Mary Ellen Schneider

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found that women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for maintaining bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey was conducted in February and included responses from 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

Risk Minimization Guidance

The Food and Drug Administration has released three guidance documents to help industry improve its methods of assessing and monitoring the risks associated with drugs and biologic products in clinical development and general use. One document addresses risk minimization action plans (RiskMAPs) that industry could use to address specific risk-related goals and objectives. How the new guidance protocols would specifically address a drug with red safety flags such as Vioxx (rofecoxib), “is hard to speculate,” Paul J. Seligman, M.D., director of the Office of Pharmacoepidemiology and Statistical Science with the FDA's Center for Drug Evaluation and Research, said at a press conference. “It would be difficult for us to come up with a drug that would allow us to walk through the guidances,” as all drugs need to be evaluated on a case-by-case basis, Dr. Seligman said.

Top 'Fortified' Cities

Bethesda, Frederick, and Gaithersburg, Md., have the distinction of being at the top of a list of the most “fortified” cities in a new ranking from the General Nutrition Centers (GNC) based on vitamin intake and other nutritional factors. GNC, a global retailer of nutritional supplements, determined its rankings by looking at fruit and vegetable intake in 94 sampled markets, along with per capita GNC multivitamin sales in those areas. Wichita and Topeka in Kansas topped the list of least fortified cities. “One trend we noticed is that participating markets in the East seemed to rank high, while the Midwest and Southern markets ranked toward the bottom,” said Susan Trimbo, Ph.D., senior vice president of scientific affairs at GNC. “The results seem to indicate that people in the East consume more fruits, vegetables, and multivitamins.” A complete ranking of the 94 markets is available online at

www.gnc.com

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. In 2003, the survey included 20,500 adults aged 18-64 with employer-sponsored health coverage; in 2001, it included 28,000 working-age adults with employer coverage.

Part B Costs Expected to Rise

Payments for Medicare Part B services—coverage for physician visits and outpatient services—are expected to grow at an annual average rate of about 6.9% over the next 10 years, the program's trustees announced in their annual report. More use of services like office visits and lab and diagnostic tests account for the accelerated growth in Part B costs—and needs further detailed examination, said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Medicare's hospital fund in the meantime isn't expected to dry out until 2020, 1 year later than estimated in last year's report. “However, if you look at historical projections, President Bush has presided over an unprecedented drop in solvency,” countered Rep. Pete Stark (D-Calif.), ranking Democrat on the House Ways and Means health subcommittee, in a statement.

Report on Health Care Disparities

Disparities related to race, ethnicity, and socioeconomic status continue to plague the health care system, according to the 2004 National Healthcare Disparities Report from the Agency for Healthcare Research and Quality. Using comparable data from 2000 and 2001, researchers analyzed 38 measures of effectiveness for health care and 31 measures of access to care. Of the measures tracked for these two consecutive years, AHRQ found that blacks received poorer quality of care than whites for about two-thirds of the quality measures and had worse access to care than whites for about 40% of access measures. Hispanics, Asians, American Indians, and Alaska natives also scored lower than whites on quality measures and access to care.

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found that women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for maintaining bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey was conducted in February and included responses from 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

Risk Minimization Guidance

The Food and Drug Administration has released three guidance documents to help industry improve its methods of assessing and monitoring the risks associated with drugs and biologic products in clinical development and general use. One document addresses risk minimization action plans (RiskMAPs) that industry could use to address specific risk-related goals and objectives. How the new guidance protocols would specifically address a drug with red safety flags such as Vioxx (rofecoxib), “is hard to speculate,” Paul J. Seligman, M.D., director of the Office of Pharmacoepidemiology and Statistical Science with the FDA's Center for Drug Evaluation and Research, said at a press conference. “It would be difficult for us to come up with a drug that would allow us to walk through the guidances,” as all drugs need to be evaluated on a case-by-case basis, Dr. Seligman said.

Top 'Fortified' Cities

Bethesda, Frederick, and Gaithersburg, Md., have the distinction of being at the top of a list of the most “fortified” cities in a new ranking from the General Nutrition Centers (GNC) based on vitamin intake and other nutritional factors. GNC, a global retailer of nutritional supplements, determined its rankings by looking at fruit and vegetable intake in 94 sampled markets, along with per capita GNC multivitamin sales in those areas. Wichita and Topeka in Kansas topped the list of least fortified cities. “One trend we noticed is that participating markets in the East seemed to rank high, while the Midwest and Southern markets ranked toward the bottom,” said Susan Trimbo, Ph.D., senior vice president of scientific affairs at GNC. “The results seem to indicate that people in the East consume more fruits, vegetables, and multivitamins.” A complete ranking of the 94 markets is available online at

www.gnc.com

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. In 2003, the survey included 20,500 adults aged 18-64 with employer-sponsored health coverage; in 2001, it included 28,000 working-age adults with employer coverage.

Part B Costs Expected to Rise

Payments for Medicare Part B services—coverage for physician visits and outpatient services—are expected to grow at an annual average rate of about 6.9% over the next 10 years, the program's trustees announced in their annual report. More use of services like office visits and lab and diagnostic tests account for the accelerated growth in Part B costs—and needs further detailed examination, said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Medicare's hospital fund in the meantime isn't expected to dry out until 2020, 1 year later than estimated in last year's report. “However, if you look at historical projections, President Bush has presided over an unprecedented drop in solvency,” countered Rep. Pete Stark (D-Calif.), ranking Democrat on the House Ways and Means health subcommittee, in a statement.

Report on Health Care Disparities

Disparities related to race, ethnicity, and socioeconomic status continue to plague the health care system, according to the 2004 National Healthcare Disparities Report from the Agency for Healthcare Research and Quality. Using comparable data from 2000 and 2001, researchers analyzed 38 measures of effectiveness for health care and 31 measures of access to care. Of the measures tracked for these two consecutive years, AHRQ found that blacks received poorer quality of care than whites for about two-thirds of the quality measures and had worse access to care than whites for about 40% of access measures. Hispanics, Asians, American Indians, and Alaska natives also scored lower than whites on quality measures and access to care.

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found that women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for maintaining bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey was conducted in February and included responses from 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

Risk Minimization Guidance

The Food and Drug Administration has released three guidance documents to help industry improve its methods of assessing and monitoring the risks associated with drugs and biologic products in clinical development and general use. One document addresses risk minimization action plans (RiskMAPs) that industry could use to address specific risk-related goals and objectives. How the new guidance protocols would specifically address a drug with red safety flags such as Vioxx (rofecoxib), “is hard to speculate,” Paul J. Seligman, M.D., director of the Office of Pharmacoepidemiology and Statistical Science with the FDA's Center for Drug Evaluation and Research, said at a press conference. “It would be difficult for us to come up with a drug that would allow us to walk through the guidances,” as all drugs need to be evaluated on a case-by-case basis, Dr. Seligman said.

