will start doing things because it's the right thing to do, but people don't always keep doing things once the excitement dies down,” he said.

NASHVILLE, TENN. — Integrating mental health and primary care has the potential to reduce medication mistakes and improve communication among providers, experts said at the annual conference of the National Academy for State Health Policy.

“This is a medical error reduction opportunity as well as a quality and cost opportunity,” said Joseph J. Parks Jr., M.D., a psychiatrist and medical director for the Missouri Department of Mental Health.

The status quo isn't working, he said. Individuals with mental illness have increased or early mortality, have high rates of medical comorbidity, and receive inadequate and poorly coordinated health care.

Mental illness also predicts underutilization of medical services. A study of older patients with psychiatric disorders found that individuals with diabetes were less likely to receive more than one medical visit if they also had schizophrenia, bipolar disorder, or posttraumatic stress disorder. Patients with hypertension and any psychiatric disorder were also less likely to have more than one medical visit (Psychiatr. Serv. 2002;53:874–8).

There are several models for integrated mental health and physical care, including embedding primary care in a mental health program, creating a unified primary care/mental health program with common administration and financing, and improving collaboration between mental health and medical providers.

Evidence seems to show that trying to create linkage is difficult, Dr. Parks said. “Collaboration is basically an unnatural act between separate organizations,” he said. While this model is easier to set up initially, it is harder to make successful over the long run.

Models where primary care is embedded in mental health clinics or primary care and mental health programs are unified are harder to set up initially but easier to operate day to day, he said.

In general, the colocation of services is popular with both patients and providers. On the provider side, it allows physicians and other providers to have a more accurate understanding of one another's incentives, methods, and constraints, Dr. Parks said. Colocation also allows physicians to maintain a single clinical record, which requires less time and creates less potential for errors.

For patients, it breaks down some of the barriers to care, said Susan C. Braun, a nurse practitioner and project director of the Center for Integrated Health Care at the University of Illinois at Chicago.

She runs a program that brings primary care services into an established psychiatric rehabilitation program. That setup allows mentally ill patients to access medical services without going to a large medical center. Instead, they are cared for in a familiar setting, she said.

Providers at Cherokee Health Systems Inc. in Talbott, Tenn., have taken the opposite approach. There, a behavioral health consultant is embedded with the primary care team.

For example, a behaviorist is involved in all well-child visits, said Dennis Freeman, Ph.D., chief executive officer of Cherokee Health Systems. Behaviorists also manage the psychosocial aspects of chronic and acute diseases, address lifestyle and health risk issues, and comanage treatment of mental disorders.

Dr. Freeman said that state regulators and policy makers should reject carved out payments for mental health services because the majority of these services will continue to be delivered by primary care physicians. And he encouraged more payers to implement the Health and Behavior Assessment/Intervention CPT codes 96150 through 96155 that were issued in 2002. The codes are for use by nonphysicians for services involving the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems.

Contractual requirements and financial incentives through state Medicaid programs will also help encourage integration of services, Dr. Parks said.

“People will start doing things because it's the right thing to do, but people don't always keep doing things once the excitement dies down,” he said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to -4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects are when new premiums are imposed, especially on lower-income beneficiaries, Ms. Kenney said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to -4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects are when new premiums are imposed, especially on lower-income beneficiaries, Ms. Kenney said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to -4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects are when new premiums are imposed, especially on lower-income beneficiaries, Ms. Kenney said.

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

“We need to be highly convenient to people,” Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same. Physicians should be sure to look for EHRs that are designed for interoperability with other systems, he said.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

In the past, patients expected physicians to be able to recall all of the information important to their care. But today, the younger generation of patients won't trust information that you give them from the top of your head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. “It is the new platform of communication that really revolutionizes care,” Dr. Scherger said.

This is not standard e-mail, he said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many current EHR systems are now embedding secure messaging in the patient record.

With messaging that's incorporated into the EHR, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and the communication is private, Dr. Scherger said. But he recommends setting up a special secure system.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said physicians also need to create more of a team atmosphere in the care of patients that includes the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

“We need to be highly convenient to people,” Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same. Physicians should be sure to look for EHRs that are designed for interoperability with other systems, he said.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

In the past, patients expected physicians to be able to recall all of the information important to their care. But today, the younger generation of patients won't trust information that you give them from the top of your head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. “It is the new platform of communication that really revolutionizes care,” Dr. Scherger said.

This is not standard e-mail, he said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many current EHR systems are now embedding secure messaging in the patient record.

With messaging that's incorporated into the EHR, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and the communication is private, Dr. Scherger said. But he recommends setting up a special secure system.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said physicians also need to create more of a team atmosphere in the care of patients that includes the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

“We need to be highly convenient to people,” Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same. Physicians should be sure to look for EHRs that are designed for interoperability with other systems, he said.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

In the past, patients expected physicians to be able to recall all of the information important to their care. But today, the younger generation of patients won't trust information that you give them from the top of your head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. “It is the new platform of communication that really revolutionizes care,” Dr. Scherger said.

This is not standard e-mail, he said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many current EHR systems are now embedding secure messaging in the patient record.

With messaging that's incorporated into the EHR, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and the communication is private, Dr. Scherger said. But he recommends setting up a special secure system.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said physicians also need to create more of a team atmosphere in the care of patients that includes the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

Medicare officials are changing the way hospitals get paid to provide cardiac care in an effort to level the playing field between general hospitals and cardiac specialty hospitals.

