Mary Ellen Schneider

NEW ORLEANS — Dermatologists are well qualified to interpret skin specimens based on their dermatopathology training, according to research presented at the annual meeting of the American Academy of Dermatology.

Researchers from Wake Forest University in Winston-Salem, N.C., found that dermatology residents gain more experience in dermatopathology than pathology residents and that there is more dermatopathology-related content in the dermatology literature than in pathology journals.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest, and his colleagues wanted to examine the qualifications of dermatologists in light of efforts in Ohio to allow only licensed pathologists to bill for the interpretation of pathology specimens.

The researchers examined the extent of dermatopathology training in pathology and dermatology residencies by quantifying hours of dermatopathology in pathology and dermatology programs across the United States. They also assessed the continuing medical education of dermatopathology by surveying principal journals in both fields.

Dr. Feldman and his colleagues contacted 151 anatomic and clinical pathology fellowship and residency programs and 108 dermatology programs by e-mail. They received responses from 51 dermatology programs and 59 pathology programs.

Dermatology residency programs reported an average of 570.4 hours of dermatopathology training over 3 years; pathology residencies averaged 216.5 hours over 4 years.

Pathology also fell short in terms of continuing medical education. For example, between May 2003 and May 2004, 40% of the articles and 31% of the clinical vignettes in the Archives of Dermatology contained dermatopathology content. This compares with Modern Pathology, which contained facets of dermatopathology in 14% of its articles.

But the researchers noted that it was difficult for program officials to tabulate the number of hours of dermatopathology training. In particular, it was hard to calculate the time spent outside the hospital studying or the time spent on case sign-outs.

Several pathologists told the researchers that a considerable portion of their dermatopathology training is mixed in with surgical pathology training as a whole. Elective time spent on dermatopathology was not included in the analysis.

The take-home message of the study is that dermatologists are "very good at what they choose to do," Dr. Feldman said, and they have at least as much training as pathologists.

"Physicians who are well trained and have appropriate expertise should not be excluded from providing medical services. Practicing dermatologists and the public should be confident knowing dermatologists have a strong background in dermatopathology," according to the research poster presented at the annual meeting of the American Academy of Dermatology. "Although much of the emphasis of training for dermatologists and pathologists differs, they share a common ground in dermatopathology."

The study was conducted by researchers at the Center for Dermatology Research at Wake Forest. The center is supported by an educational grant from Galderma Laboratories.

NEW ORLEANS — Dermatologists are well qualified to interpret skin specimens based on their dermatopathology training, according to research presented at the annual meeting of the American Academy of Dermatology.

Researchers from Wake Forest University in Winston-Salem, N.C., found that dermatology residents gain more experience in dermatopathology than pathology residents and that there is more dermatopathology-related content in the dermatology literature than in pathology journals.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest, and his colleagues wanted to examine the qualifications of dermatologists in light of efforts in Ohio to allow only licensed pathologists to bill for the interpretation of pathology specimens.

The researchers examined the extent of dermatopathology training in pathology and dermatology residencies by quantifying hours of dermatopathology in pathology and dermatology programs across the United States. They also assessed the continuing medical education of dermatopathology by surveying principal journals in both fields.

Dr. Feldman and his colleagues contacted 151 anatomic and clinical pathology fellowship and residency programs and 108 dermatology programs by e-mail. They received responses from 51 dermatology programs and 59 pathology programs.

Dermatology residency programs reported an average of 570.4 hours of dermatopathology training over 3 years; pathology residencies averaged 216.5 hours over 4 years.

Pathology also fell short in terms of continuing medical education. For example, between May 2003 and May 2004, 40% of the articles and 31% of the clinical vignettes in the Archives of Dermatology contained dermatopathology content. This compares with Modern Pathology, which contained facets of dermatopathology in 14% of its articles.

But the researchers noted that it was difficult for program officials to tabulate the number of hours of dermatopathology training. In particular, it was hard to calculate the time spent outside the hospital studying or the time spent on case sign-outs.

Several pathologists told the researchers that a considerable portion of their dermatopathology training is mixed in with surgical pathology training as a whole. Elective time spent on dermatopathology was not included in the analysis.

The take-home message of the study is that dermatologists are "very good at what they choose to do," Dr. Feldman said, and they have at least as much training as pathologists.

"Physicians who are well trained and have appropriate expertise should not be excluded from providing medical services. Practicing dermatologists and the public should be confident knowing dermatologists have a strong background in dermatopathology," according to the research poster presented at the annual meeting of the American Academy of Dermatology. "Although much of the emphasis of training for dermatologists and pathologists differs, they share a common ground in dermatopathology."

The study was conducted by researchers at the Center for Dermatology Research at Wake Forest. The center is supported by an educational grant from Galderma Laboratories.

NEW ORLEANS — Dermatologists are well qualified to interpret skin specimens based on their dermatopathology training, according to research presented at the annual meeting of the American Academy of Dermatology.

Researchers from Wake Forest University in Winston-Salem, N.C., found that dermatology residents gain more experience in dermatopathology than pathology residents and that there is more dermatopathology-related content in the dermatology literature than in pathology journals.

Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at Wake Forest, and his colleagues wanted to examine the qualifications of dermatologists in light of efforts in Ohio to allow only licensed pathologists to bill for the interpretation of pathology specimens.

