Mary Ellen Schneider

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, a company that sells health savings accounts. Lumenos is based in Alexandria, Va.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines their insurance product with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to encourage them to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to the accounts.

HSAs and similar accounts, such as health reimbursement accounts, also are capable of creating big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, a company that sells health savings accounts. Lumenos is based in Alexandria, Va.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines their insurance product with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to encourage them to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to the accounts.

HSAs and similar accounts, such as health reimbursement accounts, also are capable of creating big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, a company that sells health savings accounts. Lumenos is based in Alexandria, Va.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines their insurance product with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to encourage them to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to the accounts.

HSAs and similar accounts, such as health reimbursement accounts, also are capable of creating big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early.

This year, health plans will start collecting data on the utilization of disease-modifying antirheumatic drugs in rheumatoid arthritis patients as part of a new arthritis-focused endeavor by the National Committee for Quality Assurance.

The measurement of disease-modifying antirheumatic drug (DMARD) usage is being added to the list of more than 60 quality measures that comprise the Health Plan Employer Data and Information Set (HEDIS)—a quality assessment and reporting system used by most U.S. health plans.

Under the new HEDIS measure, health plans will be asked to assess whether rheumatoid arthritis (RA) patients have had at least one ambulatory prescription dispensed for a DMARD during the calendar year.

Allowable DMARDs include methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, infliximab, cyclophosphamide, penicillamine, etanercept, anakinra, gold (oral or intramuscular), cyclosporine, azathioprine, adalimumab, minocycline, and staphylococcal protein A.

In September 2006, NCQA will report aggregate data on the performance of plans at the regional and national level. Starting in 2007, the organization will provide annual reports on performance at the individual health plan level. Such information can then inform the decisions of health plan purchasers when making their contact decisions.

Despite strong evidence that backs their effectiveness, DMARDs are underutilized, which is why NCQA officials created the measure, explained Phil Renner, assistant vice president for quality measurement at NCQA.

NCQA officials expect the use of DMARDs in rheumatoid arthritis patients will rise sharply within the first few years as health plans and physicians begin to conduct quality improvement programs, Mr. Renner said. And they expect to see steady improvement over time.

“This is incredibly good news for patients,” said Patience White, M.D., a rheumatologist and chief public health officer for the Arthritis Foundation.

Physicians already know that DMARDs have a huge impact on RA prognosis, Dr. White said, but the high cost of the drugs has been a significant barrier to their use.

The development of a HEDIS measure puts this information in the hands of patients, physicians, insurers and—most importantly—health plan purchasers. And it gives physicians more leverage to make the case to insurance companies that expensive biologics ought to be covered, she said.

“It is another way to get the marketplace to do the right thing,” Dr. White said.

Similarly, plans at the Centers for Medicare and Medicaid Services to cover injectable drugs as part of the new Medicare prescription drug benefit will probably have an even greater impact on what gets covered in the marketplace, Dr. White predicted.

At the same time, evidence is now available for professional associations such as the American College of Rheumatology to issue guidelines on how to prescribe DMARDs in these patients.

The combination of these forces is likely to increase the availability of DMARDs for RA patients, Dr. White said.

Although the DMARD measure is the first arthritis-related HEDIS measure, Mr. Renner said, it's unlikely to be the last. “We're very interested in developing measures for arthritis,” he said.

Previous attempts by NCQA to measure arthritis care quality have been encumbered by difficulty in capturing this information through health plan databases, he said. As a result, NCQA is considering ways to gather this information at the provider level.

Already established NCQA programs that measure quality at the provider level include the Diabetes Physician Recognition Program and the Heart/Stroke Physician Recognition Program, which recognize physicians who voluntarily comply with their standards.

This is a nonpunitive program, Mr. Renner said. If a physician does not achieve recognition, that status is not published. But for physicians who do meet the qualifications, it can be an opportunity to be recognized by health plans, he said.

Some health plans are already using these programs as part of their pay for performance efforts. They highlight recognized physicians in their directories or encourage other physicians to use the recognition as a basis for referrals, he said.

This year, health plans will start collecting data on the utilization of disease-modifying antirheumatic drugs in rheumatoid arthritis patients as part of a new arthritis-focused endeavor by the National Committee for Quality Assurance.

The measurement of disease-modifying antirheumatic drug (DMARD) usage is being added to the list of more than 60 quality measures that comprise the Health Plan Employer Data and Information Set (HEDIS)—a quality assessment and reporting system used by most U.S. health plans.

Under the new HEDIS measure, health plans will be asked to assess whether rheumatoid arthritis (RA) patients have had at least one ambulatory prescription dispensed for a DMARD during the calendar year.

Allowable DMARDs include methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, infliximab, cyclophosphamide, penicillamine, etanercept, anakinra, gold (oral or intramuscular), cyclosporine, azathioprine, adalimumab, minocycline, and staphylococcal protein A.

In September 2006, NCQA will report aggregate data on the performance of plans at the regional and national level. Starting in 2007, the organization will provide annual reports on performance at the individual health plan level. Such information can then inform the decisions of health plan purchasers when making their contact decisions.

Despite strong evidence that backs their effectiveness, DMARDs are underutilized, which is why NCQA officials created the measure, explained Phil Renner, assistant vice president for quality measurement at NCQA.

NCQA officials expect the use of DMARDs in rheumatoid arthritis patients will rise sharply within the first few years as health plans and physicians begin to conduct quality improvement programs, Mr. Renner said. And they expect to see steady improvement over time.

“This is incredibly good news for patients,” said Patience White, M.D., a rheumatologist and chief public health officer for the Arthritis Foundation.

Physicians already know that DMARDs have a huge impact on RA prognosis, Dr. White said, but the high cost of the drugs has been a significant barrier to their use.

The development of a HEDIS measure puts this information in the hands of patients, physicians, insurers and—most importantly—health plan purchasers. And it gives physicians more leverage to make the case to insurance companies that expensive biologics ought to be covered, she said.

“It is another way to get the marketplace to do the right thing,” Dr. White said.

Similarly, plans at the Centers for Medicare and Medicaid Services to cover injectable drugs as part of the new Medicare prescription drug benefit will probably have an even greater impact on what gets covered in the marketplace, Dr. White predicted.

At the same time, evidence is now available for professional associations such as the American College of Rheumatology to issue guidelines on how to prescribe DMARDs in these patients.

The combination of these forces is likely to increase the availability of DMARDs for RA patients, Dr. White said.

Although the DMARD measure is the first arthritis-related HEDIS measure, Mr. Renner said, it's unlikely to be the last. “We're very interested in developing measures for arthritis,” he said.

Previous attempts by NCQA to measure arthritis care quality have been encumbered by difficulty in capturing this information through health plan databases, he said. As a result, NCQA is considering ways to gather this information at the provider level.

Already established NCQA programs that measure quality at the provider level include the Diabetes Physician Recognition Program and the Heart/Stroke Physician Recognition Program, which recognize physicians who voluntarily comply with their standards.

This is a nonpunitive program, Mr. Renner said. If a physician does not achieve recognition, that status is not published. But for physicians who do meet the qualifications, it can be an opportunity to be recognized by health plans, he said.

Some health plans are already using these programs as part of their pay for performance efforts. They highlight recognized physicians in their directories or encourage other physicians to use the recognition as a basis for referrals, he said.

This year, health plans will start collecting data on the utilization of disease-modifying antirheumatic drugs in rheumatoid arthritis patients as part of a new arthritis-focused endeavor by the National Committee for Quality Assurance.

