Mary Ellen Schneider

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.

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, explained 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 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, explained 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 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, explained 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 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.

Despite efforts to increase error reporting in medicine, some physicians say they have been targets for retaliation after reporting unsafe or inadequate care in their hospitals and clinics.

W. Harry Horner, M.D., an internist from Waynesboro, Va., said that administrators at the state mental hospital where he worked trumped up charges against him after he raised serious patient safety issues and refused to stop documenting lack of appropriate care on patient charts.

“I just said this is unacceptable,” Dr. Horner told this newspaper.

He was dismissed in May 2001 on charges of abuse and neglect of a patient, failing to follow a supervisor's instructions, and violating an employee's confidentiality.

Dr. Horner sued the state on the grounds that the hospital short-circuited the state's normal grievance process by not allowing his immediate supervisor, who disagreed with the charges, to reinstate him immediately.

Last June, the Virginia Supreme Court ruled in Dr. Horner's favor and ordered the state to pay him back wages and benefits and reinstate him at Western State Hospital in Staunton. The state asked for a rehearing of the case, but the Virginia Supreme Court refused.

Martha Mead, director of legislation and public relations at the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services, said she couldn't discuss the ongoing litigation concerning Dr. Horner.

But she noted that the Western State facility is fully accredited and was released from oversight by the Department of Justice last year. The hospital is nationally recognized for its work in psychosocial rehabilitation, she said.

During his legal battle, Dr. Horner has been following 35-40 similar cases across the country and says he's not alone in facing retaliation. “This wasn't a personal thing or a local phenomenon,” he said.

Although federal law offers whistleblowers some protections, there is little relief at the state level. And it takes years to get a remedy in court, Dr. Horner explained.

“It's a huge problem,” said Reuben Guttman, a lawyer in New York who has litigated several cases involving the federal False Claims Act.

But there are legal avenues for physicians to pursue if they observe quality problems or wrongdoing. Physicians can submit a claim under the federal False Claims Act, which protects workers who report fraud.

Protection under the False Claims Act also can include reports of quality problems since it is considered fraud for hospitals to file claims to Medicare and Medicaid if they are not in compliance with a broad range of regulations that include quality issues, Mr. Guttman said.

Many states have also adopted a general exception to the “employee at will” provision of employment law, stating that an employee can't be terminated if the employee's actions further a public policy such as reporting wrongdoing.

Many physicians just aren't aware that they have these rights, Mr. Guttman said.

But Eric W. Springer, counsel with a Pittsburgh law firm that works with hospitals and their medical staffs, said the problem is not widespread.

Although there are legitimate whistleblowers, more often physicians use quality claims as a defense when their behavior is identified as disruptive, he said.

“The disruptive doctor uses the whistleblower flag as a cover for his own behavior,” Mr. Springer said.

Danae Powers, M.D., an anesthesiologist working in State College, Pa., said she was labeled as disruptive when she raised quality of care issues at Centre Community Hospital in State College, now renamed Mount Nittany Medical Center.

Even after settling lawsuits that she had brought against the hospital arising from her concerns over alleged negligent care, she concluded that she didn't accomplish what she set out to do–making it easier for physicians to voice their concerns.

“If doctors can't speak up to protect patients then patients aren't getting the best care,” Dr. Powers said.

Officials at Mount Nittany Medical Center said Dr. Powers was not the victim of retaliation, and they stand by their efforts to encourage communication between physicians and administrators.

“We are very proud of our patient care and safety at Mount Nittany Medical Center,” said hospital spokeswoman Maureen Karstetter. “We pride ourselves on open physician-hospital communications.”

The hospital has a patient safety committee made up of hospital administration, physicians, and community members.

The hospital also has in place a telephone hotline for anonymous quality complaints from physicians and the public, a nonpunitive reporting policy for physicians, a joint conference committee that includes physicians and members of the hospital's board of trustees, and an ethics committee composed mostly of physicians, Ms. Karstetter said.

Hospitals have a great deal of financial and other power over physician practices from referrals up to the ability to list physicians in the National Practitioner Data Bank, Dr. Powers said. “The data bank is the ultimate threat to physicians.”