Top 'Fortified' Cities

Bethesda, Frederick, and Gaithersburg, Md., have the distinction of being at the top of a list of the most “fortified” cities in a new ranking from the General Nutrition Centers (GNC) based on vitamin intake and other nutritional factors. GNC, a global retailer of nutritional supplements, determined its rankings by looking at fruit and vegetable intake in 94 sampled markets, along with per capita GNC multivitamin sales in those areas. Wichita and Topeka in Kansas topped the list of least fortified cities. “One trend we noticed is that participating markets in the East seemed to rank high, while the Midwest and Southern markets ranked toward the bottom,” said Susan Trimbo, Ph.D., senior vice president of scientific affairs at GNC. “The results seem to indicate that people in the East consume more fruits, vegetables, and multivitamins.” A complete ranking of the 94 markets is available online at

www.gnc.com

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. In 2003, the survey included 20,500 adults aged 18-64 with employer-sponsored health coverage; in 2001, it included 28,000 working-age adults with employer coverage.

Part B Costs Expected to Rise

Payments for Medicare Part B services—coverage for physician visits and outpatient services—are expected to grow at an annual average rate of about 6.9% over the next 10 years, the program's trustees announced in their annual report. More use of services like office visits and lab and diagnostic tests account for the accelerated growth in Part B costs—and needs further detailed examination, said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Medicare's hospital fund in the meantime isn't expected to dry out until 2020, 1 year later than estimated in last year's report. “However, if you look at historical projections, President Bush has presided over an unprecedented drop in solvency,” countered Rep. Pete Stark (D-Calif.), ranking Democrat on the House Ways and Means health subcommittee, in a statement.

Report on Health Care Disparities

Disparities related to race, ethnicity, and socioeconomic status continue to plague the health care system, according to the 2004 National Healthcare Disparities Report from the Agency for Healthcare Research and Quality. Using comparable data from 2000 and 2001, researchers analyzed 38 measures of effectiveness for health care and 31 measures of access to care. Of the measures tracked for these two consecutive years, AHRQ found that blacks received poorer quality of care than whites for about two-thirds of the quality measures and had worse access to care than whites for about 40% of access measures. Hispanics, Asians, American Indians, and Alaska natives also scored lower than whites on quality measures and access to care.

Underestimating Disparities

Only about one-third of cardiologists who participated in a survey said they believe racial and ethnic disparities in health care occur often in the United States, despite evidence of the problem. The survey, conducted by the Rand Corporation in 2004 and published in the March issue of the journal Circulation, found that 34% of cardiologists agreed that differences in care based solely on race or ethnicity occur in overall health care. In addition, 33% said that disparities occur specifically in cardiovascular care. But fewer were willing to admit that these disparities existed at their institutions. About 12% said that disparities existed in their own hospitals, and 5% said their own patients were treated differently based on their race or ethnicity. The Web-based survey was completed by 344 practicing cardiologists.

Obesity in African Americans

Officials at the Department of Health and Human Services have awarded $1.2 million to fight obesity among African Americans. The money will be used by a coalition of national organizations to fund prevention, education, public awareness, and outreach activities aimed at promoting a greater understanding of the impact of obesity. Nearly two-thirds of Americans are considered overweight or obese but the problem appears to be more prevalent in the African American community. Adult African American women have age-adjusted obesity rates of 49%, compared with 31% for adult white women, according to 1999-2002 data from the Centers for Disease Control and Prevention. African American girls and boys also had higher rates of overweight than did white children in the same age groups. HHS plans a second phase of the initiative targeting the Hispanic community.

Tobacco Legislation

New legislation in Congress would give the Food and Drug Administration the authority to regulate tobacco products. The bill (S. 666/H.R. 1376) would restrict tobacco advertising and promotions, stop illegal sales of tobacco products to children, ban candy-flavored cigarettes, and require changes in tobacco products such as the reduction or elimination of harmful chemicals. It would also require the disclosure of the contents of tobacco products, and prohibit the use of terms “light,” “mild,” and “low-tar.” “Overall, this legislation would bring about significant changes in every aspect of the manufacturing, marketing, labeling, and distribution, and sale of tobacco products,” the American Cancer Society, American Heart Association, American Lung Association, and Campaign for Tobacco-Free Kids said in a joint statement. In the last Congress, the legislation was passed by the Senate, but not by the House.

Smoking Cessation Counseling

It's official: Medicare is adding coverage for smoking and tobacco cessation counseling for certain beneficiaries who want to kick the habit. The coverage decision applies to Medicare patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, or osteoporosis—diseases that account for the bulk of Medicare spending. It also applies to beneficiaries whose medications are compromised by tobacco use. “It is our hope that Medicare's decision to pay for smoking cessation counseling will encourage and help seniors quit smoking once and for all,” Ronald Davis, M.D., trustee with the American Medical Association, said in a statement. Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the CDC. The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. The survey included adults aged 18-64 with employer-sponsored health coverage; 20,500 in 2003 and 28,000 in 2001.

Underestimating Disparities

Only about one-third of cardiologists who participated in a survey said they believe racial and ethnic disparities in health care occur often in the United States, despite evidence of the problem. The survey, conducted by the Rand Corporation in 2004 and published in the March issue of the journal Circulation, found that 34% of cardiologists agreed that differences in care based solely on race or ethnicity occur in overall health care. In addition, 33% said that disparities occur specifically in cardiovascular care. But fewer were willing to admit that these disparities existed at their institutions. About 12% said that disparities existed in their own hospitals, and 5% said their own patients were treated differently based on their race or ethnicity. The Web-based survey was completed by 344 practicing cardiologists.

Obesity in African Americans

Officials at the Department of Health and Human Services have awarded $1.2 million to fight obesity among African Americans. The money will be used by a coalition of national organizations to fund prevention, education, public awareness, and outreach activities aimed at promoting a greater understanding of the impact of obesity. Nearly two-thirds of Americans are considered overweight or obese but the problem appears to be more prevalent in the African American community. Adult African American women have age-adjusted obesity rates of 49%, compared with 31% for adult white women, according to 1999-2002 data from the Centers for Disease Control and Prevention. African American girls and boys also had higher rates of overweight than did white children in the same age groups. HHS plans a second phase of the initiative targeting the Hispanic community.

Tobacco Legislation

New legislation in Congress would give the Food and Drug Administration the authority to regulate tobacco products. The bill (S. 666/H.R. 1376) would restrict tobacco advertising and promotions, stop illegal sales of tobacco products to children, ban candy-flavored cigarettes, and require changes in tobacco products such as the reduction or elimination of harmful chemicals. It would also require the disclosure of the contents of tobacco products, and prohibit the use of terms “light,” “mild,” and “low-tar.” “Overall, this legislation would bring about significant changes in every aspect of the manufacturing, marketing, labeling, and distribution, and sale of tobacco products,” the American Cancer Society, American Heart Association, American Lung Association, and Campaign for Tobacco-Free Kids said in a joint statement. In the last Congress, the legislation was passed by the Senate, but not by the House.

Smoking Cessation Counseling

It's official: Medicare is adding coverage for smoking and tobacco cessation counseling for certain beneficiaries who want to kick the habit. The coverage decision applies to Medicare patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, or osteoporosis—diseases that account for the bulk of Medicare spending. It also applies to beneficiaries whose medications are compromised by tobacco use. “It is our hope that Medicare's decision to pay for smoking cessation counseling will encourage and help seniors quit smoking once and for all,” Ronald Davis, M.D., trustee with the American Medical Association, said in a statement. Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the CDC. The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. The survey included adults aged 18-64 with employer-sponsored health coverage; 20,500 in 2003 and 28,000 in 2001.