The measurement of disease-modifying antirheumatic drug (DMARD) usage is being added to the list of more than 60 quality measures that comprise the Health Plan Employer Data and Information Set (HEDIS)—a quality assessment and reporting system used by most U.S. health plans.

Under the new HEDIS measure, health plans will be asked to assess whether rheumatoid arthritis (RA) patients have had at least one ambulatory prescription dispensed for a DMARD during the calendar year.

Allowable DMARDs include methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, infliximab, cyclophosphamide, penicillamine, etanercept, anakinra, gold (oral or intramuscular), cyclosporine, azathioprine, adalimumab, minocycline, and staphylococcal protein A.

In September 2006, NCQA will report aggregate data on the performance of plans at the regional and national level. Starting in 2007, the organization will provide annual reports on performance at the individual health plan level. Such information can then inform the decisions of health plan purchasers when making their contact decisions.

Despite strong evidence that backs their effectiveness, DMARDs are underutilized, which is why NCQA officials created the measure, explained Phil Renner, assistant vice president for quality measurement at NCQA.

NCQA officials expect the use of DMARDs in rheumatoid arthritis patients will rise sharply within the first few years as health plans and physicians begin to conduct quality improvement programs, Mr. Renner said. And they expect to see steady improvement over time.

“This is incredibly good news for patients,” said Patience White, M.D., a rheumatologist and chief public health officer for the Arthritis Foundation.

Physicians already know that DMARDs have a huge impact on RA prognosis, Dr. White said, but the high cost of the drugs has been a significant barrier to their use.

The development of a HEDIS measure puts this information in the hands of patients, physicians, insurers and—most importantly—health plan purchasers. And it gives physicians more leverage to make the case to insurance companies that expensive biologics ought to be covered, she said.

“It is another way to get the marketplace to do the right thing,” Dr. White said.

Similarly, plans at the Centers for Medicare and Medicaid Services to cover injectable drugs as part of the new Medicare prescription drug benefit will probably have an even greater impact on what gets covered in the marketplace, Dr. White predicted.

At the same time, evidence is now available for professional associations such as the American College of Rheumatology to issue guidelines on how to prescribe DMARDs in these patients.

The combination of these forces is likely to increase the availability of DMARDs for RA patients, Dr. White said.

Although the DMARD measure is the first arthritis-related HEDIS measure, Mr. Renner said, it's unlikely to be the last. “We're very interested in developing measures for arthritis,” he said.

Previous attempts by NCQA to measure arthritis care quality have been encumbered by difficulty in capturing this information through health plan databases, he said. As a result, NCQA is considering ways to gather this information at the provider level.

Already established NCQA programs that measure quality at the provider level include the Diabetes Physician Recognition Program and the Heart/Stroke Physician Recognition Program, which recognize physicians who voluntarily comply with their standards.

This is a nonpunitive program, Mr. Renner said. If a physician does not achieve recognition, that status is not published. But for physicians who do meet the qualifications, it can be an opportunity to be recognized by health plans, he said.

Some health plans are already using these programs as part of their pay for performance efforts. They highlight recognized physicians in their directories or encourage other physicians to use the recognition as a basis for referrals, he said.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

"Paper is still the dominant mode of data collection," William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper.

"We're seeing a steady movement toward a paperless office," Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

"Many groups stumble at every point along the way," Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

HHS has already asked the industry for comments on how to design a mechanism that would allow physicians and other health care providers to share information across the health care system.

The agency is now reviewing the more than 500 responses on how to address the legal, economic, privacy, and technical concerns involved in creating an interoperable system, Dr. Brailer said.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

"Paper is still the dominant mode of data collection," William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper.

"We're seeing a steady movement toward a paperless office," Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

"Many groups stumble at every point along the way," Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

HHS has already asked the industry for comments on how to design a mechanism that would allow physicians and other health care providers to share information across the health care system.

The agency is now reviewing the more than 500 responses on how to address the legal, economic, privacy, and technical concerns involved in creating an interoperable system, Dr. Brailer said.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

"Paper is still the dominant mode of data collection," William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper.

"We're seeing a steady movement toward a paperless office," Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

"Many groups stumble at every point along the way," Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

HHS has already asked the industry for comments on how to design a mechanism that would allow physicians and other health care providers to share information across the health care system.

The agency is now reviewing the more than 500 responses on how to address the legal, economic, privacy, and technical concerns involved in creating an interoperable system, Dr. Brailer said.

NEW ORLEANS — Some members of the dermatology community are getting in on the latest Internet craze—blogging.

A "blog," which is shorthand for "Web log," can be anything from an online diary to a list of Web links. Blogging has really taken off in areas like entertainment and politics, but now a group at the University of Texas, Galveston, is trying it out as a way to bring together medical students interested in dermatology.

Medical students at the University of Texas Medical Branch (UTMB) launched a blog last summer (www.digutmb.blogspot.com

Tasneem Poonawalla, Pharm.D., a medical student at UTMB, and Richard F. Wagner, Jr., M.D., a professor of dermatology there, presented information on the blog at the annual meeting of the American Academy of Dermatology.

"People are just more cohesive now because of the Web site," said Dr. Poonawalla, who came up with the idea for the blog and operates the site.

Ms. Poonawalla said she doesn't consider herself to be technologically savvy but found that creating the site was fairly easy. She used one of a number of online services that help users to construct Web sites using customizable templates.

The site acts as an electronic newsletter and offers information on research, clinical experiences, and volunteer opportunities within the dermatology community. It highlights achievements by students, residents, and faculty at UTMB.

The site can also help students find dermatology mentors, and even offers information to patients about preventive measures to protect against skin diseases.

So far, the site has been dominated by announcements, Ms. Poonawalla said, but she is working toward creating more of a conversation on the blog.

"It's a great resource," said Dr. Wagner, who is also the faculty advisor for the student-run blog.

There has been a lot of positive response about the blog, Dr. Wagner said, and he has used it as a way to provide students with more information about pursuing a career in dermatology.

The Web site is unique, he said, because it is so comprehensive. "Ours is sort of like a diary of what is happening day to day," Dr. Wagner said.

The biggest plus, Ms. Poonawalla said, is having so much information accessible in one place.

Her advice to people thinking about starting a blog is to just go for it. "People tend to get intimidated by technology," she said.

NEW ORLEANS — Some members of the dermatology community are getting in on the latest Internet craze—blogging.

A "blog," which is shorthand for "Web log," can be anything from an online diary to a list of Web links. Blogging has really taken off in areas like entertainment and politics, but now a group at the University of Texas, Galveston, is trying it out as a way to bring together medical students interested in dermatology.

Medical students at the University of Texas Medical Branch (UTMB) launched a blog last summer (www.digutmb.blogspot.com

Tasneem Poonawalla, Pharm.D., a medical student at UTMB, and Richard F. Wagner, Jr., M.D., a professor of dermatology there, presented information on the blog at the annual meeting of the American Academy of Dermatology.

"People are just more cohesive now because of the Web site," said Dr. Poonawalla, who came up with the idea for the blog and operates the site.

Ms. Poonawalla said she doesn't consider herself to be technologically savvy but found that creating the site was fairly easy. She used one of a number of online services that help users to construct Web sites using customizable templates.

The site acts as an electronic newsletter and offers information on research, clinical experiences, and volunteer opportunities within the dermatology community. It highlights achievements by students, residents, and faculty at UTMB.

The site can also help students find dermatology mentors, and even offers information to patients about preventive measures to protect against skin diseases.

So far, the site has been dominated by announcements, Ms. Poonawalla said, but she is working toward creating more of a conversation on the blog.

"It's a great resource," said Dr. Wagner, who is also the faculty advisor for the student-run blog.