Proponents of specialty hospitals are welcoming the move, saying it will show that physician owners aren't skimming the cream off the system and are providing efficient care.

However, opponents object that the payment changes, which went into effect on Oct. 1, don't address the apparent underlying conflict of interest when physicians refer to hospitals in which they have an ownership interest.

Officials at the Centers for Medicare and Medicaid Services are replacing 9 current cardiovascular diagnosis-related groups (DRGs) commonly billed by specialty hospitals with 12 new DRGs that the agency says will better recognize the severity of illness of the patient.

The changes affect DRGs for coronary artery bypass graft surgery, permanent pacemaker implantation, percutaneous vascular procedures, and “other” vascular procedures.

In the 2006 Inpatient Prospective Payment System final rule, published in August, CMS said that the changes will address a portion of the “inappropriately higher payments” to specialty hospitals under the current system.

Compared with the current DRGs, the new DRGs have higher average standardized charges for procedures in patients diagnosed with a major cardiovascular condition (MCV), as identified in the ruling, and lower charges for procedures in patients without an MCV diagnosis.

For example, CMS has replaced DRG 107, for coronary bypass with cardiac catheterization, which had average standardized charges of $82,398, with two new DRG codes: New DRG 547 will be used for procedures in patients with an MCV diagnosis carrying a charge of $92,542 (up 12.3%), and new DRG 548 will be used for procedures in patients without an MCV diagnosis, valued at $71,906 (down 12.7%).

The changes to the DRGs are expected to decrease the case-mix index and the resulting payments by an average of 1% among specialty hospitals, according to CMS. On average, the impact of the changes on any particular hospital group will be small. Urban hospitals are expected to see a 0.1% increase and rural hospitals should see a 0.1% decrease, CMS said.

“We believe these new DRGs are an improvement over the existing DRG structure because they better recognize a patient's severity of illness and, accordingly, permit us to make higher payments for more severely ill patients who require more resources while lowering our payments for less severely ill and less resource-intensive patients,” CMS said in its final ruling.

In the meantime, CMS officials are continuing to examine the specialty hospital issue and could propose further changes to the DRG system for fiscal year 2007.

Samuel Wann, M.D., chairman of cardiovascular medicine at the Wisconsin Heart Hospital, said he has no objection to changes that make payments more accurate. “I'm against gaming the system, too,” he said.

Even if payments for some services decrease, Dr. Wann predicts that his hospital will do fine, because it can rely on efficiency and economies of scale.

Regina Herzlinger, a professor at Harvard Business School who has analyzed the issue of specialty hospitals for a number of years, agrees. The more accurate the reimbursement is, the more institutions that provide cost-effective care will thrive, she said.

“My bet is that this will be very good for the specialty hospital.” The changes will weed out the less cost-effective providers, whether they are in general hospitals or specialty hospitals, she said. “They should be competing because they are better and cheaper.”

Richard Coorsh, a spokesman for the Federation of American Hospitals (FAH), also supports the reexamination of DRGs as a way to improve the system overall. But he doesn't see it as addressing the main objection that community hospitals have to physician-owned specialty hospitals—self-referral. FAH has urged CMS to prohibit physician owners of specialty hospitals to self-refer patients.

And FAH is supporting the Hospital Fair Competition Act of 2005 (S. 1002), which was introduced by Sen. Charles Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.). The legislation would, among other things, prohibit certain physician self-referrals to physician-owned specialty hospitals.

Congress imposed a moratorium on physician-investor referrals of Medicare or Medicaid patients to new specialty hospitals, effectively freezing their development. That moratorium expired on June 8, but CMS has established a sort of administrative moratorium by halting processing of Medicare participation applications from specialty hospitals until January 2006.

The Grassley-Baucus legislation is a “step in the right direction,” Mr. Coorsh said.

He said FAH officials are hopeful that it will be acted on before the administrative moratorium expires in January 2006.

Medicare officials are changing the way hospitals get paid to provide cardiac care in an effort to level the playing field between general hospitals and cardiac specialty hospitals.

Proponents of specialty hospitals are welcoming the move, saying it will show that physician owners aren't skimming the cream off the system and are providing efficient care.

However, opponents object that the payment changes, which went into effect on Oct. 1, don't address the apparent underlying conflict of interest when physicians refer to hospitals in which they have an ownership interest.

Officials at the Centers for Medicare and Medicaid Services are replacing 9 current cardiovascular diagnosis-related groups (DRGs) commonly billed by specialty hospitals with 12 new DRGs that the agency says will better recognize the severity of illness of the patient.

The changes affect DRGs for coronary artery bypass graft surgery, permanent pacemaker implantation, percutaneous vascular procedures, and “other” vascular procedures.

In the 2006 Inpatient Prospective Payment System final rule, published in August, CMS said that the changes will address a portion of the “inappropriately higher payments” to specialty hospitals under the current system.

Compared with the current DRGs, the new DRGs have higher average standardized charges for procedures in patients diagnosed with a major cardiovascular condition (MCV), as identified in the ruling, and lower charges for procedures in patients without an MCV diagnosis.

For example, CMS has replaced DRG 107, for coronary bypass with cardiac catheterization, which had average standardized charges of $82,398, with two new DRG codes: New DRG 547 will be used for procedures in patients with an MCV diagnosis carrying a charge of $92,542 (up 12.3%), and new DRG 548 will be used for procedures in patients without an MCV diagnosis, valued at $71,906 (down 12.7%).