Underestimating Disparities

Only about one-third of cardiologists who participated in a survey said they believe racial and ethnic disparities in health care occur often in the United States, despite evidence of the problem. The survey, conducted by the Rand Corporation in 2004 and published in the March issue of the journal Circulation, found that 34% of cardiologists agreed that differences in care based solely on race or ethnicity occur in overall health care. In addition, 33% said that disparities occur specifically in cardiovascular care. But fewer were willing to admit that these disparities existed at their institutions. About 12% said that disparities existed in their own hospitals, and 5% said their own patients were treated differently based on their race or ethnicity. The Web-based survey was completed by 344 practicing cardiologists.

Obesity in African Americans

Officials at the Department of Health and Human Services have awarded $1.2 million to fight obesity among African Americans. The money will be used by a coalition of national organizations to fund prevention, education, public awareness, and outreach activities aimed at promoting a greater understanding of the impact of obesity. Nearly two-thirds of Americans are considered overweight or obese but the problem appears to be more prevalent in the African American community. Adult African American women have age-adjusted obesity rates of 49%, compared with 31% for adult white women, according to 1999-2002 data from the Centers for Disease Control and Prevention. African American girls and boys also had higher rates of overweight than did white children in the same age groups. HHS plans a second phase of the initiative targeting the Hispanic community.

Tobacco Legislation

New legislation in Congress would give the Food and Drug Administration the authority to regulate tobacco products. The bill (S. 666/H.R. 1376) would restrict tobacco advertising and promotions, stop illegal sales of tobacco products to children, ban candy-flavored cigarettes, and require changes in tobacco products such as the reduction or elimination of harmful chemicals. It would also require the disclosure of the contents of tobacco products, and prohibit the use of terms “light,” “mild,” and “low-tar.” “Overall, this legislation would bring about significant changes in every aspect of the manufacturing, marketing, labeling, and distribution, and sale of tobacco products,” the American Cancer Society, American Heart Association, American Lung Association, and Campaign for Tobacco-Free Kids said in a joint statement. In the last Congress, the legislation was passed by the Senate, but not by the House.

Smoking Cessation Counseling

It's official: Medicare is adding coverage for smoking and tobacco cessation counseling for certain beneficiaries who want to kick the habit. The coverage decision applies to Medicare patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, or osteoporosis—diseases that account for the bulk of Medicare spending. It also applies to beneficiaries whose medications are compromised by tobacco use. “It is our hope that Medicare's decision to pay for smoking cessation counseling will encourage and help seniors quit smoking once and for all,” Ronald Davis, M.D., trustee with the American Medical Association, said in a statement. Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the CDC. The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

Trading Choice for Savings

More patients are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, the Center for Studying Health System Change (HSC) reported. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to make this trade-off increased from 55% to 59%—after the rate had been stable since 1997, the study found. Low-income consumers were the most willing to give up provider choice in return for lower cost. In addition, the proportion of chronically ill working-age adults with employer coverage who are willing to trade choice for lower costs rose from 51% in 2001 to 56% in 2003. The study's findings were based on HSC's Community Tracking Household Survey. The survey included adults aged 18-64 with employer-sponsored health coverage; 20,500 in 2003 and 28,000 in 2001.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium on the development of new physician-owned specialty hospitals, but its chairman urged members of Congress not to close the door on these hospitals before the potential benefits can be fully investigated.

“Frankly, the status quo in our health care system is not great,” MedPAC chairman Glenn Hackbarth testified at a hearing of the Senate Finance Committee on specialty hospitals in March. “We've got real quality and cost issues.”

MedPAC members are concerned about the potential conflict of interest in physician-owned specialty hospitals, Mr. Hackbarth said, but they are not prepared to recommend outlawing them until they see evidence on whether specialty hospitals offer increased quality of care and efficiency.

And policymakers do not yet have the answers to those questions, he said.

Sen. Chuck Grassley (R-Iowa), chairman of the Senate Finance Committee, and Sen. Max Baucus (D-Mont.), the committee's ranking Democrat, are drafting legislation that will set Medicare policy on specialty hospitals.

Sen. Grassley said that he will rely on the MedPAC findings as he drafts the legislation. He is also awaiting the final results of a study on quality of care at specialty hospitals from the Centers for Medicare and Medicaid Services.

Officials at CMS presented preliminary findings from that study at the hearing. CMS was charged under the Medicare Modernization Act of 2003 with examining referral patterns of specialty-hospital physician owners, assessing quality of care and patient satisfaction, and examining differences in the uncompensated care and tax payments between specialty hospitals and community hospitals. Based on claims analysis, the preliminary results show that quality of care at cardiac hospitals was generally at least as good and in some cases better than the quality of care at community hospitals. Complication and mortality rates were also lower at cardiac specialty hospitals even when adjusted for severity of illness.

However, a statistical assessment could not be made for surgical and orthopedic hospitals due to the small number of discharges, said Thomas A. Gustafson, Ph.D., deputy director of the Center for Medicare Management at CMS.

Patient satisfaction was high at cardiac, surgical, and orthopedic hospitals, Dr. Gustafson said, due to amenities like larger rooms and easy parking, adding that patients had a favorable perception of the clinical quality of care they received at the specialty hospitals.

But Sen. Baucus expressed skepticism about the findings and how the study was conducted. He urged caution in using the results of the CMS study as a basis for policymaking.

In its report to Congress, MedPAC recommended that the moratorium on construction of new specialty hospitals be extended another 18 months—until Jan. 1, 2007.

While MedPAC stopped short of recommending that Congress ban new specialty hospitals, the panel did recommend payment changes that would remove incentives for hospitals to treat healthier but more profitable patients.

The panel recommended that the secretary of Health and Human Services refine the current diagnosis-related groups (DRGs) to better capture differences in severity of illness among Medicare patients. It also advised the HHS secretary to base the DRG relative weights on the estimated cost of providing care, rather than on charges. And MedPAC recommended that Congress amend the law to allow the HHS secretary to adjust DRG relative weights to account for differences in the prevalence of high-cost outlier cases.

These changes would affect all hospitals that see Medicare patients and increase the accuracy and fairness of payments, Mr. Hackbarth said.

MedPAC also tried to address physicians' concerns that they do not have a say in the management of community hospitals by recommending that Congress allow the HHS secretary to permit “gainsharing” arrangements between physicians and hospitals. Gainsharing allows physicians to share in the cost savings realized from delivering efficient care in the hospital.

But even with these changes, Mr. Hackbarth said MedPAC members still have concerns about the impact of physician ownership on clinical decision making. And members of the Senate Finance Committee also raised questions about the appropriateness of physician self-referral.

“When it comes to physician ownership of specialty hospitals, I'm not sure the playing field is level,” Sen. Baucus said. Physicians are the ones who choose where patients will receive care, he said. He compared the physician owners of specialty hospitals to coaches who choose the starting lineup for both teams.

Advocates for specialty hospitals, including the American Medical Association and the American Surgical Hospital Association, are lobbying Congress to end the moratorium, saying it will allow competition and won't hurt community hospitals.

But opponents are asking Congress to close the federal self-referral-law exemption that allows physicians to invest in the “whole hospital” rather than a single department. Sen. Baucus said that surgical specialty hospitals, which on average have only 14 beds, look more like hospital departments than full-service hospitals. “This loophole may well need closing,” he said.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium on the development of new physician-owned specialty hospitals, but its chairman urged members of Congress not to close the door on these hospitals before the potential benefits can be fully investigated.