In hospitals with a culture of safety this isn't a problem, Dr. Powers said, but there are some hospitals where economics are placed above patient care.

Dr. Powers proposes doing away with the databank and introducing external, financially independent, and specialty-specific peer review to hospitals.

For example, a thoracic surgeon should be able to call the Board of Thoracic Surgery to request a review of a patient safety issue, she said.

This system could mimic the Accreditation Council for Graduate Medical Education reviews that already occur in teaching programs.

In addition, if hospitals want to strip physicians of credentials, the institution should allow physicians to call for a review of the entire department by the specialty society, Dr. Powers said.

The American Hospital Association urges physicians and other hospital employees who have seen an error or a potential risk to report that without fear of retaliation, said Don Nielsen, M.D., senior vice president for quality at the AHA.

It is “unacceptable” for hospital administration to punish someone for reporting, he said.

To prevent this, all hospitals have an appeals process in place if privileges are restricted or if a physician is fired, Dr. Nielsen said.

For its part, AHA has been providing tools to hospitals to encourage the creation of a culture of safety.

Changing the culture won't happen overnight, said Paul Schyve, M.D., who is senior vice president at the Joint Commission on Accreditation of Healthcare Organizations.

“Hospitals are making clear positive steps in that direction,” he said.

But the legal culture of the United States continues in the name, blame, and shame culture, Dr. Schyve said.

Congress is beginning to address this through patient safety legislation, he added.

In March, the Senate's Health, Education, Labor, and Pensions Committee approved the Patient Safety and Quality Improvement Act (S. 544). The bill would allow hospitals and physicians to report information to a patient safety organization without its being disclosed and used against them in court.

In addition, the legislation would prohibit employers from taking action against an employee who makes a report.

The bill still needs approval from the full Senate and House. In the last Congress, the House and Senate each passed versions of this legislation but could not come to agreement on a final bill.

Despite efforts to increase error reporting in medicine, some physicians say they have been targets for retaliation after reporting unsafe or inadequate care in their hospitals and clinics.

W. Harry Horner, M.D., an internist from Waynesboro, Va., said that administrators at the state mental hospital where he worked trumped up charges against him after he raised serious patient safety issues and refused to stop documenting lack of appropriate care on patient charts.

“I just said this is unacceptable,” Dr. Horner told this newspaper.

He was dismissed in May 2001 on charges of abuse and neglect of a patient, failing to follow a supervisor's instructions, and violating an employee's confidentiality.

Dr. Horner sued the state on the grounds that the hospital short-circuited the state's normal grievance process by not allowing his immediate supervisor, who disagreed with the charges, to reinstate him immediately.

Last June, the Virginia Supreme Court ruled in Dr. Horner's favor and ordered the state to pay him back wages and benefits and reinstate him at Western State Hospital in Staunton. The state asked for a rehearing of the case, but the Virginia Supreme Court refused.

Martha Mead, director of legislation and public relations at the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services, said she couldn't discuss the ongoing litigation concerning Dr. Horner.

But she noted that the Western State facility is fully accredited and was released from oversight by the Department of Justice last year. The hospital is nationally recognized for its work in psychosocial rehabilitation, she said.

During his legal battle, Dr. Horner has been following 35-40 similar cases across the country and says he's not alone in facing retaliation. “This wasn't a personal thing or a local phenomenon,” he said.

Although federal law offers whistleblowers some protections, there is little relief at the state level. And it takes years to get a remedy in court, Dr. Horner explained.

“It's a huge problem,” said Reuben Guttman, a lawyer in New York who has litigated several cases involving the federal False Claims Act.

But there are legal avenues for physicians to pursue if they observe quality problems or wrongdoing. Physicians can submit a claim under the federal False Claims Act, which protects workers who report fraud.

Protection under the False Claims Act also can include reports of quality problems since it is considered fraud for hospitals to file claims to Medicare and Medicaid if they are not in compliance with a broad range of regulations that include quality issues, Mr. Guttman said.

Many states have also adopted a general exception to the “employee at will” provision of employment law, stating that an employee can't be terminated if the employee's actions further a public policy such as reporting wrongdoing.