The changes to the DRGs are expected to decrease the case-mix index and the resulting payments by an average of 1% among specialty hospitals, according to CMS. On average, the impact of the changes on any particular hospital group will be small. Urban hospitals are expected to see a 0.1% increase and rural hospitals should see a 0.1% decrease, CMS said.

“We believe these new DRGs are an improvement over the existing DRG structure because they better recognize a patient's severity of illness and, accordingly, permit us to make higher payments for more severely ill patients who require more resources while lowering our payments for less severely ill and less resource-intensive patients,” CMS said in its final ruling.

In the meantime, CMS officials are continuing to examine the specialty hospital issue and could propose further changes to the DRG system for fiscal year 2007.

Samuel Wann, M.D., chairman of cardiovascular medicine at the Wisconsin Heart Hospital, said he has no objection to changes that make payments more accurate. “I'm against gaming the system, too,” he said.

Even if payments for some services decrease, Dr. Wann predicts that his hospital will do fine, because it can rely on efficiency and economies of scale.

Regina Herzlinger, a professor at Harvard Business School who has analyzed the issue of specialty hospitals for a number of years, agrees. The more accurate the reimbursement is, the more institutions that provide cost-effective care will thrive, she said.

“My bet is that this will be very good for the specialty hospital.” The changes will weed out the less cost-effective providers, whether they are in general hospitals or specialty hospitals, she said. “They should be competing because they are better and cheaper.”

Richard Coorsh, a spokesman for the Federation of American Hospitals (FAH), also supports the reexamination of DRGs as a way to improve the system overall. But he doesn't see it as addressing the main objection that community hospitals have to physician-owned specialty hospitals—self-referral. FAH has urged CMS to prohibit physician owners of specialty hospitals to self-refer patients.

And FAH is supporting the Hospital Fair Competition Act of 2005 (S. 1002), which was introduced by Sen. Charles Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.). The legislation would, among other things, prohibit certain physician self-referrals to physician-owned specialty hospitals.

Congress imposed a moratorium on physician-investor referrals of Medicare or Medicaid patients to new specialty hospitals, effectively freezing their development. That moratorium expired on June 8, but CMS has established a sort of administrative moratorium by halting processing of Medicare participation applications from specialty hospitals until January 2006.

The Grassley-Baucus legislation is a “step in the right direction,” Mr. Coorsh said.

He said FAH officials are hopeful that it will be acted on before the administrative moratorium expires in January 2006.

Medicare officials are changing the way hospitals get paid to provide cardiac care in an effort to level the playing field between general hospitals and cardiac specialty hospitals.

Proponents of specialty hospitals are welcoming the move, saying it will show that physician owners aren't skimming the cream off the system and are providing efficient care.

However, opponents object that the payment changes, which went into effect on Oct. 1, don't address the apparent underlying conflict of interest when physicians refer to hospitals in which they have an ownership interest.

Officials at the Centers for Medicare and Medicaid Services are replacing 9 current cardiovascular diagnosis-related groups (DRGs) commonly billed by specialty hospitals with 12 new DRGs that the agency says will better recognize the severity of illness of the patient.

The changes affect DRGs for coronary artery bypass graft surgery, permanent pacemaker implantation, percutaneous vascular procedures, and “other” vascular procedures.

In the 2006 Inpatient Prospective Payment System final rule, published in August, CMS said that the changes will address a portion of the “inappropriately higher payments” to specialty hospitals under the current system.

Compared with the current DRGs, the new DRGs have higher average standardized charges for procedures in patients diagnosed with a major cardiovascular condition (MCV), as identified in the ruling, and lower charges for procedures in patients without an MCV diagnosis.

For example, CMS has replaced DRG 107, for coronary bypass with cardiac catheterization, which had average standardized charges of $82,398, with two new DRG codes: New DRG 547 will be used for procedures in patients with an MCV diagnosis carrying a charge of $92,542 (up 12.3%), and new DRG 548 will be used for procedures in patients without an MCV diagnosis, valued at $71,906 (down 12.7%).

The changes to the DRGs are expected to decrease the case-mix index and the resulting payments by an average of 1% among specialty hospitals, according to CMS. On average, the impact of the changes on any particular hospital group will be small. Urban hospitals are expected to see a 0.1% increase and rural hospitals should see a 0.1% decrease, CMS said.

“We believe these new DRGs are an improvement over the existing DRG structure because they better recognize a patient's severity of illness and, accordingly, permit us to make higher payments for more severely ill patients who require more resources while lowering our payments for less severely ill and less resource-intensive patients,” CMS said in its final ruling.

In the meantime, CMS officials are continuing to examine the specialty hospital issue and could propose further changes to the DRG system for fiscal year 2007.

Samuel Wann, M.D., chairman of cardiovascular medicine at the Wisconsin Heart Hospital, said he has no objection to changes that make payments more accurate. “I'm against gaming the system, too,” he said.

Even if payments for some services decrease, Dr. Wann predicts that his hospital will do fine, because it can rely on efficiency and economies of scale.

Regina Herzlinger, a professor at Harvard Business School who has analyzed the issue of specialty hospitals for a number of years, agrees. The more accurate the reimbursement is, the more institutions that provide cost-effective care will thrive, she said.

“My bet is that this will be very good for the specialty hospital.” The changes will weed out the less cost-effective providers, whether they are in general hospitals or specialty hospitals, she said. “They should be competing because they are better and cheaper.”