“Frankly, the status quo in our health care system is not great,” MedPAC chairman Glenn Hackbarth testified at a hearing of the Senate Finance Committee on specialty hospitals in March. “We've got real quality and cost issues.”

MedPAC members are concerned about the potential conflict of interest in physician-owned specialty hospitals, Mr. Hackbarth said, but they are not prepared to recommend outlawing them until they see evidence on whether specialty hospitals offer increased quality of care and efficiency.

And policymakers do not yet have the answers to those questions, he said.

Sen. Chuck Grassley (R-Iowa), chairman of the Senate Finance Committee, and Sen. Max Baucus (D-Mont.), the committee's ranking Democrat, are drafting legislation that will set Medicare policy on specialty hospitals.

Sen. Grassley said that he will rely on the MedPAC findings as he drafts the legislation. He is also awaiting the final results of a study on quality of care at specialty hospitals from the Centers for Medicare and Medicaid Services.

Officials at CMS presented preliminary findings from that study at the hearing. CMS was charged under the Medicare Modernization Act of 2003 with examining referral patterns of specialty-hospital physician owners, assessing quality of care and patient satisfaction, and examining differences in the uncompensated care and tax payments between specialty hospitals and community hospitals. Based on claims analysis, the preliminary results show that quality of care at cardiac hospitals was generally at least as good and in some cases better than the quality of care at community hospitals. Complication and mortality rates were also lower at cardiac specialty hospitals even when adjusted for severity of illness.

However, a statistical assessment could not be made for surgical and orthopedic hospitals due to the small number of discharges, said Thomas A. Gustafson, Ph.D., deputy director of the Center for Medicare Management at CMS.

Patient satisfaction was high at cardiac, surgical, and orthopedic hospitals, Dr. Gustafson said, due to amenities like larger rooms and easy parking, adding that patients had a favorable perception of the clinical quality of care they received at the specialty hospitals.

But Sen. Baucus expressed skepticism about the findings and how the study was conducted. He urged caution in using the results of the CMS study as a basis for policymaking.

In its report to Congress, MedPAC recommended that the moratorium on construction of new specialty hospitals be extended another 18 months—until Jan. 1, 2007.

While MedPAC stopped short of recommending that Congress ban new specialty hospitals, the panel did recommend payment changes that would remove incentives for hospitals to treat healthier but more profitable patients.

The panel recommended that the secretary of Health and Human Services refine the current diagnosis-related groups (DRGs) to better capture differences in severity of illness among Medicare patients. It also advised the HHS secretary to base the DRG relative weights on the estimated cost of providing care, rather than on charges. And MedPAC recommended that Congress amend the law to allow the HHS secretary to adjust DRG relative weights to account for differences in the prevalence of high-cost outlier cases.

These changes would affect all hospitals that see Medicare patients and increase the accuracy and fairness of payments, Mr. Hackbarth said.

MedPAC also tried to address physicians' concerns that they do not have a say in the management of community hospitals by recommending that Congress allow the HHS secretary to permit “gainsharing” arrangements between physicians and hospitals. Gainsharing allows physicians to share in the cost savings realized from delivering efficient care in the hospital.

But even with these changes, Mr. Hackbarth said MedPAC members still have concerns about the impact of physician ownership on clinical decision making. And members of the Senate Finance Committee also raised questions about the appropriateness of physician self-referral.

“When it comes to physician ownership of specialty hospitals, I'm not sure the playing field is level,” Sen. Baucus said. Physicians are the ones who choose where patients will receive care, he said. He compared the physician owners of specialty hospitals to coaches who choose the starting lineup for both teams.

Advocates for specialty hospitals, including the American Medical Association and the American Surgical Hospital Association, are lobbying Congress to end the moratorium, saying it will allow competition and won't hurt community hospitals.

But opponents are asking Congress to close the federal self-referral-law exemption that allows physicians to invest in the “whole hospital” rather than a single department. Sen. Baucus said that surgical specialty hospitals, which on average have only 14 beds, look more like hospital departments than full-service hospitals. “This loophole may well need closing,” he said.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium on the development of new physician-owned specialty hospitals, but its chairman urged members of Congress not to close the door on these hospitals before the potential benefits can be fully investigated.

“Frankly, the status quo in our health care system is not great,” MedPAC chairman Glenn Hackbarth testified at a hearing of the Senate Finance Committee on specialty hospitals in March. “We've got real quality and cost issues.”

MedPAC members are concerned about the potential conflict of interest in physician-owned specialty hospitals, Mr. Hackbarth said, but they are not prepared to recommend outlawing them until they see evidence on whether specialty hospitals offer increased quality of care and efficiency.

And policymakers do not yet have the answers to those questions, he said.

Sen. Chuck Grassley (R-Iowa), chairman of the Senate Finance Committee, and Sen. Max Baucus (D-Mont.), the committee's ranking Democrat, are drafting legislation that will set Medicare policy on specialty hospitals.

Sen. Grassley said that he will rely on the MedPAC findings as he drafts the legislation. He is also awaiting the final results of a study on quality of care at specialty hospitals from the Centers for Medicare and Medicaid Services.

Officials at CMS presented preliminary findings from that study at the hearing. CMS was charged under the Medicare Modernization Act of 2003 with examining referral patterns of specialty-hospital physician owners, assessing quality of care and patient satisfaction, and examining differences in the uncompensated care and tax payments between specialty hospitals and community hospitals. Based on claims analysis, the preliminary results show that quality of care at cardiac hospitals was generally at least as good and in some cases better than the quality of care at community hospitals. Complication and mortality rates were also lower at cardiac specialty hospitals even when adjusted for severity of illness.

However, a statistical assessment could not be made for surgical and orthopedic hospitals due to the small number of discharges, said Thomas A. Gustafson, Ph.D., deputy director of the Center for Medicare Management at CMS.

Patient satisfaction was high at cardiac, surgical, and orthopedic hospitals, Dr. Gustafson said, due to amenities like larger rooms and easy parking, adding that patients had a favorable perception of the clinical quality of care they received at the specialty hospitals.

But Sen. Baucus expressed skepticism about the findings and how the study was conducted. He urged caution in using the results of the CMS study as a basis for policymaking.

In its report to Congress, MedPAC recommended that the moratorium on construction of new specialty hospitals be extended another 18 months—until Jan. 1, 2007.

While MedPAC stopped short of recommending that Congress ban new specialty hospitals, the panel did recommend payment changes that would remove incentives for hospitals to treat healthier but more profitable patients.

The panel recommended that the secretary of Health and Human Services refine the current diagnosis-related groups (DRGs) to better capture differences in severity of illness among Medicare patients. It also advised the HHS secretary to base the DRG relative weights on the estimated cost of providing care, rather than on charges. And MedPAC recommended that Congress amend the law to allow the HHS secretary to adjust DRG relative weights to account for differences in the prevalence of high-cost outlier cases.

These changes would affect all hospitals that see Medicare patients and increase the accuracy and fairness of payments, Mr. Hackbarth said.