There has been a lot of positive response about the blog, Dr. Wagner said, and he has used it as a way to provide students with more information about pursuing a career in dermatology.

The Web site is unique, he said, because it is so comprehensive. "Ours is sort of like a diary of what is happening day to day," Dr. Wagner said.

The biggest plus, Ms. Poonawalla said, is having so much information accessible in one place.

Her advice to people thinking about starting a blog is to just go for it. "People tend to get intimidated by technology," she said.

NEW ORLEANS — Some members of the dermatology community are getting in on the latest Internet craze—blogging.

A "blog," which is shorthand for "Web log," can be anything from an online diary to a list of Web links. Blogging has really taken off in areas like entertainment and politics, but now a group at the University of Texas, Galveston, is trying it out as a way to bring together medical students interested in dermatology.

Medical students at the University of Texas Medical Branch (UTMB) launched a blog last summer (www.digutmb.blogspot.com

Tasneem Poonawalla, Pharm.D., a medical student at UTMB, and Richard F. Wagner, Jr., M.D., a professor of dermatology there, presented information on the blog at the annual meeting of the American Academy of Dermatology.

"People are just more cohesive now because of the Web site," said Dr. Poonawalla, who came up with the idea for the blog and operates the site.

Ms. Poonawalla said she doesn't consider herself to be technologically savvy but found that creating the site was fairly easy. She used one of a number of online services that help users to construct Web sites using customizable templates.

The site acts as an electronic newsletter and offers information on research, clinical experiences, and volunteer opportunities within the dermatology community. It highlights achievements by students, residents, and faculty at UTMB.

The site can also help students find dermatology mentors, and even offers information to patients about preventive measures to protect against skin diseases.

So far, the site has been dominated by announcements, Ms. Poonawalla said, but she is working toward creating more of a conversation on the blog.

"It's a great resource," said Dr. Wagner, who is also the faculty advisor for the student-run blog.

There has been a lot of positive response about the blog, Dr. Wagner said, and he has used it as a way to provide students with more information about pursuing a career in dermatology.

The Web site is unique, he said, because it is so comprehensive. "Ours is sort of like a diary of what is happening day to day," Dr. Wagner said.

The biggest plus, Ms. Poonawalla said, is having so much information accessible in one place.

Her advice to people thinking about starting a blog is to just go for it. "People tend to get intimidated by technology," she said.

WHO Says No to Underage Tanning

No individual under age 18 should use a tanning bed, according to the World Health Organization. Young people who get burned from exposure to UV light will have a greater risk of developing melanoma later in life and studies show a direct link between the use of tanning beds and cancer, according to the organization. The American Academy of Dermatology endorsed the recommendation and called on U.S. states to enact and enforce regulations to prohibit indoor tanning by minors. Currently, 26 states regulate tanning salon operators, but the statutes vary and enforcement is limited, according to AAD. "We know that ultraviolet light is the primary cause of skin cancer and avoiding excessive exposure to the sun and other forms of ultraviolet radiation is the solution," AAD President Clay J. Cockerell, M.D., said in a statement. "Individuals who utilize tanning beds are intentionally putting their health at risk."

Skin Cancer Education

Medical students generally want earlier exposure to how to do a skin cancer exam and how to provide patient education, according to interviews and focus groups of students and dermatology educators from five U.S. medical schools. The research was conducted by Heather A. Brandling-Bennett, M.D., clinical fellow in pediatrics at Massachusetts General Hospital in Boston, and her colleagues and was presented in a poster at the annual meeting of the American Academy of Dermatology. Students said they wanted skin cancer education to be integrated into the clinical years via lectures, rounds, and clinic time with a dermatologist, and they "stressed repetition and more interactive skills development," the investigators said. Dermatology educators frequently cited faculty and student time constraints as a major limitation. Participating medical schools included Boston University, Harvard University, Brown University, the University of Massachusetts, and Dartmouth College.

Rise in Facial Plastic Surgery

There was a 22% increase in overall cosmetic surgical and nonsurgical procedures from 2003 to 2004, according to a study from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The most common procedures in 2004 were filler injections, which were up 115%, and Botox injections, which increased by 107%. Looking younger is the primary motivation for men and women who undergo these procedures, according to the AAFPRS. The plastic surgeons who were surveyed said men were likely to report receiving facial cosmetic surgery for work-related reasons, and women opt for surgery to "look less tired" or to look or feel better. Surgeons who responded reported that over half of all patients (54%) have had multiple procedures in the same year. There was also an increase in teens undergoing cosmetic surgery. About 37% of facial plastic surgeons identified this as a trend.

The Cost of Skin Disease

Skin disease cost the United States $37 billion each year, according to a study released by the American Academy of Dermatology and the Society for Investigative Dermatology. The most costly skin diseases are skin ulcers and wounds, melanoma, nonmelanoma skin cancer, atopic dermatitis, and acne, which carried a price tag of about $22 billion in 2004. These cost figures include visits to physicians, over-the-counter and prescription medicine costs, and lost productivity. Last month, dermatologists gathered in Washington, D.C., making an appeal to Congress to increase the overall research funding for the National Institutes of Health by 6% and to spend more money on research into skin disease. "There are tremendous opportunities to apply technologic advances and translational approaches to skin diseases," Kevin D. Cooper, M.D., president of the Society for Investigative Dermatology said in a statement. "However, without increased funding for research advances, improved treatment methods, and ultimately, potential cures will remain out of reach for dermatologists and their patients."

Discount Cards: Not Created Equal

Some discount medical cards provide value, while others have serious drawbacks such as high-pressure sales tactics, exaggerated claims of savings, inaccurate promotions, or difficulty finding participating physicians, a survey from the Commonwealth Fund concluded. The cards promise discounts for a range of providers, including physicians and hospitals, as well as for laboratory work, surgical procedures, and other services. Some discount card companies are seeking to reform the market through a trade association and voluntary code of conduct. Because the cards aren't regulated, however, "legislative action is needed that gives state insurance departments the authority and resources to have direct oversight of the discount medical card industry," the survey's authors stated.

Researchers tested 5 of 27 cards advertised in the Washington, D.C., area by undergoing the application process, seeking health care services from participating providers, and then canceling the cards.

'Rent-a-Patient' Fraud

Hundreds of patients from across the country underwent unnecessary and sometimes dangerous surgical procedures that resulted in the submission of tens of millions of dollars in fraudulent medical claims, according to a $30 million lawsuit filed by 12 Blue Cross and Blue Shield Plans.

The lawsuit was filed against nine California-based outpatient surgery clinics, seven medical management companies, and 34 individuals, in a Los Angeles federal district court.

The Blues Plans allege that paid recruiters enlisted patients to travel to the surgical centers and undergo "needless and sometimes hazardous" surgical procedures and treatments. In return, the patients allegedly received cash payments or cosmetic surgery, and the providers submitted fraudulent insurance claims. These "rent-a-patient" tactics have resulted in significant financial losses to insurance companies and employee benefit plans since 1999, according to the slawuit.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not be put on committees that advise the Food and Drug Administration, a coalition of public interest groups has recommended. Financial conflicts undermine "the public's faith in the fairness and credibility of the panel's work," the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M., Ph.D. The groups cited the FDA advisory committee that recently reviewed the safety of cyclooxygenase-2 (COX-2) inhibitors and noted that 10 of the committee's 32 members reported having direct financial conflicts.

In addition to prohibiting scientists, physicians, and clinicians with relevant conflicts of interest from serving on advisory committees, the groups also recommended that people with any industry ties should make up no more than half of a committee.