Many physicians just aren't aware that they have these rights, Mr. Guttman said.

But Eric W. Springer, counsel with a Pittsburgh law firm that works with hospitals and their medical staffs, said the problem is not widespread.

Although there are legitimate whistleblowers, more often physicians use quality claims as a defense when their behavior is identified as disruptive, he said.

“The disruptive doctor uses the whistleblower flag as a cover for his own behavior,” Mr. Springer said.

Danae Powers, M.D., an anesthesiologist working in State College, Pa., said she was labeled as disruptive when she raised quality of care issues at Centre Community Hospital in State College, now renamed Mount Nittany Medical Center.

Even after settling lawsuits that she had brought against the hospital arising from her concerns over alleged negligent care, she concluded that she didn't accomplish what she set out to do–making it easier for physicians to voice their concerns.

“If doctors can't speak up to protect patients then patients aren't getting the best care,” Dr. Powers said.

Officials at Mount Nittany Medical Center said Dr. Powers was not the victim of retaliation, and they stand by their efforts to encourage communication between physicians and administrators.

“We are very proud of our patient care and safety at Mount Nittany Medical Center,” said hospital spokeswoman Maureen Karstetter. “We pride ourselves on open physician-hospital communications.”

The hospital has a patient safety committee made up of hospital administration, physicians, and community members.

The hospital also has in place a telephone hotline for anonymous quality complaints from physicians and the public, a nonpunitive reporting policy for physicians, a joint conference committee that includes physicians and members of the hospital's board of trustees, and an ethics committee composed mostly of physicians, Ms. Karstetter said.

Hospitals have a great deal of financial and other power over physician practices from referrals up to the ability to list physicians in the National Practitioner Data Bank, Dr. Powers said. “The data bank is the ultimate threat to physicians.”

In hospitals with a culture of safety this isn't a problem, Dr. Powers said, but there are some hospitals where economics are placed above patient care.

Dr. Powers proposes doing away with the databank and introducing external, financially independent, and specialty-specific peer review to hospitals.

For example, a thoracic surgeon should be able to call the Board of Thoracic Surgery to request a review of a patient safety issue, she said.

This system could mimic the Accreditation Council for Graduate Medical Education reviews that already occur in teaching programs.

In addition, if hospitals want to strip physicians of credentials, the institution should allow physicians to call for a review of the entire department by the specialty society, Dr. Powers said.

The American Hospital Association urges physicians and other hospital employees who have seen an error or a potential risk to report that without fear of retaliation, said Don Nielsen, M.D., senior vice president for quality at the AHA.

It is “unacceptable” for hospital administration to punish someone for reporting, he said.

To prevent this, all hospitals have an appeals process in place if privileges are restricted or if a physician is fired, Dr. Nielsen said.

For its part, AHA has been providing tools to hospitals to encourage the creation of a culture of safety.

Changing the culture won't happen overnight, said Paul Schyve, M.D., who is senior vice president at the Joint Commission on Accreditation of Healthcare Organizations.

“Hospitals are making clear positive steps in that direction,” he said.

But the legal culture of the United States continues in the name, blame, and shame culture, Dr. Schyve said.

Congress is beginning to address this through patient safety legislation, he added.

In March, the Senate's Health, Education, Labor, and Pensions Committee approved the Patient Safety and Quality Improvement Act (S. 544). The bill would allow hospitals and physicians to report information to a patient safety organization without its being disclosed and used against them in court.

In addition, the legislation would prohibit employers from taking action against an employee who makes a report.

The bill still needs approval from the full Senate and House. In the last Congress, the House and Senate each passed versions of this legislation but could not come to agreement on a final bill.

Despite efforts to increase error reporting in medicine, some physicians say they have been targets for retaliation after reporting unsafe or inadequate care in their hospitals and clinics.

W. Harry Horner, M.D., an internist from Waynesboro, Va., said that administrators at the state mental hospital where he worked trumped up charges against him after he raised serious patient safety issues and refused to stop documenting lack of appropriate care on patient charts.