MedPAC also tried to address physicians' concerns that they do not have a say in the management of community hospitals by recommending that Congress allow the HHS secretary to permit “gainsharing” arrangements between physicians and hospitals. Gainsharing allows physicians to share in the cost savings realized from delivering efficient care in the hospital.

But even with these changes, Mr. Hackbarth said MedPAC members still have concerns about the impact of physician ownership on clinical decision making. And members of the Senate Finance Committee also raised questions about the appropriateness of physician self-referral.

“When it comes to physician ownership of specialty hospitals, I'm not sure the playing field is level,” Sen. Baucus said. Physicians are the ones who choose where patients will receive care, he said. He compared the physician owners of specialty hospitals to coaches who choose the starting lineup for both teams.

Advocates for specialty hospitals, including the American Medical Association and the American Surgical Hospital Association, are lobbying Congress to end the moratorium, saying it will allow competition and won't hurt community hospitals.

But opponents are asking Congress to close the federal self-referral-law exemption that allows physicians to invest in the “whole hospital” rather than a single department. Sen. Baucus said that surgical specialty hospitals, which on average have only 14 beds, look more like hospital departments than full-service hospitals. “This loophole may well need closing,” he said.

NEW ORLEANS — A simple form could help to ease communication between primary care physicians and the dermatologists to whom they refer patients, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

The researchers designed a one-page form for dermatologists to use to quickly send back information to the referring primary care physician about a consultation.

It can sometimes take as long as 3 weeks to get information back from specialists, said Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study. And when the information arrives, it's usually in the form of several pages of office notes, he told this newspaper.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest University, and his colleagues designed the form to include only the most important information. The study was supported by Galderma Laboratories, LP.

The form includes a section for the diagnosis and a silhouette for marking the location of skin lesions or eruptions. It also includes a section for listing the most frequently prescribed medications as well as the dosage, frequency, and duration of treatment.

The one-page form doesn't require dictation, transcription, or mailing. It is designed to be filled out at the point of care and can be faxed to the primary care physician.

To make the process more efficient for dermatologists, Dr. Feldman and his colleagues tracked the most frequently prescribed medications in his solo dermatology practice and added them to the form with a checkbox next to each one.

The multilayered form also doubles as a prescription pad, he said.

The advantage of this type of one-page form is that it's easy enough for the dermatologist to complete that he or she can get it back to the referring physician in a day or two, Dr. Shea said.

“It's good medicine when you can keep the patient's chart up to date,” Dr. Shea said.

Having the diagnosis and treatment plan in hand allows the primary care physician to treat the other facets of the condition, Dr. Shea said. It also allows him or her to look for drug interactions with the patient's other medications.

The form also helps to eliminate a situation where a patient returns to the primary care physician's office before receiving the report on the consultation. This information lag compromises patient care, according to Dr. Feldman; the patient is unable to be treated because the referring physician doesn't know the patient's diagnosis, treatment plan, and health status.

The researchers measured the effectiveness of the form by surveying five primary care physicians or their office staff about their experiences using the tool. They also interviewed another eight primary care physicians.

In general, the primary care physicians who were interviewed about the form said that reporting delays are a common problem and that the form is a potential way to eliminate those delays.

Dr. Feldman told FAMILY PRACTICE NEWS he plans to use the form in his practice and will continue to improve it based on feedback from referring physicians. He has no plans to commercialize the form but said he is happy to share it with other physicians.

But there's not just one way to streamline the communication between primary care physicians and specialists, said Rosemarie Nelson, a consultant for the Medical Group Management Association.

For example, some practices are having their transcription service save each patient's note in a separate electronic file and are sending that to the referring physician by fax. This doesn't need to be done using an electronic medical record, Ms. Nelson told this newspaper. Instead, it can be done with more basic technology like a fax modem or fax server.

“In most cases, technology is underutilized,” she said.

For physicians with an electronic medical record, they can print out two copies of the summary of the visit—one for the patient and one for the referring physician. This allows the patient to bring the second copy to their primary care physician at their next appointment. Although this doesn't replace having the specialist send along a report on the visit, it's a way to engage patients in their own care, Ms. Nelson said.

Any process that reduces this lag time and still communicates the information to the referring physician is a positive development, said Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J.

In his own office, Dr. Eastern uses a simple computer template to record the diagnosis and treatment information for the referring physician. He makes a point of filling out the template the same day and sending it off to the referring physician in the morning.

Dr. Eastern said he prefers to send this abbreviated form, rather than a more detailed consultation letter, because he finds it's more useful for the referring physician.

“They want it fast,” Dr. Eastern said. “That's the No. 1 thing for them.”

The referral form can be accessed atwww.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN

NEW ORLEANS — A simple form could help to ease communication between primary care physicians and the dermatologists to whom they refer patients, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

The researchers designed a one-page form for dermatologists to use to quickly send back information to the referring primary care physician about a consultation.

It can sometimes take as long as 3 weeks to get information back from specialists, said Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study. And when the information arrives, it's usually in the form of several pages of office notes, he told this newspaper.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest University, and his colleagues designed the form to include only the most important information. The study was supported by Galderma Laboratories, LP.

The form includes a section for the diagnosis and a silhouette for marking the location of skin lesions or eruptions. It also includes a section for listing the most frequently prescribed medications as well as the dosage, frequency, and duration of treatment.

The one-page form doesn't require dictation, transcription, or mailing. It is designed to be filled out at the point of care and can be faxed to the primary care physician.

To make the process more efficient for dermatologists, Dr. Feldman and his colleagues tracked the most frequently prescribed medications in his solo dermatology practice and added them to the form with a checkbox next to each one.

The multilayered form also doubles as a prescription pad, he said.

The advantage of this type of one-page form is that it's easy enough for the dermatologist to complete that he or she can get it back to the referring physician in a day or two, Dr. Shea said.

“It's good medicine when you can keep the patient's chart up to date,” Dr. Shea said.

Having the diagnosis and treatment plan in hand allows the primary care physician to treat the other facets of the condition, Dr. Shea said. It also allows him or her to look for drug interactions with the patient's other medications.

The form also helps to eliminate a situation where a patient returns to the primary care physician's office before receiving the report on the consultation. This information lag compromises patient care, according to Dr. Feldman; the patient is unable to be treated because the referring physician doesn't know the patient's diagnosis, treatment plan, and health status.

The researchers measured the effectiveness of the form by surveying five primary care physicians or their office staff about their experiences using the tool. They also interviewed another eight primary care physicians.

In general, the primary care physicians who were interviewed about the form said that reporting delays are a common problem and that the form is a potential way to eliminate those delays.

Dr. Feldman told FAMILY PRACTICE NEWS he plans to use the form in his practice and will continue to improve it based on feedback from referring physicians. He has no plans to commercialize the form but said he is happy to share it with other physicians.

But there's not just one way to streamline the communication between primary care physicians and specialists, said Rosemarie Nelson, a consultant for the Medical Group Management Association.

For example, some practices are having their transcription service save each patient's note in a separate electronic file and are sending that to the referring physician by fax. This doesn't need to be done using an electronic medical record, Ms. Nelson told this newspaper. Instead, it can be done with more basic technology like a fax modem or fax server.

“In most cases, technology is underutilized,” she said.