Richard Coorsh, a spokesman for the Federation of American Hospitals (FAH), also supports the reexamination of DRGs as a way to improve the system overall. But he doesn't see it as addressing the main objection that community hospitals have to physician-owned specialty hospitals—self-referral. FAH has urged CMS to prohibit physician owners of specialty hospitals to self-refer patients.

And FAH is supporting the Hospital Fair Competition Act of 2005 (S. 1002), which was introduced by Sen. Charles Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.). The legislation would, among other things, prohibit certain physician self-referrals to physician-owned specialty hospitals.

Congress imposed a moratorium on physician-investor referrals of Medicare or Medicaid patients to new specialty hospitals, effectively freezing their development. That moratorium expired on June 8, but CMS has established a sort of administrative moratorium by halting processing of Medicare participation applications from specialty hospitals until January 2006.

The Grassley-Baucus legislation is a “step in the right direction,” Mr. Coorsh said.

He said FAH officials are hopeful that it will be acted on before the administrative moratorium expires in January 2006.

The Department of Health and Human Services has loosened restrictions on ownership of pharmaceutical and biotech company stocks by National Institutes of Health employees.

A final rule on conflict of interest, announced at a teleconference, continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation "stringent" despite the changes to stock ownership. "We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff," he said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families must divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may be required to divest of stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed potential conflicts of interest among NIH scientists. Under the earlier plan, about 6,000 top NIH employees would have been required to sell off all stock holdings in companies affected by NIH decisions. The remainder of NIH employees would have faced the $15,000 limit.

The changes aim to target the requirements at employees making decisions on grants and studies, Dr. Zerhouni said.

The final rule will give NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews, subject to prior approval and review by ethics officials.

The regulation continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees also can practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology, or medical device manufacturers, health care providers or insurers, and NIH grantee institutions. Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said.

The changes were praised as being "right on target" by Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a "cooling off period" and served as an opportunity to gather more information, she said. The final regulation will serve as a benchmark for the rest of the research community, Ms. Woolley said.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group, said the changes weakened the agency's earlier attempts to address conflicts of interest. Allowing NIH employees to participate in paid outside academic work, which often includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni advocated a broad dialogue about conflict of interest with the entire scientific community. "This is a debate that is way beyond that of NIH," he said.

For more information on NIH ethics rules visit www.nih.gov/about/ethics_COI.htm

The Department of Health and Human Services has loosened restrictions on ownership of pharmaceutical and biotech company stocks by National Institutes of Health employees.

A final rule on conflict of interest, announced at a teleconference, continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation "stringent" despite the changes to stock ownership. "We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff," he said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families must divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may be required to divest of stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed potential conflicts of interest among NIH scientists. Under the earlier plan, about 6,000 top NIH employees would have been required to sell off all stock holdings in companies affected by NIH decisions. The remainder of NIH employees would have faced the $15,000 limit.

The changes aim to target the requirements at employees making decisions on grants and studies, Dr. Zerhouni said.

The final rule will give NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews, subject to prior approval and review by ethics officials.

The regulation continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees also can practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology, or medical device manufacturers, health care providers or insurers, and NIH grantee institutions. Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said.

The changes were praised as being "right on target" by Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a "cooling off period" and served as an opportunity to gather more information, she said. The final regulation will serve as a benchmark for the rest of the research community, Ms. Woolley said.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group, said the changes weakened the agency's earlier attempts to address conflicts of interest. Allowing NIH employees to participate in paid outside academic work, which often includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni advocated a broad dialogue about conflict of interest with the entire scientific community. "This is a debate that is way beyond that of NIH," he said.

For more information on NIH ethics rules visit www.nih.gov/about/ethics_COI.htm

The Department of Health and Human Services has loosened restrictions on ownership of pharmaceutical and biotech company stocks by National Institutes of Health employees.

A final rule on conflict of interest, announced at a teleconference, continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation "stringent" despite the changes to stock ownership. "We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff," he said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families must divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may be required to divest of stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed potential conflicts of interest among NIH scientists. Under the earlier plan, about 6,000 top NIH employees would have been required to sell off all stock holdings in companies affected by NIH decisions. The remainder of NIH employees would have faced the $15,000 limit.

The changes aim to target the requirements at employees making decisions on grants and studies, Dr. Zerhouni said.

The final rule will give NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews, subject to prior approval and review by ethics officials.

The regulation continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees also can practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology, or medical device manufacturers, health care providers or insurers, and NIH grantee institutions. Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said.

The changes were praised as being "right on target" by Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a "cooling off period" and served as an opportunity to gather more information, she said. The final regulation will serve as a benchmark for the rest of the research community, Ms. Woolley said.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group, said the changes weakened the agency's earlier attempts to address conflicts of interest. Allowing NIH employees to participate in paid outside academic work, which often includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni advocated a broad dialogue about conflict of interest with the entire scientific community. "This is a debate that is way beyond that of NIH," he said.

For more information on NIH ethics rules visit www.nih.gov/about/ethics_COI.htm

Alefacept for Sale

Biogen Idec, which markets alefacept (Amevive), has announced plans to sell its global alefacept business franchise. The company plans to focus instead on other products in the oncology, immunology, and neurology fields. At press time, the company was in discussions with potential buyers. John Palmer, senior vice president of the immunology business unit at Biogen Idec, noted that the pending sale will not impact delivery of the drug. During this interim period, the product supply will remain available through normal distribution channels and the company will continue to provide customer service and medical support, according to a letter from Biogen Idec to doctors who prescribe the drug. In addition, ongoing clinical studies and associated activities will be continued, the letter said. "The dermatology community and psoriasis patients deserve the best support available and we are committed to finding a company that ensures ongoing support and development of Amevive," the letter said. Physicians with questions can call the company at 866-263-8483.