WHO Says No to Underage Tanning

No individual under age 18 should use a tanning bed, according to the World Health Organization. Young people who get burned from exposure to UV light will have a greater risk of developing melanoma later in life and studies show a direct link between the use of tanning beds and cancer, according to the organization. The American Academy of Dermatology endorsed the recommendation and called on U.S. states to enact and enforce regulations to prohibit indoor tanning by minors. Currently, 26 states regulate tanning salon operators, but the statutes vary and enforcement is limited, according to AAD. "We know that ultraviolet light is the primary cause of skin cancer and avoiding excessive exposure to the sun and other forms of ultraviolet radiation is the solution," AAD President Clay J. Cockerell, M.D., said in a statement. "Individuals who utilize tanning beds are intentionally putting their health at risk."

Skin Cancer Education

Medical students generally want earlier exposure to how to do a skin cancer exam and how to provide patient education, according to interviews and focus groups of students and dermatology educators from five U.S. medical schools. The research was conducted by Heather A. Brandling-Bennett, M.D., clinical fellow in pediatrics at Massachusetts General Hospital in Boston, and her colleagues and was presented in a poster at the annual meeting of the American Academy of Dermatology. Students said they wanted skin cancer education to be integrated into the clinical years via lectures, rounds, and clinic time with a dermatologist, and they "stressed repetition and more interactive skills development," the investigators said. Dermatology educators frequently cited faculty and student time constraints as a major limitation. Participating medical schools included Boston University, Harvard University, Brown University, the University of Massachusetts, and Dartmouth College.

Rise in Facial Plastic Surgery

There was a 22% increase in overall cosmetic surgical and nonsurgical procedures from 2003 to 2004, according to a study from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The most common procedures in 2004 were filler injections, which were up 115%, and Botox injections, which increased by 107%. Looking younger is the primary motivation for men and women who undergo these procedures, according to the AAFPRS. The plastic surgeons who were surveyed said men were likely to report receiving facial cosmetic surgery for work-related reasons, and women opt for surgery to "look less tired" or to look or feel better. Surgeons who responded reported that over half of all patients (54%) have had multiple procedures in the same year. There was also an increase in teens undergoing cosmetic surgery. About 37% of facial plastic surgeons identified this as a trend.

The Cost of Skin Disease

Skin disease cost the United States $37 billion each year, according to a study released by the American Academy of Dermatology and the Society for Investigative Dermatology. The most costly skin diseases are skin ulcers and wounds, melanoma, nonmelanoma skin cancer, atopic dermatitis, and acne, which carried a price tag of about $22 billion in 2004. These cost figures include visits to physicians, over-the-counter and prescription medicine costs, and lost productivity. Last month, dermatologists gathered in Washington, D.C., making an appeal to Congress to increase the overall research funding for the National Institutes of Health by 6% and to spend more money on research into skin disease. "There are tremendous opportunities to apply technologic advances and translational approaches to skin diseases," Kevin D. Cooper, M.D., president of the Society for Investigative Dermatology said in a statement. "However, without increased funding for research advances, improved treatment methods, and ultimately, potential cures will remain out of reach for dermatologists and their patients."

Discount Cards: Not Created Equal

Some discount medical cards provide value, while others have serious drawbacks such as high-pressure sales tactics, exaggerated claims of savings, inaccurate promotions, or difficulty finding participating physicians, a survey from the Commonwealth Fund concluded. The cards promise discounts for a range of providers, including physicians and hospitals, as well as for laboratory work, surgical procedures, and other services. Some discount card companies are seeking to reform the market through a trade association and voluntary code of conduct. Because the cards aren't regulated, however, "legislative action is needed that gives state insurance departments the authority and resources to have direct oversight of the discount medical card industry," the survey's authors stated.

Researchers tested 5 of 27 cards advertised in the Washington, D.C., area by undergoing the application process, seeking health care services from participating providers, and then canceling the cards.

'Rent-a-Patient' Fraud

Hundreds of patients from across the country underwent unnecessary and sometimes dangerous surgical procedures that resulted in the submission of tens of millions of dollars in fraudulent medical claims, according to a $30 million lawsuit filed by 12 Blue Cross and Blue Shield Plans.

The lawsuit was filed against nine California-based outpatient surgery clinics, seven medical management companies, and 34 individuals, in a Los Angeles federal district court.

The Blues Plans allege that paid recruiters enlisted patients to travel to the surgical centers and undergo "needless and sometimes hazardous" surgical procedures and treatments. In return, the patients allegedly received cash payments or cosmetic surgery, and the providers submitted fraudulent insurance claims. These "rent-a-patient" tactics have resulted in significant financial losses to insurance companies and employee benefit plans since 1999, according to the slawuit.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not be put on committees that advise the Food and Drug Administration, a coalition of public interest groups has recommended. Financial conflicts undermine "the public's faith in the fairness and credibility of the panel's work," the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M., Ph.D. The groups cited the FDA advisory committee that recently reviewed the safety of cyclooxygenase-2 (COX-2) inhibitors and noted that 10 of the committee's 32 members reported having direct financial conflicts.

In addition to prohibiting scientists, physicians, and clinicians with relevant conflicts of interest from serving on advisory committees, the groups also recommended that people with any industry ties should make up no more than half of a committee.

WHO Says No to Underage Tanning

No individual under age 18 should use a tanning bed, according to the World Health Organization. Young people who get burned from exposure to UV light will have a greater risk of developing melanoma later in life and studies show a direct link between the use of tanning beds and cancer, according to the organization. The American Academy of Dermatology endorsed the recommendation and called on U.S. states to enact and enforce regulations to prohibit indoor tanning by minors. Currently, 26 states regulate tanning salon operators, but the statutes vary and enforcement is limited, according to AAD. "We know that ultraviolet light is the primary cause of skin cancer and avoiding excessive exposure to the sun and other forms of ultraviolet radiation is the solution," AAD President Clay J. Cockerell, M.D., said in a statement. "Individuals who utilize tanning beds are intentionally putting their health at risk."

Skin Cancer Education

Medical students generally want earlier exposure to how to do a skin cancer exam and how to provide patient education, according to interviews and focus groups of students and dermatology educators from five U.S. medical schools. The research was conducted by Heather A. Brandling-Bennett, M.D., clinical fellow in pediatrics at Massachusetts General Hospital in Boston, and her colleagues and was presented in a poster at the annual meeting of the American Academy of Dermatology. Students said they wanted skin cancer education to be integrated into the clinical years via lectures, rounds, and clinic time with a dermatologist, and they "stressed repetition and more interactive skills development," the investigators said. Dermatology educators frequently cited faculty and student time constraints as a major limitation. Participating medical schools included Boston University, Harvard University, Brown University, the University of Massachusetts, and Dartmouth College.

Rise in Facial Plastic Surgery

There was a 22% increase in overall cosmetic surgical and nonsurgical procedures from 2003 to 2004, according to a study from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The most common procedures in 2004 were filler injections, which were up 115%, and Botox injections, which increased by 107%. Looking younger is the primary motivation for men and women who undergo these procedures, according to the AAFPRS. The plastic surgeons who were surveyed said men were likely to report receiving facial cosmetic surgery for work-related reasons, and women opt for surgery to "look less tired" or to look or feel better. Surgeons who responded reported that over half of all patients (54%) have had multiple procedures in the same year. There was also an increase in teens undergoing cosmetic surgery. About 37% of facial plastic surgeons identified this as a trend.