“I just said this is unacceptable,” Dr. Horner told this newspaper.

He was dismissed in May 2001 on charges of abuse and neglect of a patient, failing to follow a supervisor's instructions, and violating an employee's confidentiality.

Dr. Horner sued the state on the grounds that the hospital short-circuited the state's normal grievance process by not allowing his immediate supervisor, who disagreed with the charges, to reinstate him immediately.

Last June, the Virginia Supreme Court ruled in Dr. Horner's favor and ordered the state to pay him back wages and benefits and reinstate him at Western State Hospital in Staunton. The state asked for a rehearing of the case, but the Virginia Supreme Court refused.

Martha Mead, director of legislation and public relations at the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services, said she couldn't discuss the ongoing litigation concerning Dr. Horner.

But she noted that the Western State facility is fully accredited and was released from oversight by the Department of Justice last year. The hospital is nationally recognized for its work in psychosocial rehabilitation, she said.

During his legal battle, Dr. Horner has been following 35-40 similar cases across the country and says he's not alone in facing retaliation. “This wasn't a personal thing or a local phenomenon,” he said.

Although federal law offers whistleblowers some protections, there is little relief at the state level. And it takes years to get a remedy in court, Dr. Horner explained.

“It's a huge problem,” said Reuben Guttman, a lawyer in New York who has litigated several cases involving the federal False Claims Act.

But there are legal avenues for physicians to pursue if they observe quality problems or wrongdoing. Physicians can submit a claim under the federal False Claims Act, which protects workers who report fraud.

Protection under the False Claims Act also can include reports of quality problems since it is considered fraud for hospitals to file claims to Medicare and Medicaid if they are not in compliance with a broad range of regulations that include quality issues, Mr. Guttman said.

Many states have also adopted a general exception to the “employee at will” provision of employment law, stating that an employee can't be terminated if the employee's actions further a public policy such as reporting wrongdoing.

Many physicians just aren't aware that they have these rights, Mr. Guttman said.

But Eric W. Springer, counsel with a Pittsburgh law firm that works with hospitals and their medical staffs, said the problem is not widespread.

Although there are legitimate whistleblowers, more often physicians use quality claims as a defense when their behavior is identified as disruptive, he said.

“The disruptive doctor uses the whistleblower flag as a cover for his own behavior,” Mr. Springer said.

Danae Powers, M.D., an anesthesiologist working in State College, Pa., said she was labeled as disruptive when she raised quality of care issues at Centre Community Hospital in State College, now renamed Mount Nittany Medical Center.

Even after settling lawsuits that she had brought against the hospital arising from her concerns over alleged negligent care, she concluded that she didn't accomplish what she set out to do–making it easier for physicians to voice their concerns.

“If doctors can't speak up to protect patients then patients aren't getting the best care,” Dr. Powers said.

Officials at Mount Nittany Medical Center said Dr. Powers was not the victim of retaliation, and they stand by their efforts to encourage communication between physicians and administrators.

“We are very proud of our patient care and safety at Mount Nittany Medical Center,” said hospital spokeswoman Maureen Karstetter. “We pride ourselves on open physician-hospital communications.”

The hospital has a patient safety committee made up of hospital administration, physicians, and community members.

The hospital also has in place a telephone hotline for anonymous quality complaints from physicians and the public, a nonpunitive reporting policy for physicians, a joint conference committee that includes physicians and members of the hospital's board of trustees, and an ethics committee composed mostly of physicians, Ms. Karstetter said.

Hospitals have a great deal of financial and other power over physician practices from referrals up to the ability to list physicians in the National Practitioner Data Bank, Dr. Powers said. “The data bank is the ultimate threat to physicians.”

In hospitals with a culture of safety this isn't a problem, Dr. Powers said, but there are some hospitals where economics are placed above patient care.

Dr. Powers proposes doing away with the databank and introducing external, financially independent, and specialty-specific peer review to hospitals.

For example, a thoracic surgeon should be able to call the Board of Thoracic Surgery to request a review of a patient safety issue, she said.

This system could mimic the Accreditation Council for Graduate Medical Education reviews that already occur in teaching programs.