Salary Affects Specialty Choice

When it comes to choosing a specialty, U.S. medical graduates are more concerned with earning power than medical liability costs, according to a study published in the September issue of Obstetrics and Gynecology. Procedure-based and hospital-based specialties, generally associated with higher incomes, are the most likely to have residency positions filled by U.S. medical graduates, the researchers found, even when the specialty had higher professional liability costs. For example, U.S. medical students filled more than 90% of the residency positions in neurosurgery and orthopedic surgery, where liability insurance costs are high, but so are incomes. But the researchers noted that students also may be attracted to high-earning fields because of the technical challenges or the ability to have a more controllable lifestyle. The results are based on data from the 2004 National Resident Matching Program, the American Medical Association, the Medical Group Management Association, and a major Massachusetts liability insurer.

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current $78.20 premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services as the primary reason for the premium increase. "This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services," the agency said in a statement. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see significantly lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays for their entire Part B premium, and about 33% can receive assistance for their Part D premium.

Health IT Standards

The National Committee for Quality Assurance (NCQA) is planning to make changes to its 2-year-old program that recognizes physicians for using clinical information and technology to improve patient care. The Physician Practice Connections (PPC) program was launched in 2004 with nine modules. The new version attempts to streamline those modules into eight standards as part of a single program. The eight elements include patient tracking and registry functions, care management, patient self-management support, electronic prescribing, tracking of laboratory and radiology tests, referral tracking, performance reporting and improvement, and interconnectivity. Currently 80 practices, representing nearly 700 physicians, are recognized under the NCQA program. For more information, visit

www.ncqa.org/ppc

Research Fraud Investigation

Key members of the House Energy and Commerce Committee are calling for an investigation into the alleged misuse of millions of dollars in government research funds at top U.S. universities. Committee chairman Rep. Joe Barton (R-Tex.) and Rep. Ed Whitfield (R-Ky.), chairman of the committee's oversight and investigations subcommittee, have asked the Department of Health and Human Services' Office of Inspector General to audit some of the largest research grants from the National Institutes of Health to compare the number of research activities projected to the NIH and the number actually performed. They cited recent settlements between NIH university grantees and the Department of Justice over allegations that federal grant funds were misused. "The alleged misuse of NIH grant funds raises serious public policy concerns of waste, effectiveness, and integrity of taxpayer-support research programs," the congressmen said in a letter to the inspector general.

Alefacept for Sale

Biogen Idec, which markets alefacept (Amevive), has announced plans to sell its global alefacept business franchise. The company plans to focus instead on other products in the oncology, immunology, and neurology fields. At press time, the company was in discussions with potential buyers. John Palmer, senior vice president of the immunology business unit at Biogen Idec, noted that the pending sale will not impact delivery of the drug. During this interim period, the product supply will remain available through normal distribution channels and the company will continue to provide customer service and medical support, according to a letter from Biogen Idec to doctors who prescribe the drug. In addition, ongoing clinical studies and associated activities will be continued, the letter said. "The dermatology community and psoriasis patients deserve the best support available and we are committed to finding a company that ensures ongoing support and development of Amevive," the letter said. Physicians with questions can call the company at 866-263-8483.

Salary Affects Specialty Choice

When it comes to choosing a specialty, U.S. medical graduates are more concerned with earning power than medical liability costs, according to a study published in the September issue of Obstetrics and Gynecology. Procedure-based and hospital-based specialties, generally associated with higher incomes, are the most likely to have residency positions filled by U.S. medical graduates, the researchers found, even when the specialty had higher professional liability costs. For example, U.S. medical students filled more than 90% of the residency positions in neurosurgery and orthopedic surgery, where liability insurance costs are high, but so are incomes. But the researchers noted that students also may be attracted to high-earning fields because of the technical challenges or the ability to have a more controllable lifestyle. The results are based on data from the 2004 National Resident Matching Program, the American Medical Association, the Medical Group Management Association, and a major Massachusetts liability insurer.

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current $78.20 premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services as the primary reason for the premium increase. "This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services," the agency said in a statement. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see significantly lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays for their entire Part B premium, and about 33% can receive assistance for their Part D premium.

Health IT Standards

The National Committee for Quality Assurance (NCQA) is planning to make changes to its 2-year-old program that recognizes physicians for using clinical information and technology to improve patient care. The Physician Practice Connections (PPC) program was launched in 2004 with nine modules. The new version attempts to streamline those modules into eight standards as part of a single program. The eight elements include patient tracking and registry functions, care management, patient self-management support, electronic prescribing, tracking of laboratory and radiology tests, referral tracking, performance reporting and improvement, and interconnectivity. Currently 80 practices, representing nearly 700 physicians, are recognized under the NCQA program. For more information, visit

www.ncqa.org/ppc

Research Fraud Investigation

Key members of the House Energy and Commerce Committee are calling for an investigation into the alleged misuse of millions of dollars in government research funds at top U.S. universities. Committee chairman Rep. Joe Barton (R-Tex.) and Rep. Ed Whitfield (R-Ky.), chairman of the committee's oversight and investigations subcommittee, have asked the Department of Health and Human Services' Office of Inspector General to audit some of the largest research grants from the National Institutes of Health to compare the number of research activities projected to the NIH and the number actually performed. They cited recent settlements between NIH university grantees and the Department of Justice over allegations that federal grant funds were misused. "The alleged misuse of NIH grant funds raises serious public policy concerns of waste, effectiveness, and integrity of taxpayer-support research programs," the congressmen said in a letter to the inspector general.