The Cost of Skin Disease

Skin disease cost the United States $37 billion each year, according to a study released by the American Academy of Dermatology and the Society for Investigative Dermatology. The most costly skin diseases are skin ulcers and wounds, melanoma, nonmelanoma skin cancer, atopic dermatitis, and acne, which carried a price tag of about $22 billion in 2004. These cost figures include visits to physicians, over-the-counter and prescription medicine costs, and lost productivity. Last month, dermatologists gathered in Washington, D.C., making an appeal to Congress to increase the overall research funding for the National Institutes of Health by 6% and to spend more money on research into skin disease. "There are tremendous opportunities to apply technologic advances and translational approaches to skin diseases," Kevin D. Cooper, M.D., president of the Society for Investigative Dermatology said in a statement. "However, without increased funding for research advances, improved treatment methods, and ultimately, potential cures will remain out of reach for dermatologists and their patients."

Discount Cards: Not Created Equal

Some discount medical cards provide value, while others have serious drawbacks such as high-pressure sales tactics, exaggerated claims of savings, inaccurate promotions, or difficulty finding participating physicians, a survey from the Commonwealth Fund concluded. The cards promise discounts for a range of providers, including physicians and hospitals, as well as for laboratory work, surgical procedures, and other services. Some discount card companies are seeking to reform the market through a trade association and voluntary code of conduct. Because the cards aren't regulated, however, "legislative action is needed that gives state insurance departments the authority and resources to have direct oversight of the discount medical card industry," the survey's authors stated.

Researchers tested 5 of 27 cards advertised in the Washington, D.C., area by undergoing the application process, seeking health care services from participating providers, and then canceling the cards.

'Rent-a-Patient' Fraud

Hundreds of patients from across the country underwent unnecessary and sometimes dangerous surgical procedures that resulted in the submission of tens of millions of dollars in fraudulent medical claims, according to a $30 million lawsuit filed by 12 Blue Cross and Blue Shield Plans.

The lawsuit was filed against nine California-based outpatient surgery clinics, seven medical management companies, and 34 individuals, in a Los Angeles federal district court.

The Blues Plans allege that paid recruiters enlisted patients to travel to the surgical centers and undergo "needless and sometimes hazardous" surgical procedures and treatments. In return, the patients allegedly received cash payments or cosmetic surgery, and the providers submitted fraudulent insurance claims. These "rent-a-patient" tactics have resulted in significant financial losses to insurance companies and employee benefit plans since 1999, according to the slawuit.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not be put on committees that advise the Food and Drug Administration, a coalition of public interest groups has recommended. Financial conflicts undermine "the public's faith in the fairness and credibility of the panel's work," the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M., Ph.D. The groups cited the FDA advisory committee that recently reviewed the safety of cyclooxygenase-2 (COX-2) inhibitors and noted that 10 of the committee's 32 members reported having direct financial conflicts.

In addition to prohibiting scientists, physicians, and clinicians with relevant conflicts of interest from serving on advisory committees, the groups also recommended that people with any industry ties should make up no more than half of a committee.

EC Mandate

New legislation would require the Department of Justice to include emergency contraception as part of its first national medical guidelines for treating sexual assault victims. The Justice Department has come under fire for failing to include emergency contraceptives in its National Protocol for Sexual Assault Medical Forensic Examination. Reps. Carolyn Maloney (D-N.Y.), Chris Shays (R-Conn.), Diane E. Watson (D-Calif.) and James R. Langevin (D-R.I.) introduced the “Best Help for Rape Victims Act” (H.R. 1214) last month. The bill would require the Justice Department to include language in the protocol stating that a victim of sexual assault should be offered information about emergency contraception and should be provided with it on site if requested. “It is unthinkable that a national protocol to treat victims of sexual assault would not require health practitioners to provide a full understanding of the risks they face and treatment options,” Rep. Shays said. “Rape victims deserve to be fully informed of all their options and this bill would ensure they get that respect.”

Cancer Awareness Campaign

Members of Congress are trying to raise awareness of gynecologic cancers by reintroducing legislation to create a national public awareness campaign aimed at early detection. “Johanna's Law: The Gynecologic Cancer Education and Awareness Act of 2005” (H.R. 1245) would authorize the Health and Human Services secretary to spend $15 million over 3 years on a campaign intended to encourage women to talk to their physicians about their risk for gynecologic cancers. The bill also calls for demonstration grants for outreach and education. “Through awareness and early detection, we help women beat gynecologic cancers,” said Rep. Sander Levin (D-Mich.), one of the sponsors. “This legislation will help women across the nation understand the symptoms to be on the lookout for and the steps to take if they need care.” The bill was first introduced in November 2003.

U.N. Calls for Cloning Ban

The United Nations General Assembly is calling on member countries to prohibit all forms of human cloning. The nonbinding declaration also asks countries to “adopt all measures necessary to protect adequately human life in the application of life sciences.” The declaration, sponsored by Honduras, received support from the United States. The National Right to Life Committee called the move a significant step and called on Congress to pass legislation to ban the cloning and destruction of human embryos. But the Coalition for the Advancement of Medical Research, which supports what it calls therapeutic cloning, said the declaration was “toothless.” “Since the declaration is unenforceable by law, countries will continue to pursue therapeutic cloning research which seeks to develop stem cells to cure some of life's most debilitating diseases,” said the coalition's president, Daniel Perry.

Medical Records Fight

Planned Parenthood of Kansas and Mid-Missouri has asked the Kansas Supreme Court to keep the state's attorney general from obtaining the medical records of abortion patients. Kansas Attorney General Phill Kline has been seeking the records as part of an effort to investigate “child rape and potential illegal late-term abortions.” But Planned Parenthood officials say it's important to protect patients' identities and medical information not relevant to the investigation. “It's simply wrong to expect any doctor to turn over the medical records of dozens of patients based on the hunch—or the hope—of the attorney general that he may find evidence of crimes,” said Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri. Mr. Kline said the records were sought because of probable cause that a crime had been committed and said he has offered to have the court remove identifying information before handing records over to his office.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not serve on Food and Drug Administration advisory committees, a coalition of public interest groups has recommended. Financial conflicts undermine “the public's faith in the fairness and credibility of the panel's work,” the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M. They cited the FDA advisory committees that reviewed the safety of cyclooxygenase-2 inhibitors, noting 10 of the 32 members had direct financial conflicts. In addition to prohibiting scientists, physicians, and clinicians with conflicts from serving on such committees, the groups said people with industry ties should make up no more than half of a committee.

EC Mandate

New legislation would require the Department of Justice to include emergency contraception as part of its first national medical guidelines for treating sexual assault victims. The Justice Department has come under fire for failing to include emergency contraceptives in its National Protocol for Sexual Assault Medical Forensic Examination. Reps. Carolyn Maloney (D-N.Y.), Chris Shays (R-Conn.), Diane E. Watson (D-Calif.) and James R. Langevin (D-R.I.) introduced the “Best Help for Rape Victims Act” (H.R. 1214) last month. The bill would require the Justice Department to include language in the protocol stating that a victim of sexual assault should be offered information about emergency contraception and should be provided with it on site if requested. “It is unthinkable that a national protocol to treat victims of sexual assault would not require health practitioners to provide a full understanding of the risks they face and treatment options,” Rep. Shays said. “Rape victims deserve to be fully informed of all their options and this bill would ensure they get that respect.”

Cancer Awareness Campaign

Members of Congress are trying to raise awareness of gynecologic cancers by reintroducing legislation to create a national public awareness campaign aimed at early detection. “Johanna's Law: The Gynecologic Cancer Education and Awareness Act of 2005” (H.R. 1245) would authorize the Health and Human Services secretary to spend $15 million over 3 years on a campaign intended to encourage women to talk to their physicians about their risk for gynecologic cancers. The bill also calls for demonstration grants for outreach and education. “Through awareness and early detection, we help women beat gynecologic cancers,” said Rep. Sander Levin (D-Mich.), one of the sponsors. “This legislation will help women across the nation understand the symptoms to be on the lookout for and the steps to take if they need care.” The bill was first introduced in November 2003.