In addition, if hospitals want to strip physicians of credentials, the institution should allow physicians to call for a review of the entire department by the specialty society, Dr. Powers said.

The American Hospital Association urges physicians and other hospital employees who have seen an error or a potential risk to report that without fear of retaliation, said Don Nielsen, M.D., senior vice president for quality at the AHA.

It is “unacceptable” for hospital administration to punish someone for reporting, he said.

To prevent this, all hospitals have an appeals process in place if privileges are restricted or if a physician is fired, Dr. Nielsen said.

For its part, AHA has been providing tools to hospitals to encourage the creation of a culture of safety.

Changing the culture won't happen overnight, said Paul Schyve, M.D., who is senior vice president at the Joint Commission on Accreditation of Healthcare Organizations.

“Hospitals are making clear positive steps in that direction,” he said.

But the legal culture of the United States continues in the name, blame, and shame culture, Dr. Schyve said.

Congress is beginning to address this through patient safety legislation, he added.

In March, the Senate's Health, Education, Labor, and Pensions Committee approved the Patient Safety and Quality Improvement Act (S. 544). The bill would allow hospitals and physicians to report information to a patient safety organization without its being disclosed and used against them in court.

In addition, the legislation would prohibit employers from taking action against an employee who makes a report.

The bill still needs approval from the full Senate and House. In the last Congress, the House and Senate each passed versions of this legislation but could not come to agreement on a final bill.

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, an Alexandria, Va.-based company that sells health savings accounts.

“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 that with a program that also 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 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, can also create 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 may simply forego needed medical care because they can't afford to pay for it.

Actions such as those 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, an Alexandria, Va.-based company that sells health savings accounts.

“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 that with a program that also 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 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, can also create 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 may simply forego needed medical care because they can't afford to pay for it.

Actions such as those 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, an Alexandria, Va.-based company that sells health savings accounts.

“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 that with a program that also 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 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, can also create 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 may simply forego needed medical care because they can't afford to pay for it.

Actions such as those 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.

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 an individual 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, he said.

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.

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 an individual 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, he said.

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.

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 an individual 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, he said.

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.

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.

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.

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.

WASHINGTON – Medicare managed care plans, known as Medicare Advantage, can now design targeted health plans for low-income and institutionalized patients.

“Those are the beneficiaries who have the most to gain from our health care system but only if they get help in maneuvering the complexity and putting all the different kinds of services that they need to receive together in an effective way,” said Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services.

Under a provision in the 2003 Medicare Modernization Act, Medicare Advantage plans can limit enrollment to beneficiaries who are dually eligible for Medicare and Medicaid, or long-term institutionalized beneficiaries.

Already health plans are starting to take advantage of the new provisions, Dr. McClellan said at a meeting on Medicare and Medicaid sponsored by America's Health Insurance Plans.

This new option is a key way for Medicare, which was designed to care for acute problems, to begin addressing the increasing needs of low-income and frail seniors, said Patricia Smith, director of the Medicare Advantage Group at CMS.

“It's a baby step for the program, but it's a very important one,” she said.

CMS has issued interim guidance on special needs plans for “dual eligible” and institutionalized beneficiaries and is preparing a final regulation on the special needs plans, said Danielle Moon, director of the division of enrollment and eligibility policy at the CMS Center for Beneficiary Choices.

Under interim guidance released by CMS, health plans have to offer the specialty plan to the entire group of dual eligibles, instead of targeting a subset of that group. Plans can't just target the Qualified Medicare Beneficiaries or the Special Low-income Medicare Beneficiaries, Ms. Moon said.

WASHINGTON – Medicare managed care plans, known as Medicare Advantage, can now design targeted health plans for low-income and institutionalized patients.

“Those are the beneficiaries who have the most to gain from our health care system but only if they get help in maneuvering the complexity and putting all the different kinds of services that they need to receive together in an effective way,” said Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services.

Under a provision in the 2003 Medicare Modernization Act, Medicare Advantage plans can limit enrollment to beneficiaries who are dually eligible for Medicare and Medicaid, or long-term institutionalized beneficiaries.