For physicians with an electronic medical record, they can print out two copies of the summary of the visit—one for the patient and one for the referring physician. This allows the patient to bring the second copy to their primary care physician at their next appointment. Although this doesn't replace having the specialist send along a report on the visit, it's a way to engage patients in their own care, Ms. Nelson said.

Any process that reduces this lag time and still communicates the information to the referring physician is a positive development, said Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J.

In his own office, Dr. Eastern uses a simple computer template to record the diagnosis and treatment information for the referring physician. He makes a point of filling out the template the same day and sending it off to the referring physician in the morning.

Dr. Eastern said he prefers to send this abbreviated form, rather than a more detailed consultation letter, because he finds it's more useful for the referring physician.

“They want it fast,” Dr. Eastern said. “That's the No. 1 thing for them.”

The referral form can be accessed atwww.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN

NEW ORLEANS — A simple form could help to ease communication between primary care physicians and the dermatologists to whom they refer patients, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

The researchers designed a one-page form for dermatologists to use to quickly send back information to the referring primary care physician about a consultation.

It can sometimes take as long as 3 weeks to get information back from specialists, said Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study. And when the information arrives, it's usually in the form of several pages of office notes, he told this newspaper.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest University, and his colleagues designed the form to include only the most important information. The study was supported by Galderma Laboratories, LP.

The form includes a section for the diagnosis and a silhouette for marking the location of skin lesions or eruptions. It also includes a section for listing the most frequently prescribed medications as well as the dosage, frequency, and duration of treatment.

The one-page form doesn't require dictation, transcription, or mailing. It is designed to be filled out at the point of care and can be faxed to the primary care physician.

To make the process more efficient for dermatologists, Dr. Feldman and his colleagues tracked the most frequently prescribed medications in his solo dermatology practice and added them to the form with a checkbox next to each one.

The multilayered form also doubles as a prescription pad, he said.

The advantage of this type of one-page form is that it's easy enough for the dermatologist to complete that he or she can get it back to the referring physician in a day or two, Dr. Shea said.

“It's good medicine when you can keep the patient's chart up to date,” Dr. Shea said.

Having the diagnosis and treatment plan in hand allows the primary care physician to treat the other facets of the condition, Dr. Shea said. It also allows him or her to look for drug interactions with the patient's other medications.

The form also helps to eliminate a situation where a patient returns to the primary care physician's office before receiving the report on the consultation. This information lag compromises patient care, according to Dr. Feldman; the patient is unable to be treated because the referring physician doesn't know the patient's diagnosis, treatment plan, and health status.

The researchers measured the effectiveness of the form by surveying five primary care physicians or their office staff about their experiences using the tool. They also interviewed another eight primary care physicians.

In general, the primary care physicians who were interviewed about the form said that reporting delays are a common problem and that the form is a potential way to eliminate those delays.

Dr. Feldman told FAMILY PRACTICE NEWS he plans to use the form in his practice and will continue to improve it based on feedback from referring physicians. He has no plans to commercialize the form but said he is happy to share it with other physicians.

But there's not just one way to streamline the communication between primary care physicians and specialists, said Rosemarie Nelson, a consultant for the Medical Group Management Association.

For example, some practices are having their transcription service save each patient's note in a separate electronic file and are sending that to the referring physician by fax. This doesn't need to be done using an electronic medical record, Ms. Nelson told this newspaper. Instead, it can be done with more basic technology like a fax modem or fax server.

“In most cases, technology is underutilized,” she said.

For physicians with an electronic medical record, they can print out two copies of the summary of the visit—one for the patient and one for the referring physician. This allows the patient to bring the second copy to their primary care physician at their next appointment. Although this doesn't replace having the specialist send along a report on the visit, it's a way to engage patients in their own care, Ms. Nelson said.

Any process that reduces this lag time and still communicates the information to the referring physician is a positive development, said Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J.

In his own office, Dr. Eastern uses a simple computer template to record the diagnosis and treatment information for the referring physician. He makes a point of filling out the template the same day and sending it off to the referring physician in the morning.

Dr. Eastern said he prefers to send this abbreviated form, rather than a more detailed consultation letter, because he finds it's more useful for the referring physician.

“They want it fast,” Dr. Eastern said. “That's the No. 1 thing for them.”

The referral form can be accessed atwww.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts.

“It's still on the list of danger zones,” Dr. Solomon said.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts.

“It's still on the list of danger zones,” Dr. Solomon said.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts.

“It's still on the list of danger zones,” Dr. Solomon said.

NEW ORLEANS — Dermatologists diagnosed nearly twice the number of neoplastic and cystic skin lesions correctly than did nondermatologist physicians, according to research presented at the annual meeting of the American Academy of Dermatology.

Dermatologists were right 75% of the time when diagnosing neoplastic and cystic skin lesions, compared with nondermatologist physicians, who were right about 40% of the time. The research was conducted by Klaus Sellheyer, M.D., and Wilma Bergfeld, M.D., of the Cleveland Clinic Foundation.

The researchers reviewed 4,451 skin specimens submitted to their dermatopathology clinic between Jan. 1, 2004, and March 31, 2004. The specimens were submitted by 37 dermatologists and 162 nondermatologists, including plastic surgeons, family physicians, internists, pediatricians, surgeons, and others.

The clinical diagnosis by family physicians for neoplastic and cystic skin lesions matched the histopathologic diagnosis in 26% of cases, the researchers found.

Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in recognizing skin tumors but still had a diagnostic accuracy rate of 45%.

For inflammatory skin diseases, dermatologists were correct in their diagnoses in about 71% of cases, compared with nondermatologists, who were right in about 34% of cases, the researchers found.

The researchers recommended that nondermatologists continue to perform skin biopsies, but only if they have acquired enough knowledge of basic dermatology and dermatopathology. This type of knowledge is important not only in correctly performing skin biopsies, they said, but in avoiding unnecessary invasive biopsy procedures.

Mary Frank, M.D., president of the American Academy of Family Physicians, said it's key for family physicians to be able to recognize whether a skin lesion is suspicious and should be biopsied. Having that level of suspicion is key to ensuring the right diagnosis and treatment, she said.

But she said it's less important that family doctors pinpoint the right diagnosis before sending the results off to the lab.

Physicians should be able to recognize suspicious lesions that could be skin cancer or those that may point to another health problem, such as the skin changes associated with lupus, she said.

Dr. Frank agreed it is important for family physicians and other nondermatologists to be appropriately trained in dermatology and skin biopsy. But she said dermatology and biopsy techniques are already part of family medicine residency training.

In addition, if a family physician isn't comfortable performing a biopsy on a lesion of concern, he or she should refer the patient to another physician—such as a family physician colleague, a dermatologist, or another subspecialist.

NEW ORLEANS — Dermatologists diagnosed nearly twice the number of neoplastic and cystic skin lesions correctly than did nondermatologist physicians, according to research presented at the annual meeting of the American Academy of Dermatology.

Dermatologists were right 75% of the time when diagnosing neoplastic and cystic skin lesions, compared with nondermatologist physicians, who were right about 40% of the time. The research was conducted by Klaus Sellheyer, M.D., and Wilma Bergfeld, M.D., of the Cleveland Clinic Foundation.

The researchers reviewed 4,451 skin specimens submitted to their dermatopathology clinic between Jan. 1, 2004, and March 31, 2004. The specimens were submitted by 37 dermatologists and 162 nondermatologists, including plastic surgeons, family physicians, internists, pediatricians, surgeons, and others.