U.N. Calls for Cloning Ban

The United Nations General Assembly is calling on member countries to prohibit all forms of human cloning. The nonbinding declaration also asks countries to “adopt all measures necessary to protect adequately human life in the application of life sciences.” The declaration, sponsored by Honduras, received support from the United States. The National Right to Life Committee called the move a significant step and called on Congress to pass legislation to ban the cloning and destruction of human embryos. But the Coalition for the Advancement of Medical Research, which supports what it calls therapeutic cloning, said the declaration was “toothless.” “Since the declaration is unenforceable by law, countries will continue to pursue therapeutic cloning research which seeks to develop stem cells to cure some of life's most debilitating diseases,” said the coalition's president, Daniel Perry.

Medical Records Fight

Planned Parenthood of Kansas and Mid-Missouri has asked the Kansas Supreme Court to keep the state's attorney general from obtaining the medical records of abortion patients. Kansas Attorney General Phill Kline has been seeking the records as part of an effort to investigate “child rape and potential illegal late-term abortions.” But Planned Parenthood officials say it's important to protect patients' identities and medical information not relevant to the investigation. “It's simply wrong to expect any doctor to turn over the medical records of dozens of patients based on the hunch—or the hope—of the attorney general that he may find evidence of crimes,” said Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri. Mr. Kline said the records were sought because of probable cause that a crime had been committed and said he has offered to have the court remove identifying information before handing records over to his office.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not serve on Food and Drug Administration advisory committees, a coalition of public interest groups has recommended. Financial conflicts undermine “the public's faith in the fairness and credibility of the panel's work,” the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M. They cited the FDA advisory committees that reviewed the safety of cyclooxygenase-2 inhibitors, noting 10 of the 32 members had direct financial conflicts. In addition to prohibiting scientists, physicians, and clinicians with conflicts from serving on such committees, the groups said people with industry ties should make up no more than half of a committee.

EC Mandate

New legislation would require the Department of Justice to include emergency contraception as part of its first national medical guidelines for treating sexual assault victims. The Justice Department has come under fire for failing to include emergency contraceptives in its National Protocol for Sexual Assault Medical Forensic Examination. Reps. Carolyn Maloney (D-N.Y.), Chris Shays (R-Conn.), Diane E. Watson (D-Calif.) and James R. Langevin (D-R.I.) introduced the “Best Help for Rape Victims Act” (H.R. 1214) last month. The bill would require the Justice Department to include language in the protocol stating that a victim of sexual assault should be offered information about emergency contraception and should be provided with it on site if requested. “It is unthinkable that a national protocol to treat victims of sexual assault would not require health practitioners to provide a full understanding of the risks they face and treatment options,” Rep. Shays said. “Rape victims deserve to be fully informed of all their options and this bill would ensure they get that respect.”

Cancer Awareness Campaign

Members of Congress are trying to raise awareness of gynecologic cancers by reintroducing legislation to create a national public awareness campaign aimed at early detection. “Johanna's Law: The Gynecologic Cancer Education and Awareness Act of 2005” (H.R. 1245) would authorize the Health and Human Services secretary to spend $15 million over 3 years on a campaign intended to encourage women to talk to their physicians about their risk for gynecologic cancers. The bill also calls for demonstration grants for outreach and education. “Through awareness and early detection, we help women beat gynecologic cancers,” said Rep. Sander Levin (D-Mich.), one of the sponsors. “This legislation will help women across the nation understand the symptoms to be on the lookout for and the steps to take if they need care.” The bill was first introduced in November 2003.

U.N. Calls for Cloning Ban

The United Nations General Assembly is calling on member countries to prohibit all forms of human cloning. The nonbinding declaration also asks countries to “adopt all measures necessary to protect adequately human life in the application of life sciences.” The declaration, sponsored by Honduras, received support from the United States. The National Right to Life Committee called the move a significant step and called on Congress to pass legislation to ban the cloning and destruction of human embryos. But the Coalition for the Advancement of Medical Research, which supports what it calls therapeutic cloning, said the declaration was “toothless.” “Since the declaration is unenforceable by law, countries will continue to pursue therapeutic cloning research which seeks to develop stem cells to cure some of life's most debilitating diseases,” said the coalition's president, Daniel Perry.

Medical Records Fight

Planned Parenthood of Kansas and Mid-Missouri has asked the Kansas Supreme Court to keep the state's attorney general from obtaining the medical records of abortion patients. Kansas Attorney General Phill Kline has been seeking the records as part of an effort to investigate “child rape and potential illegal late-term abortions.” But Planned Parenthood officials say it's important to protect patients' identities and medical information not relevant to the investigation. “It's simply wrong to expect any doctor to turn over the medical records of dozens of patients based on the hunch—or the hope—of the attorney general that he may find evidence of crimes,” said Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri. Mr. Kline said the records were sought because of probable cause that a crime had been committed and said he has offered to have the court remove identifying information before handing records over to his office.

Conflict-of-Interest Rules Targeted

People with direct financial conflicts of interest should not serve on Food and Drug Administration advisory committees, a coalition of public interest groups has recommended. Financial conflicts undermine “the public's faith in the fairness and credibility of the panel's work,” the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M. They cited the FDA advisory committees that reviewed the safety of cyclooxygenase-2 inhibitors, noting 10 of the 32 members had direct financial conflicts. In addition to prohibiting scientists, physicians, and clinicians with conflicts from serving on such committees, the groups said people with industry ties should make up no more than half of a committee.

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 last month. “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, because of the small number of discharges, a statistically significant assessment could not be made for surgical and orthopedic hospitals, 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.

First, 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. The panel 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.

In addition, MedPAC 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 aligns financial incentives for physicians and hospitals by allowing 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 last month. “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, because of the small number of discharges, a statistically significant assessment could not be made for surgical and orthopedic hospitals, 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.

First, 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. The panel 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.

In addition, MedPAC 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 aligns financial incentives for physicians and hospitals by allowing 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 last month. “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, because of the small number of discharges, a statistically significant assessment could not be made for surgical and orthopedic hospitals, 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.

First, 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. The panel 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.

In addition, MedPAC 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 aligns financial incentives for physicians and hospitals by allowing 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 — The real social crisis facing America right now isn't fixing Social Security but tackling the problem of the uninsured, former Sen. John Breaux said at the annual meeting of the American Academy of Dermatology.

“The crisis that I see in health care in this country is the fact that we have 44 million Americans who have no form of health insurance whatsoever,” he said.

And the crisis is likely to get worse as more and more companies are opting not to provide health insurance to their employees, said Mr. Breaux, a Democrat who represented Louisiana in the U.S. Senate for the past 18 years.

But the problem isn't how much money is being spent on the system, he said, it's the way the system is organized. Currently, most individuals receive their health coverage either through their employer or through Medicare, Medicaid, or the Department of Veterans Affairs. If they don't fit into one of these eligible groups, or their employer doesn't provide coverage, they are unlikely to be insured.

One way to get away from this traditional system of coverage would be to create a federal mandate that every individual must have health insurance, Mr. Breaux said. Under this type of plan, the government would offer subsidies to low-income individuals to purchase coverage.

The government would also need to create some type of state or multistate purchasing pools and ensure that the system prevents adverse risk selection so that insurance could be purchased at a reasonable price, he said.

Mr. Breaux compared such a plan to the existing requirement in most states that drivers must have a liability insurance policy. “People understand that and they have accepted that,” he said.