Already health plans are starting to take advantage of the new provisions, Dr. McClellan said at a meeting on Medicare and Medicaid sponsored by America's Health Insurance Plans.

This new option is a key way for Medicare, which was designed to care for acute problems, to begin addressing the increasing needs of low-income and frail seniors, said Patricia Smith, director of the Medicare Advantage Group at CMS.

“It's a baby step for the program, but it's a very important one,” she said.

CMS has issued interim guidance on special needs plans for “dual eligible” and institutionalized beneficiaries and is preparing a final regulation on the special needs plans, said Danielle Moon, director of the division of enrollment and eligibility policy at the CMS Center for Beneficiary Choices.

Under interim guidance released by CMS, health plans have to offer the specialty plan to the entire group of dual eligibles, instead of targeting a subset of that group. Plans can't just target the Qualified Medicare Beneficiaries or the Special Low-income Medicare Beneficiaries, Ms. Moon said.

WASHINGTON – Medicare managed care plans, known as Medicare Advantage, can now design targeted health plans for low-income and institutionalized patients.

“Those are the beneficiaries who have the most to gain from our health care system but only if they get help in maneuvering the complexity and putting all the different kinds of services that they need to receive together in an effective way,” said Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services.

Under a provision in the 2003 Medicare Modernization Act, Medicare Advantage plans can limit enrollment to beneficiaries who are dually eligible for Medicare and Medicaid, or long-term institutionalized beneficiaries.

Already health plans are starting to take advantage of the new provisions, Dr. McClellan said at a meeting on Medicare and Medicaid sponsored by America's Health Insurance Plans.

This new option is a key way for Medicare, which was designed to care for acute problems, to begin addressing the increasing needs of low-income and frail seniors, said Patricia Smith, director of the Medicare Advantage Group at CMS.

“It's a baby step for the program, but it's a very important one,” she said.

CMS has issued interim guidance on special needs plans for “dual eligible” and institutionalized beneficiaries and is preparing a final regulation on the special needs plans, said Danielle Moon, director of the division of enrollment and eligibility policy at the CMS Center for Beneficiary Choices.

Under interim guidance released by CMS, health plans have to offer the specialty plan to the entire group of dual eligibles, instead of targeting a subset of that group. Plans can't just target the Qualified Medicare Beneficiaries or the Special Low-income Medicare Beneficiaries, Ms. Moon 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 an individual 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, he said.

Mr. Breaux predicted 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.

Although 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 commented at the meeting.

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 an individual 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, he said.

Mr. Breaux predicted 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.

Although 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 commented at the meeting.

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 an individual 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, he said.

Mr. Breaux predicted 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.

Although 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 commented at the meeting.

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

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

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

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

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

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

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

Eric B. Larson, M.D., an internist in Seattle, and chair of the American College of Physicians' Board of Regents, said he's not too surprised by the findings. And he said they are important because they point to the need for internists to acquire and maintain the necessary dermatology skills.

For some physicians, that may mean shadowing a dermatologist to hone biopsy skills. "The key thing is to keep up the skill," Dr. Larson said.

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

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

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

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

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

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

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

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

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

Eric B. Larson, M.D., an internist in Seattle, and chair of the American College of Physicians' Board of Regents, said he's not too surprised by the findings. And he said they are important because they point to the need for internists to acquire and maintain the necessary dermatology skills.

For some physicians, that may mean shadowing a dermatologist to hone biopsy skills. "The key thing is to keep up the skill," Dr. Larson said.

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

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

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

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

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

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

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

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

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

Eric B. Larson, M.D., an internist in Seattle, and chair of the American College of Physicians' Board of Regents, said he's not too surprised by the findings. And he said they are important because they point to the need for internists to acquire and maintain the necessary dermatology skills.

For some physicians, that may mean shadowing a dermatologist to hone biopsy skills. "The key thing is to keep up the skill," Dr. Larson said.

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

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

NEW ORLEANS — A simple form could be all that you need to help ease the flow of communication with your primary care referrers, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at the university in Winston-Salem, N.C., helped to design the form. Dr. Feldman, who is also a solo dermatologist in Mount Airy, N.C., understands firsthand the difficulties in communicating information to the primary care physicians who refer patients to him.