The clinical diagnosis by family physicians for neoplastic and cystic skin lesions matched the histopathologic diagnosis in 26% of cases, the researchers found.

Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in recognizing skin tumors but still had a diagnostic accuracy rate of 45%.

For inflammatory skin diseases, dermatologists were correct in their diagnoses in about 71% of cases, compared with nondermatologists, who were right in about 34% of cases, the researchers found.

The researchers recommended that nondermatologists continue to perform skin biopsies, but only if they have acquired enough knowledge of basic dermatology and dermatopathology. This type of knowledge is important not only in correctly performing skin biopsies, they said, but in avoiding unnecessary invasive biopsy procedures.

Mary Frank, M.D., president of the American Academy of Family Physicians, said it's key for family physicians to be able to recognize whether a skin lesion is suspicious and should be biopsied. Having that level of suspicion is key to ensuring the right diagnosis and treatment, she said.

But she said it's less important that family doctors pinpoint the right diagnosis before sending the results off to the lab.

Physicians should be able to recognize suspicious lesions that could be skin cancer or those that may point to another health problem, such as the skin changes associated with lupus, she said.

Dr. Frank agreed it is important for family physicians and other nondermatologists to be appropriately trained in dermatology and skin biopsy. But she said dermatology and biopsy techniques are already part of family medicine residency training.

In addition, if a family physician isn't comfortable performing a biopsy on a lesion of concern, he or she should refer the patient to another physician—such as a family physician colleague, a dermatologist, or another subspecialist.

NEW ORLEANS — Dermatologists diagnosed nearly twice the number of neoplastic and cystic skin lesions correctly than did nondermatologist physicians, according to research presented at the annual meeting of the American Academy of Dermatology.

Dermatologists were right 75% of the time when diagnosing neoplastic and cystic skin lesions, compared with nondermatologist physicians, who were right about 40% of the time. The research was conducted by Klaus Sellheyer, M.D., and Wilma Bergfeld, M.D., of the Cleveland Clinic Foundation.

The researchers reviewed 4,451 skin specimens submitted to their dermatopathology clinic between Jan. 1, 2004, and March 31, 2004. The specimens were submitted by 37 dermatologists and 162 nondermatologists, including plastic surgeons, family physicians, internists, pediatricians, surgeons, and others.

The clinical diagnosis by family physicians for neoplastic and cystic skin lesions matched the histopathologic diagnosis in 26% of cases, the researchers found.

Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in recognizing skin tumors but still had a diagnostic accuracy rate of 45%.

For inflammatory skin diseases, dermatologists were correct in their diagnoses in about 71% of cases, compared with nondermatologists, who were right in about 34% of cases, the researchers found.

The researchers recommended that nondermatologists continue to perform skin biopsies, but only if they have acquired enough knowledge of basic dermatology and dermatopathology. This type of knowledge is important not only in correctly performing skin biopsies, they said, but in avoiding unnecessary invasive biopsy procedures.

Mary Frank, M.D., president of the American Academy of Family Physicians, said it's key for family physicians to be able to recognize whether a skin lesion is suspicious and should be biopsied. Having that level of suspicion is key to ensuring the right diagnosis and treatment, she said.

But she said it's less important that family doctors pinpoint the right diagnosis before sending the results off to the lab.

Physicians should be able to recognize suspicious lesions that could be skin cancer or those that may point to another health problem, such as the skin changes associated with lupus, she said.

Dr. Frank agreed it is important for family physicians and other nondermatologists to be appropriately trained in dermatology and skin biopsy. But she said dermatology and biopsy techniques are already part of family medicine residency training.

In addition, if a family physician isn't comfortable performing a biopsy on a lesion of concern, he or she should refer the patient to another physician—such as a family physician colleague, a dermatologist, or another subspecialist.

The malpractice environment may be starting to improve for emergency physicians in West Virginia 2 years after a comprehensive medical liability reform bill was enacted in the state.

“It's probably too early to see a huge improvement,” said Frederick Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 134.6% in 2002 to 128.5% in 2003. Ratios above 100% indicate that the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set an overall cap of $500,000 on economic and noneconomic damages for injuries sustained at trauma centers. The law also strengthened the qualifications required of an expert witness.

Within weeks of the passage of the law, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said. The next piece will be a reduction in premiums for physicians, he said.

There has been a slight uptick in the number of emergency physicians practicing in the state, according to the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of 2004, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum of West Virginia University, Morgantown.

The law is already under attack by plaintiffs' lawyers, who are trying to have the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

The malpractice environment may be starting to improve for emergency physicians in West Virginia 2 years after a comprehensive medical liability reform bill was enacted in the state.

“It's probably too early to see a huge improvement,” said Frederick Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 134.6% in 2002 to 128.5% in 2003. Ratios above 100% indicate that the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set an overall cap of $500,000 on economic and noneconomic damages for injuries sustained at trauma centers. The law also strengthened the qualifications required of an expert witness.

Within weeks of the passage of the law, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said. The next piece will be a reduction in premiums for physicians, he said.

There has been a slight uptick in the number of emergency physicians practicing in the state, according to the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of 2004, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum of West Virginia University, Morgantown.

The law is already under attack by plaintiffs' lawyers, who are trying to have the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

The malpractice environment may be starting to improve for emergency physicians in West Virginia 2 years after a comprehensive medical liability reform bill was enacted in the state.

“It's probably too early to see a huge improvement,” said Frederick Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 134.6% in 2002 to 128.5% in 2003. Ratios above 100% indicate that the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set an overall cap of $500,000 on economic and noneconomic damages for injuries sustained at trauma centers. The law also strengthened the qualifications required of an expert witness.

Within weeks of the passage of the law, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said. The next piece will be a reduction in premiums for physicians, he said.

There has been a slight uptick in the number of emergency physicians practicing in the state, according to the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of 2004, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum of West Virginia University, Morgantown.

The law is already under attack by plaintiffs' lawyers, who are trying to have the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit. The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. The standards also would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it easier and more attractive for physicians to use the technology.

“These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing in their offices is to provide ongoing reimbursement, said JonathanTeich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, Dr. Teich said.

But payers and others can provide incentives to physicians by supplying the technology up front, by giving increased reimbursement per visit for the use of electronic prescribing, or by incorporating electronic prescribing into a pay-for-performance program, he said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices.

Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project. At the end of last year, more than 1,500 doctors had incorporated the technology into their practices.

The collaborative plans to cover the costs of the e-prescribing technology through the end of this year.

The project uses ZixCorp's PocketScript e-prescribing system. This technology allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history, as well as formulary and eligibility information. Physicians can access the program either through a secure Web site or a handheld device.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would be easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future.

“We do believe that this is a transitional technology,” he said.

The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

James Whitman, M.D., a pediatrician in Framingham, Mass., and one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said it's shown him how easy it can be to use.

Through electronic prescribing, he and his office staff have saved time, and his patients like it because they don't have to carry around prescriptions, he said.

Dr. Whitman and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. “Our experience with this system makes it a little less scary,” Dr. Whitman said.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit. The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. The standards also would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it easier and more attractive for physicians to use the technology.

“These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing in their offices is to provide ongoing reimbursement, said JonathanTeich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, Dr. Teich said.