Alefacept for Sale

Biogen Idec, which markets alefacept (Amevive), has announced plans to sell its global alefacept business franchise. The company plans to focus instead on other products in the oncology, immunology, and neurology fields. At press time, the company was in discussions with potential buyers. John Palmer, senior vice president of the immunology business unit at Biogen Idec, noted that the pending sale will not impact delivery of the drug. During this interim period, the product supply will remain available through normal distribution channels and the company will continue to provide customer service and medical support, according to a letter from Biogen Idec to doctors who prescribe the drug. In addition, ongoing clinical studies and associated activities will be continued, the letter said. "The dermatology community and psoriasis patients deserve the best support available and we are committed to finding a company that ensures ongoing support and development of Amevive," the letter said. Physicians with questions can call the company at 866-263-8483.

Salary Affects Specialty Choice

When it comes to choosing a specialty, U.S. medical graduates are more concerned with earning power than medical liability costs, according to a study published in the September issue of Obstetrics and Gynecology. Procedure-based and hospital-based specialties, generally associated with higher incomes, are the most likely to have residency positions filled by U.S. medical graduates, the researchers found, even when the specialty had higher professional liability costs. For example, U.S. medical students filled more than 90% of the residency positions in neurosurgery and orthopedic surgery, where liability insurance costs are high, but so are incomes. But the researchers noted that students also may be attracted to high-earning fields because of the technical challenges or the ability to have a more controllable lifestyle. The results are based on data from the 2004 National Resident Matching Program, the American Medical Association, the Medical Group Management Association, and a major Massachusetts liability insurer.

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current $78.20 premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services as the primary reason for the premium increase. "This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services," the agency said in a statement. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see significantly lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays for their entire Part B premium, and about 33% can receive assistance for their Part D premium.

Health IT Standards

The National Committee for Quality Assurance (NCQA) is planning to make changes to its 2-year-old program that recognizes physicians for using clinical information and technology to improve patient care. The Physician Practice Connections (PPC) program was launched in 2004 with nine modules. The new version attempts to streamline those modules into eight standards as part of a single program. The eight elements include patient tracking and registry functions, care management, patient self-management support, electronic prescribing, tracking of laboratory and radiology tests, referral tracking, performance reporting and improvement, and interconnectivity. Currently 80 practices, representing nearly 700 physicians, are recognized under the NCQA program. For more information, visit

www.ncqa.org/ppc

Research Fraud Investigation

Key members of the House Energy and Commerce Committee are calling for an investigation into the alleged misuse of millions of dollars in government research funds at top U.S. universities. Committee chairman Rep. Joe Barton (R-Tex.) and Rep. Ed Whitfield (R-Ky.), chairman of the committee's oversight and investigations subcommittee, have asked the Department of Health and Human Services' Office of Inspector General to audit some of the largest research grants from the National Institutes of Health to compare the number of research activities projected to the NIH and the number actually performed. They cited recent settlements between NIH university grantees and the Department of Justice over allegations that federal grant funds were misused. "The alleged misuse of NIH grant funds raises serious public policy concerns of waste, effectiveness, and integrity of taxpayer-support research programs," the congressmen said in a letter to the inspector general.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at the Urban Institute, and her colleagues examined the impact of premium increases in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire, where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects occur when new premiums are imposed, especially on lower-income beneficiaries. The availability and cost of employer-sponsored insurance and other public premium policies, such as sanction policies for nonpayment of premiums, may also play a role, she said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at the Urban Institute, and her colleagues examined the impact of premium increases in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire, where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects occur when new premiums are imposed, especially on lower-income beneficiaries. The availability and cost of employer-sponsored insurance and other public premium policies, such as sanction policies for nonpayment of premiums, may also play a role, she said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment in the program, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at the Urban Institute, and her colleagues examined the impact of premium increases in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose incomes are above the federal poverty level. No existing Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, which was funded by the David and Lucile Packard Foundation, looked at enrollment and disenrollment patterns in three states that increased premiums in 2003—Kansas, Kentucky, and New Hampshire.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total caseload growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, Ms. Kenney reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth, she said.

The results were similar in New Hampshire, where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials there initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%. The premium increases there also had a stronger disenrollment effect than in the other two states.

These findings add to a growing body of evidence that increased premiums appear to reduce enrollment and increase disenrollment, Ms. Kenney said, though the impact is different among subgroups.

The largest effects occur when new premiums are imposed, especially on lower-income beneficiaries. The availability and cost of employer-sponsored insurance and other public premium policies, such as sanction policies for nonpayment of premiums, may also play a role, she 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

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

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

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

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

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

EC Veto Override

The Massachusetts legislature voted to override Gov. Mitt Romney's veto of legislation to expand access to emergency contraception. The new law will require hospital emergency departments to make emergency contraception available to rape survivors and will allow specially trained pharmacists to dispense EC without a prescription. The law was vetoed by the governor in July. Gov. Romney (R) said in his veto message to the legislature that he opposed the legislation because it would make EC available to minors and because it would change the laws of the state as they relate to abortion. “To those who believe that life begins at conception, the morning-after pill can destroy the human life that was created at the moment of fertilization,” Gov. Romney said in his veto message.