It can take 7-10 days in some cases before the primary care doctor receives a report from the dermatologist. In the meantime, many patients have returned to their primary care physician's office before the report on their visit, he said.

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.

He and his colleagues at Wake Forest set out to design a form that would include the most important information. Their study was supported by Galderma Laboratories.

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 is designed to be filled out at the point of care and can be faxed to the referring physician.

To make the process more efficient from the dermatologist's standpoint, he tracked his most frequently prescribed medications and added them to the form with a check box next to each one.

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

Dr. Feldman told this newspaper that he plans to use the form in his practice and to 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.

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 the form is a potential way to eliminate those delays.

Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study agrees. "The concept of the form is fantastic," he told this newspaper.

In his experience, it can take up to 3 weeks to get information from specialists, and when the information arrives, it's usually in the form of several pages of office notes. 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 the opportunity to look for drug-drug interactions with the patient's other medications.

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 his office, Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J., 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 referrer in the morning. "They want it fast," Dr. Eastern told this newspaper. "That's the No. 1 thing for them."

The dermatology referral form can be accessed at http://www.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN

NEW ORLEANS — A simple form could be all that you need to help ease the flow of communication with your primary care referrers, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at the university in Winston-Salem, N.C., helped to design the form. Dr. Feldman, who is also a solo dermatologist in Mount Airy, N.C., understands firsthand the difficulties in communicating information to the primary care physicians who refer patients to him.

It can take 7-10 days in some cases before the primary care doctor receives a report from the dermatologist. In the meantime, many patients have returned to their primary care physician's office before the report on their visit, he said.

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.

He and his colleagues at Wake Forest set out to design a form that would include the most important information. Their study was supported by Galderma Laboratories.

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 is designed to be filled out at the point of care and can be faxed to the referring physician.

To make the process more efficient from the dermatologist's standpoint, he tracked his most frequently prescribed medications and added them to the form with a check box next to each one.

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

Dr. Feldman told this newspaper that he plans to use the form in his practice and to 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.

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 the form is a potential way to eliminate those delays.

Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study agrees. "The concept of the form is fantastic," he told this newspaper.

In his experience, it can take up to 3 weeks to get information from specialists, and when the information arrives, it's usually in the form of several pages of office notes. 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 the opportunity to look for drug-drug interactions with the patient's other medications.

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 his office, Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J., 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 referrer in the morning. "They want it fast," Dr. Eastern told this newspaper. "That's the No. 1 thing for them."

The dermatology referral form can be accessed at http://www.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN

NEW ORLEANS — A simple form could be all that you need to help ease the flow of communication with your primary care referrers, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at the university in Winston-Salem, N.C., helped to design the form. Dr. Feldman, who is also a solo dermatologist in Mount Airy, N.C., understands firsthand the difficulties in communicating information to the primary care physicians who refer patients to him.

It can take 7-10 days in some cases before the primary care doctor receives a report from the dermatologist. In the meantime, many patients have returned to their primary care physician's office before the report on their visit, he said.

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.

He and his colleagues at Wake Forest set out to design a form that would include the most important information. Their study was supported by Galderma Laboratories.

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 is designed to be filled out at the point of care and can be faxed to the referring physician.

To make the process more efficient from the dermatologist's standpoint, he tracked his most frequently prescribed medications and added them to the form with a check box next to each one.

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

Dr. Feldman told this newspaper that he plans to use the form in his practice and to 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.

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 the form is a potential way to eliminate those delays.

Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study agrees. "The concept of the form is fantastic," he told this newspaper.

In his experience, it can take up to 3 weeks to get information from specialists, and when the information arrives, it's usually in the form of several pages of office notes. 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 the opportunity to look for drug-drug interactions with the patient's other medications.

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 his office, Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J., 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 referrer in the morning. "They want it fast," Dr. Eastern told this newspaper. "That's the No. 1 thing for them."

The dermatology referral form can be accessed at http://www.wfubmc.edu/dermatology/files/consultation_form.doc

COURTESY DR. STEVEN R. FELDMAN