Under such a system, if someone without insurance sought care in an emergency department, he or she would be enrolled in a purchasing pool at that time, he said. Or people might need to show proof of health insurance when they get their driver's license.

Mr. Breaux said that such a plan would help to move away from the current segmented system of health care and the waste, fraud, abuse, and duplication that accompanies each of those separate bureaucracies.

And providing insurance to more Americans would cut down on overall costs because it would allow more people to have access to preventive treatments. The best way to get a handle on health care costs is through disease management, Mr. Breaux said, but you have to get the patients into the physician's office to do that.

While it's unlikely that such a system would be enacted anytime soon, it's a worthy goal, Mr. Breaux said.

“As we try to get a handle on the costs, we have to move away from the fact that we can just regulate it to death and control costs through regulation,” he said.

NEW ORLEANS — The real social crisis facing America right now isn't fixing Social Security but tackling the problem of the uninsured, former Sen. John Breaux said at the annual meeting of the American Academy of Dermatology.

“The crisis that I see in health care in this country is the fact that we have 44 million Americans who have no form of health insurance whatsoever,” he said.

And the crisis is likely to get worse as more and more companies are opting not to provide health insurance to their employees, said Mr. Breaux, a Democrat who represented Louisiana in the U.S. Senate for the past 18 years.

But the problem isn't how much money is being spent on the system, he said, it's the way the system is organized. Currently, most individuals receive their health coverage either through their employer or through Medicare, Medicaid, or the Department of Veterans Affairs. If they don't fit into one of these eligible groups, or their employer doesn't provide coverage, they are unlikely to be insured.

One way to get away from this traditional system of coverage would be to create a federal mandate that every individual must have health insurance, Mr. Breaux said. Under this type of plan, the government would offer subsidies to low-income individuals to purchase coverage.

The government would also need to create some type of state or multistate purchasing pools and ensure that the system prevents adverse risk selection so that insurance could be purchased at a reasonable price, he said.

Mr. Breaux compared such a plan to the existing requirement in most states that drivers must have a liability insurance policy. “People understand that and they have accepted that,” he said.

Under such a system, if someone without insurance sought care in an emergency department, he or she would be enrolled in a purchasing pool at that time, he said. Or people might need to show proof of health insurance when they get their driver's license.

Mr. Breaux said that such a plan would help to move away from the current segmented system of health care and the waste, fraud, abuse, and duplication that accompanies each of those separate bureaucracies.

And providing insurance to more Americans would cut down on overall costs because it would allow more people to have access to preventive treatments. The best way to get a handle on health care costs is through disease management, Mr. Breaux said, but you have to get the patients into the physician's office to do that.

While it's unlikely that such a system would be enacted anytime soon, it's a worthy goal, Mr. Breaux said.

“As we try to get a handle on the costs, we have to move away from the fact that we can just regulate it to death and control costs through regulation,” he said.

NEW ORLEANS — The real social crisis facing America right now isn't fixing Social Security but tackling the problem of the uninsured, former Sen. John Breaux said at the annual meeting of the American Academy of Dermatology.

“The crisis that I see in health care in this country is the fact that we have 44 million Americans who have no form of health insurance whatsoever,” he said.

And the crisis is likely to get worse as more and more companies are opting not to provide health insurance to their employees, said Mr. Breaux, a Democrat who represented Louisiana in the U.S. Senate for the past 18 years.

But the problem isn't how much money is being spent on the system, he said, it's the way the system is organized. Currently, most individuals receive their health coverage either through their employer or through Medicare, Medicaid, or the Department of Veterans Affairs. If they don't fit into one of these eligible groups, or their employer doesn't provide coverage, they are unlikely to be insured.

One way to get away from this traditional system of coverage would be to create a federal mandate that every individual must have health insurance, Mr. Breaux said. Under this type of plan, the government would offer subsidies to low-income individuals to purchase coverage.

The government would also need to create some type of state or multistate purchasing pools and ensure that the system prevents adverse risk selection so that insurance could be purchased at a reasonable price, he said.

Mr. Breaux compared such a plan to the existing requirement in most states that drivers must have a liability insurance policy. “People understand that and they have accepted that,” he said.

Under such a system, if someone without insurance sought care in an emergency department, he or she would be enrolled in a purchasing pool at that time, he said. Or people might need to show proof of health insurance when they get their driver's license.

Mr. Breaux said that such a plan would help to move away from the current segmented system of health care and the waste, fraud, abuse, and duplication that accompanies each of those separate bureaucracies.

And providing insurance to more Americans would cut down on overall costs because it would allow more people to have access to preventive treatments. The best way to get a handle on health care costs is through disease management, Mr. Breaux said, but you have to get the patients into the physician's office to do that.

While it's unlikely that such a system would be enacted anytime soon, it's a worthy goal, Mr. Breaux said.

“As we try to get a handle on the costs, we have to move away from the fact that we can just regulate it to death and control costs through regulation,” he said.

Texas physicians are working to change how the state board of medical examiners disciplines doctors by adding more due process to the system.

“The state board really is overstepping its bounds in terms of reviewing standard of care issues,” said Clyde A. Henke, M.D., an ob.gyn. in San Angelo, Tex., who has called for reform of the state board's rules.

In September 2003, the Texas legislature gave the Texas State Board of Medical Examiners new authority to regulate medical practice through the passage of Senate Bill 104. This year, the legislature will review how the agency has used those new powers during its Sunset Review Process, which occurs every 12 years.

S.B. 104 gave the board a 60% increase in funding in fiscal year 2003 to be used to pay expert physician consultants, more competitive salaries to retain staff, and 20 additional full-time employee positions.

One of the big changes made as a result has been the implementation of a new investigation module, said Donald W. Patrick, M.D., executive director of the Texas State Board of Medical Examiners. This new process is used to assess the approximately 6,000 complaints that the board receives each year.

In a national ranking of serious disciplinary actions taken against physicians in 2003, Public Citizen's Health Research Group ranked Texas in the middle—23rd out of the 50 states plus the District of Columbia.

During the board's process, a complaint is initially assessed by a nurse investigator, who refers potential violations to a physician of the same specialty as the physician named in the complaint, which is then assessed by up to three expert physicians, before it can be referred on to an informal settlement conference that involves mediation between the physician and the board.

Complaints that can't be resolved during an informal settlement conference are forwarded to the State Office of Administrative Hearings for a hearing before an administrative law judge.

Board enforcement actions have increased about threefold since fiscal year 2001 and today average about 300 per year, Dr. Patrick said, adding that the increase is due largely to changes begun in 2002 when the board began to address its large backlog of cases.

Before the board instituted its current investigation process, cases were filed against physicians immediately and consequently immediately affected their records, Dr. Patrick said. The new system is designed to give physicians more opportunities to defend their records, he said.

But critics say the increased enforcement is an overreaction to negative press reports about a lack of action by the board and negative feedback about the tort reform legislation recently passed in the state.

While the board has the duty to make sure that physicians are competent, a lot of good physicians are getting “caught up in the net,” Dr. Henke said.

In his opinion, standard of care issues are best addressed first at the local level through county medical societies and the peer review and credentialing committees of hospitals. The state board should concentrate on areas such as fraud, substance abuse, and the inability of physicians to safely perform their duties, Dr. Henke said.

Once the state medical board begins to meddle in clinical decision making, there is the potential for dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board.

But there is a sense that some investigations have been “heavy handed” toward physicians, Dr. Handel said.

Quality of care cases need to be reviewed simultaneously by three physicians who are boarded in the same specialty as the doctor they are investigating. It's critical that physicians are evaluated by others in their specialty, Dr. Handel said, and reviewing the cases at the same time creates a good interchange among the physicians.