But payers and others can provide incentives to physicians by supplying the technology up front, by giving increased reimbursement per visit for the use of electronic prescribing, or by incorporating electronic prescribing into a pay-for-performance program, he said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices.

Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project. At the end of last year, more than 1,500 doctors had incorporated the technology into their practices.

The collaborative plans to cover the costs of the e-prescribing technology through the end of this year.

The project uses ZixCorp's PocketScript e-prescribing system. This technology allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history, as well as formulary and eligibility information. Physicians can access the program either through a secure Web site or a handheld device.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would be easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future.

“We do believe that this is a transitional technology,” he said.

The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

James Whitman, M.D., a pediatrician in Framingham, Mass., and one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said it's shown him how easy it can be to use.

Through electronic prescribing, he and his office staff have saved time, and his patients like it because they don't have to carry around prescriptions, he said.

Dr. Whitman and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. “Our experience with this system makes it a little less scary,” Dr. Whitman said.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit. The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. The standards also would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it easier and more attractive for physicians to use the technology.

“These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing in their offices is to provide ongoing reimbursement, said JonathanTeich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, Dr. Teich said.

But payers and others can provide incentives to physicians by supplying the technology up front, by giving increased reimbursement per visit for the use of electronic prescribing, or by incorporating electronic prescribing into a pay-for-performance program, he said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices.

Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project. At the end of last year, more than 1,500 doctors had incorporated the technology into their practices.

The collaborative plans to cover the costs of the e-prescribing technology through the end of this year.

The project uses ZixCorp's PocketScript e-prescribing system. This technology allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history, as well as formulary and eligibility information. Physicians can access the program either through a secure Web site or a handheld device.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would be easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future.

“We do believe that this is a transitional technology,” he said.

The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

James Whitman, M.D., a pediatrician in Framingham, Mass., and one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said it's shown him how easy it can be to use.

Through electronic prescribing, he and his office staff have saved time, and his patients like it because they don't have to carry around prescriptions, he said.

Dr. Whitman and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. “Our experience with this system makes it a little less scary,” Dr. Whitman said.

The malpractice environment may be starting to improve for physicians in one state, 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness. Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians' premiums.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University. The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. The medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense among physicians around the country that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts. “It's still on the list of danger zones,” Dr. Solomon said.

The malpractice environment may be starting to improve for physicians in one state, 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness. Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians' premiums.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University. The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. The medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense among physicians around the country that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts. “It's still on the list of danger zones,” Dr. Solomon said.

The malpractice environment may be starting to improve for physicians in one state, 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. “But the signs are encouraging.”

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness. Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians' premiums.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University. The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. The medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

West Virginia physicians also must contend with the state's lingering image problem, Dr. Solomon said. There is still a sense among physicians around the country that the state has a hostile medical liability environment, he said, which can hurt recruiting efforts. “It's still on the list of danger zones,” Dr. Solomon said.

The American Hospital Association is calling on Congress to permanently ban the practice of self-referral of patients to new physician-owned specialty hospitals.

Congress placed an 18-month moratorium on the construction of new physician-owned specialty hospitals under the Medicare Modernization Act of 2003. The moratorium is set to expire in June.

In a new report, the American Hospital Association (AHA) contends that physician-owned specialty hospitals have led to increased costs and the increased use of health care services, forced cutbacks in other services at full-service hospitals, and placed access to emergency and trauma services at risk.

“This practice strips full-service hospitals of critical resources needed to provide a full array of services that the community expects,” George Lynn, chairman of AHA's board of trustees and president of AtlantiCare in Atlantic City, N.J., said during a press conference that was sponsored by AHA.

AHA examined the impact of physician-owned specialty hospitals on patients, communities, and full-service hospitals. When specialty hospitals entered a community, access to emergency and trauma care was put at risk, the report found. Investments in new technologies were delayed or cut altogether, Mr. Lynn said. The report also found that physician-owned specialty hospitals focused on higher-reimbursed services.

But Randolph B. Fenninger, Washington representative for the American Surgical Hospital Association (ASHA), the trade group for physician-owned specialty hospitals, said continuing the moratorium is unnecessary. Instead, Mr. Fenninger said the ASHA supports making changes to the current diagnosis-related-group prospective payment system to better reflect the cost of care.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium by 18 months, to study the impact of the hospitals and implement payment changes.

The American Hospital Association is calling on Congress to permanently ban the practice of self-referral of patients to new physician-owned specialty hospitals.

Congress placed an 18-month moratorium on the construction of new physician-owned specialty hospitals under the Medicare Modernization Act of 2003. The moratorium is set to expire in June.

In a new report, the American Hospital Association (AHA) contends that physician-owned specialty hospitals have led to increased costs and the increased use of health care services, forced cutbacks in other services at full-service hospitals, and placed access to emergency and trauma services at risk.

“This practice strips full-service hospitals of critical resources needed to provide a full array of services that the community expects,” George Lynn, chairman of AHA's board of trustees and president of AtlantiCare in Atlantic City, N.J., said during a press conference that was sponsored by AHA.

AHA examined the impact of physician-owned specialty hospitals on patients, communities, and full-service hospitals. When specialty hospitals entered a community, access to emergency and trauma care was put at risk, the report found. Investments in new technologies were delayed or cut altogether, Mr. Lynn said. The report also found that physician-owned specialty hospitals focused on higher-reimbursed services.

But Randolph B. Fenninger, Washington representative for the American Surgical Hospital Association (ASHA), the trade group for physician-owned specialty hospitals, said continuing the moratorium is unnecessary. Instead, Mr. Fenninger said the ASHA supports making changes to the current diagnosis-related-group prospective payment system to better reflect the cost of care.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium by 18 months, to study the impact of the hospitals and implement payment changes.

The American Hospital Association is calling on Congress to permanently ban the practice of self-referral of patients to new physician-owned specialty hospitals.

Congress placed an 18-month moratorium on the construction of new physician-owned specialty hospitals under the Medicare Modernization Act of 2003. The moratorium is set to expire in June.

In a new report, the American Hospital Association (AHA) contends that physician-owned specialty hospitals have led to increased costs and the increased use of health care services, forced cutbacks in other services at full-service hospitals, and placed access to emergency and trauma services at risk.

“This practice strips full-service hospitals of critical resources needed to provide a full array of services that the community expects,” George Lynn, chairman of AHA's board of trustees and president of AtlantiCare in Atlantic City, N.J., said during a press conference that was sponsored by AHA.

AHA examined the impact of physician-owned specialty hospitals on patients, communities, and full-service hospitals. When specialty hospitals entered a community, access to emergency and trauma care was put at risk, the report found. Investments in new technologies were delayed or cut altogether, Mr. Lynn said. The report also found that physician-owned specialty hospitals focused on higher-reimbursed services.

But Randolph B. Fenninger, Washington representative for the American Surgical Hospital Association (ASHA), the trade group for physician-owned specialty hospitals, said continuing the moratorium is unnecessary. Instead, Mr. Fenninger said the ASHA supports making changes to the current diagnosis-related-group prospective payment system to better reflect the cost of care.

The Medicare Payment Advisory Commission has recommended that Congress extend the moratorium by 18 months, to study the impact of the hospitals and implement payment changes.