Abstinence-Only Programs Challenged

Opponents of the abstinence-only sex education programs have filed a legal complaint claiming that the federally funded programs are providing false and inaccurate information. Two groups—Advocates for Youth and the Sexuality Information and Education Council of the United States—filed a challenge to the information in the programs under the Data Quality Act of 2000. They cited a 2004 report from the Democratic staff of the House Committee on Government Reform that found that many federally funded abstinence-only programs contained false information, including misrepresentation of the effectiveness of condoms and the risks of abortion. The groups are asking the Department of Health and Human Services (HHS) to immediately stop funding programs that fail to provide medically accurate and complete sexual health information. “Those who make the rules must abide by the rules,” William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States said in a statement. “HHS's own guidelines were specifically designed to ensure that only high-quality and scientifically sound data are disseminated to the American public.”

DC's Medical Liability Crisis

A recent survey by the Medical Society of the District of Columbia shows that 30% of the city's physicians plan to retire early or already have retired as a result of rising medical liability insurance rates. And 56% of the physicians surveyed said they plan to drop out of or have already dropped out of Medicaid and/or other low-reimbursing health plans because of rising rates. Only 4% of the survey respondents described their medical liability insurance rates as “fair and reasonable,” according to the medical society. “The crisis caused by the very high cost of medical liability insurance in D.C. is expanding and may soon be irreversible if action is not taken now,” medical society President-Elect Damian P. Alagia III, M.D., said in a statement. The results are based on 201 responses to a survey sent electronically to more than 1,300 physicians in the city in September.

Domestic Violence Screening

Officials at the Department of Health and Human Services should develop best practices for domestic violence screening and distribute them to state Temporary Assistance for Needy Families programs, according to a report from the Government Accountability Office. Currently 48 states have some type of policy on screening for domestic violence in their TANF program, but the approaches vary widely, the report said. Although HHS has issued information on screening, it has not issued guidelines on best practices. The report is based on GAO's survey of the TANF programs around the country and their policies for dealing with domestic violence situations. GAO investigators also conducted in-depth site visits to five states. The report is available online at

www.gao.gov

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services. “This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services,” the agency said. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see much lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays their entire Part B premium, and 33% can receive assistance for their Part D premium.

EC Veto Override

The Massachusetts legislature voted to override Gov. Mitt Romney's veto of legislation to expand access to emergency contraception. The new law will require hospital emergency departments to make emergency contraception available to rape survivors and will allow specially trained pharmacists to dispense EC without a prescription. The law was vetoed by the governor in July. Gov. Romney (R) said in his veto message to the legislature that he opposed the legislation because it would make EC available to minors and because it would change the laws of the state as they relate to abortion. “To those who believe that life begins at conception, the morning-after pill can destroy the human life that was created at the moment of fertilization,” Gov. Romney said in his veto message.

Abstinence-Only Programs Challenged

Opponents of the abstinence-only sex education programs have filed a legal complaint claiming that the federally funded programs are providing false and inaccurate information. Two groups—Advocates for Youth and the Sexuality Information and Education Council of the United States—filed a challenge to the information in the programs under the Data Quality Act of 2000. They cited a 2004 report from the Democratic staff of the House Committee on Government Reform that found that many federally funded abstinence-only programs contained false information, including misrepresentation of the effectiveness of condoms and the risks of abortion. The groups are asking the Department of Health and Human Services (HHS) to immediately stop funding programs that fail to provide medically accurate and complete sexual health information. “Those who make the rules must abide by the rules,” William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States said in a statement. “HHS's own guidelines were specifically designed to ensure that only high-quality and scientifically sound data are disseminated to the American public.”

DC's Medical Liability Crisis

A recent survey by the Medical Society of the District of Columbia shows that 30% of the city's physicians plan to retire early or already have retired as a result of rising medical liability insurance rates. And 56% of the physicians surveyed said they plan to drop out of or have already dropped out of Medicaid and/or other low-reimbursing health plans because of rising rates. Only 4% of the survey respondents described their medical liability insurance rates as “fair and reasonable,” according to the medical society. “The crisis caused by the very high cost of medical liability insurance in D.C. is expanding and may soon be irreversible if action is not taken now,” medical society President-Elect Damian P. Alagia III, M.D., said in a statement. The results are based on 201 responses to a survey sent electronically to more than 1,300 physicians in the city in September.

Domestic Violence Screening

Officials at the Department of Health and Human Services should develop best practices for domestic violence screening and distribute them to state Temporary Assistance for Needy Families programs, according to a report from the Government Accountability Office. Currently 48 states have some type of policy on screening for domestic violence in their TANF program, but the approaches vary widely, the report said. Although HHS has issued information on screening, it has not issued guidelines on best practices. The report is based on GAO's survey of the TANF programs around the country and their policies for dealing with domestic violence situations. GAO investigators also conducted in-depth site visits to five states. The report is available online at

www.gao.gov

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services. “This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services,” the agency said. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see much lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays their entire Part B premium, and 33% can receive assistance for their Part D premium.

EC Veto Override

The Massachusetts legislature voted to override Gov. Mitt Romney's veto of legislation to expand access to emergency contraception. The new law will require hospital emergency departments to make emergency contraception available to rape survivors and will allow specially trained pharmacists to dispense EC without a prescription. The law was vetoed by the governor in July. Gov. Romney (R) said in his veto message to the legislature that he opposed the legislation because it would make EC available to minors and because it would change the laws of the state as they relate to abortion. “To those who believe that life begins at conception, the morning-after pill can destroy the human life that was created at the moment of fertilization,” Gov. Romney said in his veto message.