In addition, the ad hoc committee is seeking more “due process rights” for physicians including the presumption of innocence, the right to access details of the complaints against them, the right of discovery, the right to present witnesses and cross-examine witnesses, and the right to appeal.

The current level of due process and justice for physicians “could be significantly better,” Dr. Handel said.

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months, he said.

“This process is not one day you get a complaint and the next day you're in chains,” he said.

And physicians that have complaints filed against them are already being evaluated by physicians in their specialty, he said. A simultaneous review, however, would significantly slow down the process.

As the board continues to implement the new process, more physicians are beginning to realize that it is good for the profession because it instills public confidence, Dr. Patrick said.

Texas physicians are working to change how the state board of medical examiners disciplines doctors by adding more due process to the system.

“The state board really is overstepping its bounds in terms of reviewing standard of care issues,” said Clyde A. Henke, M.D., an ob.gyn. in San Angelo, Tex., who has called for reform of the state board's rules.

In September 2003, the Texas legislature gave the Texas State Board of Medical Examiners new authority to regulate medical practice through the passage of Senate Bill 104. This year, the legislature will review how the agency has used those new powers during its Sunset Review Process, which occurs every 12 years.

S.B. 104 gave the board a 60% increase in funding in fiscal year 2003 to be used to pay expert physician consultants, more competitive salaries to retain staff, and 20 additional full-time employee positions.

One of the big changes made as a result has been the implementation of a new investigation module, said Donald W. Patrick, M.D., executive director of the Texas State Board of Medical Examiners. This new process is used to assess the approximately 6,000 complaints that the board receives each year.

In a national ranking of serious disciplinary actions taken against physicians in 2003, Public Citizen's Health Research Group ranked Texas in the middle—23rd out of the 50 states plus the District of Columbia.

During the board's process, a complaint is initially assessed by a nurse investigator, who refers potential violations to a physician of the same specialty as the physician named in the complaint, which is then assessed by up to three expert physicians, before it can be referred on to an informal settlement conference that involves mediation between the physician and the board.

Complaints that can't be resolved during an informal settlement conference are forwarded to the State Office of Administrative Hearings for a hearing before an administrative law judge.

Board enforcement actions have increased about threefold since fiscal year 2001 and today average about 300 per year, Dr. Patrick said, adding that the increase is due largely to changes begun in 2002 when the board began to address its large backlog of cases.

Before the board instituted its current investigation process, cases were filed against physicians immediately and consequently immediately affected their records, Dr. Patrick said. The new system is designed to give physicians more opportunities to defend their records, he said.

But critics say the increased enforcement is an overreaction to negative press reports about a lack of action by the board and negative feedback about the tort reform legislation recently passed in the state.

While the board has the duty to make sure that physicians are competent, a lot of good physicians are getting “caught up in the net,” Dr. Henke said.

In his opinion, standard of care issues are best addressed first at the local level through county medical societies and the peer review and credentialing committees of hospitals. The state board should concentrate on areas such as fraud, substance abuse, and the inability of physicians to safely perform their duties, Dr. Henke said.

Once the state medical board begins to meddle in clinical decision making, there is the potential for dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board.

But there is a sense that some investigations have been “heavy handed” toward physicians, Dr. Handel said.

Quality of care cases need to be reviewed simultaneously by three physicians who are boarded in the same specialty as the doctor they are investigating. It's critical that physicians are evaluated by others in their specialty, Dr. Handel said, and reviewing the cases at the same time creates a good interchange among the physicians.

In addition, the ad hoc committee is seeking more “due process rights” for physicians including the presumption of innocence, the right to access details of the complaints against them, the right of discovery, the right to present witnesses and cross-examine witnesses, and the right to appeal.

The current level of due process and justice for physicians “could be significantly better,” Dr. Handel said.

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months, he said.

“This process is not one day you get a complaint and the next day you're in chains,” he said.

And physicians that have complaints filed against them are already being evaluated by physicians in their specialty, he said. A simultaneous review, however, would significantly slow down the process.

As the board continues to implement the new process, more physicians are beginning to realize that it is good for the profession because it instills public confidence, Dr. Patrick said.

Texas physicians are working to change how the state board of medical examiners disciplines doctors by adding more due process to the system.

“The state board really is overstepping its bounds in terms of reviewing standard of care issues,” said Clyde A. Henke, M.D., an ob.gyn. in San Angelo, Tex., who has called for reform of the state board's rules.

In September 2003, the Texas legislature gave the Texas State Board of Medical Examiners new authority to regulate medical practice through the passage of Senate Bill 104. This year, the legislature will review how the agency has used those new powers during its Sunset Review Process, which occurs every 12 years.

S.B. 104 gave the board a 60% increase in funding in fiscal year 2003 to be used to pay expert physician consultants, more competitive salaries to retain staff, and 20 additional full-time employee positions.

One of the big changes made as a result has been the implementation of a new investigation module, said Donald W. Patrick, M.D., executive director of the Texas State Board of Medical Examiners. This new process is used to assess the approximately 6,000 complaints that the board receives each year.

In a national ranking of serious disciplinary actions taken against physicians in 2003, Public Citizen's Health Research Group ranked Texas in the middle—23rd out of the 50 states plus the District of Columbia.

During the board's process, a complaint is initially assessed by a nurse investigator, who refers potential violations to a physician of the same specialty as the physician named in the complaint, which is then assessed by up to three expert physicians, before it can be referred on to an informal settlement conference that involves mediation between the physician and the board.

Complaints that can't be resolved during an informal settlement conference are forwarded to the State Office of Administrative Hearings for a hearing before an administrative law judge.

Board enforcement actions have increased about threefold since fiscal year 2001 and today average about 300 per year, Dr. Patrick said, adding that the increase is due largely to changes begun in 2002 when the board began to address its large backlog of cases.

Before the board instituted its current investigation process, cases were filed against physicians immediately and consequently immediately affected their records, Dr. Patrick said. The new system is designed to give physicians more opportunities to defend their records, he said.

But critics say the increased enforcement is an overreaction to negative press reports about a lack of action by the board and negative feedback about the tort reform legislation recently passed in the state.

While the board has the duty to make sure that physicians are competent, a lot of good physicians are getting “caught up in the net,” Dr. Henke said.

In his opinion, standard of care issues are best addressed first at the local level through county medical societies and the peer review and credentialing committees of hospitals. The state board should concentrate on areas such as fraud, substance abuse, and the inability of physicians to safely perform their duties, Dr. Henke said.

Once the state medical board begins to meddle in clinical decision making, there is the potential for dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board.

But there is a sense that some investigations have been “heavy handed” toward physicians, Dr. Handel said.

Quality of care cases need to be reviewed simultaneously by three physicians who are boarded in the same specialty as the doctor they are investigating. It's critical that physicians are evaluated by others in their specialty, Dr. Handel said, and reviewing the cases at the same time creates a good interchange among the physicians.

In addition, the ad hoc committee is seeking more “due process rights” for physicians including the presumption of innocence, the right to access details of the complaints against them, the right of discovery, the right to present witnesses and cross-examine witnesses, and the right to appeal.

The current level of due process and justice for physicians “could be significantly better,” Dr. Handel said.

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months, he said.

“This process is not one day you get a complaint and the next day you're in chains,” he said.

And physicians that have complaints filed against them are already being evaluated by physicians in their specialty, he said. A simultaneous review, however, would significantly slow down the process.

As the board continues to implement the new process, more physicians are beginning to realize that it is good for the profession because it instills public confidence, Dr. Patrick 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 patient's 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 patient's 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 patient's 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