Abstinence-Only Programs Challenged

Opponents of the abstinence-only sex education programs have filed a legal complaint claiming that the federally funded programs are providing false and inaccurate information. Two groups—Advocates for Youth and the Sexuality Information and Education Council of the United States—filed a challenge to the information in the programs under the Data Quality Act of 2000. They cited a 2004 report from the Democratic staff of the House Committee on Government Reform that found that many federally funded abstinence-only programs contained false information, including misrepresentation of the effectiveness of condoms and the risks of abortion. The groups are asking the Department of Health and Human Services (HHS) to immediately stop funding programs that fail to provide medically accurate and complete sexual health information. “Those who make the rules must abide by the rules,” William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States said in a statement. “HHS's own guidelines were specifically designed to ensure that only high-quality and scientifically sound data are disseminated to the American public.”

DC's Medical Liability Crisis

A recent survey by the Medical Society of the District of Columbia shows that 30% of the city's physicians plan to retire early or already have retired as a result of rising medical liability insurance rates. And 56% of the physicians surveyed said they plan to drop out of or have already dropped out of Medicaid and/or other low-reimbursing health plans because of rising rates. Only 4% of the survey respondents described their medical liability insurance rates as “fair and reasonable,” according to the medical society. “The crisis caused by the very high cost of medical liability insurance in D.C. is expanding and may soon be irreversible if action is not taken now,” medical society President-Elect Damian P. Alagia III, M.D., said in a statement. The results are based on 201 responses to a survey sent electronically to more than 1,300 physicians in the city in September.

Domestic Violence Screening

Officials at the Department of Health and Human Services should develop best practices for domestic violence screening and distribute them to state Temporary Assistance for Needy Families programs, according to a report from the Government Accountability Office. Currently 48 states have some type of policy on screening for domestic violence in their TANF program, but the approaches vary widely, the report said. Although HHS has issued information on screening, it has not issued guidelines on best practices. The report is based on GAO's survey of the TANF programs around the country and their policies for dealing with domestic violence situations. GAO investigators also conducted in-depth site visits to five states. The report is available online at

www.gao.gov

Part B Premiums on the Rise

Monthly Medicare Part B premiums will be $88.50 in 2006, an increase of $10.30 from the current premium, the Centers for Medicare and Medicaid Services announced. The agency cited continued rapid growth in the intensity and utilization of Part B services. “This growth is seen in physician office visits, lab tests, minor procedures, and physician-administered drugs. It also includes rapid growth in hospital outpatient services,” the agency said. Part of the premium increase is necessary to increase funds held, for accounting purposes, in the Part B trust fund. Though premiums are rising, most Medicare beneficiaries will see much lower out-of-pocket health care costs in 2006 because of the savings in drug costs from the new Medicare prescription drug benefit, the agency claimed. About 25% of beneficiaries can receive assistance that pays their entire Part B premium, and 33% can receive assistance for their Part D premium.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose family incomes are above the poverty level. No Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, funded by the David and Lucile Packard Foundation, studied enrollment and disenrollment patterns in three states that increased premiums in 2003.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, she reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%.

These findings suggest that increased premiums reduce enrollment and increase disenrollment, Ms. Kenney said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose family incomes are above the poverty level. No Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, funded by the David and Lucile Packard Foundation, studied enrollment and disenrollment patterns in three states that increased premiums in 2003.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, she reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%.

These findings suggest that increased premiums reduce enrollment and increase disenrollment, Ms. Kenney said.

NASHVILLE, TENN. — Proposals to increase cost sharing for Medicaid beneficiaries could reduce enrollment, according to the preliminary results of a study presented at the annual conference of the National Academy for State Health Policy.

Genevieve Kenney, principal research associate at The Urban Institute, and her colleagues examined the impact of increases in premiums in the State Children's Health Insurance Program (SCHIP) as a way to inform policy changes under Medicaid.

More than 30 states have premiums for some children whose family incomes are above the poverty level. No Medicaid program charges premiums for children below poverty, Ms. Kenney said.

However, proposals, such as one from the National Governors' Association, would permit states to charge up to $480 annually per child to low-income families.

The research, funded by the David and Lucile Packard Foundation, studied enrollment and disenrollment patterns in three states that increased premiums in 2003.

SCHIP officials in Kansas increased premiums from $10 to $30 per family in February 2003 for families between 151% and 175% of the federal poverty level. The state then decreased the premiums to $20 in July 2003. For families between 176% and 200% of poverty, the premium was increased from $15 to $45 and then decreased to $30.

The total growth rate 6 months before the premium increase in Kansas was 14.6%. Six months after the increase the growth rate had fallen to −4.2%, she reported. Although there was an initial drop in enrollment, the caseload picked up over time, and there has been healthy growth.

The results were similar in New Hampshire where SCHIP officials increased the premiums from $20 to $25 per child in January 2003 for families between 185% and 249% of poverty. For families between 250% and 300% of poverty, the premium was increased from $40 to $45.

But in Kentucky, which instituted a premium for the first time, the decline in caseload was more dramatic. Officials initiated a $20 premium for families between 151% and 200% of poverty in December 2003. Six months before the change, the total caseload growth rate was −0.2%. Six months after the new premium was instituted, the growth rate fell to −17.4%.

These findings suggest that increased premiums reduce enrollment and increase disenrollment, Ms. Kenney said.