The researchers examined the extent of dermatopathology training in pathology and dermatology residencies by quantifying hours of dermatopathology in pathology and dermatology programs across the United States. They also assessed the continuing medical education of dermatopathology by surveying principal journals in both fields.

Dr. Feldman and his colleagues contacted 151 anatomic and clinical pathology fellowship and residency programs and 108 dermatology programs by e-mail. They received responses from 51 dermatology programs and 59 pathology programs.

Dermatology residency programs reported an average of 570.4 hours of dermatopathology training over 3 years; pathology residencies averaged 216.5 hours over 4 years.

Pathology also fell short in terms of continuing medical education. For example, between May 2003 and May 2004, 40% of the articles and 31% of the clinical vignettes in the Archives of Dermatology contained dermatopathology content. This compares with Modern Pathology, which contained facets of dermatopathology in 14% of its articles.

But the researchers noted that it was difficult for program officials to tabulate the number of hours of dermatopathology training. In particular, it was hard to calculate the time spent outside the hospital studying or the time spent on case sign-outs.

Several pathologists told the researchers that a considerable portion of their dermatopathology training is mixed in with surgical pathology training as a whole. Elective time spent on dermatopathology was not included in the analysis.

The take-home message of the study is that dermatologists are "very good at what they choose to do," Dr. Feldman said, and they have at least as much training as pathologists.

"Physicians who are well trained and have appropriate expertise should not be excluded from providing medical services. Practicing dermatologists and the public should be confident knowing dermatologists have a strong background in dermatopathology," according to the research poster presented at the annual meeting of the American Academy of Dermatology. "Although much of the emphasis of training for dermatologists and pathologists differs, they share a common ground in dermatopathology."

The study was conducted by researchers at the Center for Dermatology Research at Wake Forest. The center is supported by an educational grant from Galderma Laboratories.

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.

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.

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.

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.

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.

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.

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.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior. "It became a real dilemma," Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach. They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

"We really try to tailor the program to the individual doctor," said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center, Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a "magic moment" in the program, said Dr. Harmon, chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. "This is not mental health treatment, this is physician development," Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they hear the collective voice of their team members reflected in the report.

It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties. "Typically, our physicians are not what you'd expect," she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. "We see a lot of perfectionism," Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. "It gives physicians a chance to see themselves as others see them, and maybe for the first time."

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Proper Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips on how to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with "teamwork."

▸ Let staff members know when they are doing a good job.

▸ Praise people in public and reprimand in private.

▸ Reprimand the mistake and not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, and body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember that what is funny to one person may be offensive to another.

▸ Avoid making any sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior. "It became a real dilemma," Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach. They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

"We really try to tailor the program to the individual doctor," said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center, Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a "magic moment" in the program, said Dr. Harmon, chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. "This is not mental health treatment, this is physician development," Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they hear the collective voice of their team members reflected in the report.

It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties. "Typically, our physicians are not what you'd expect," she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. "We see a lot of perfectionism," Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. "It gives physicians a chance to see themselves as others see them, and maybe for the first time."

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Proper Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips on how to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with "teamwork."

▸ Let staff members know when they are doing a good job.

▸ Praise people in public and reprimand in private.

▸ Reprimand the mistake and not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, and body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember that what is funny to one person may be offensive to another.

▸ Avoid making any sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior. "It became a real dilemma," Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach. They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

"We really try to tailor the program to the individual doctor," said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center, Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a "magic moment" in the program, said Dr. Harmon, chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. "This is not mental health treatment, this is physician development," Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they hear the collective voice of their team members reflected in the report.

It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties. "Typically, our physicians are not what you'd expect," she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. "We see a lot of perfectionism," Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. "It gives physicians a chance to see themselves as others see them, and maybe for the first time."

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Proper Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips on how to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with "teamwork."

▸ Let staff members know when they are doing a good job.

▸ Praise people in public and reprimand in private.

▸ Reprimand the mistake and not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, and body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember that what is funny to one person may be offensive to another.

▸ Avoid making any sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

"Nothing is more important to me than preserving the trust of the public in NIH," Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. "It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries."

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

"This new policy is an extension of a profession-wide examination of physicians' relationships to industry," said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

"Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures," Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. "The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists," AAMC President Jordan J. Cohen, M.D., said in statement.

"We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary."

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

"Nothing is more important to me than preserving the trust of the public in NIH," Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. "It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries."

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

"This new policy is an extension of a profession-wide examination of physicians' relationships to industry," said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

"Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures," Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. "The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists," AAMC President Jordan J. Cohen, M.D., said in statement.

"We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary."

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

"Nothing is more important to me than preserving the trust of the public in NIH," Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. "It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries."

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

"This new policy is an extension of a profession-wide examination of physicians' relationships to industry," said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

"Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures," Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. "The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists," AAMC President Jordan J. Cohen, M.D., said in statement.

"We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary."

SkinPAC Raises $185,000

Dermatologists raised $185,000 in the last election cycle as part of the American Academy of Dermatology Association's political action committee. SkinPAC, which raised the money from 205 AADA members, distributed the funds to 68 congressional candidates. The federal, nonpartisan PAC has focused on addressing physician payment issues, medical liability reform, increasing funding for skin disease research, and enacting indoor tanning legislation, according to Cynthia Yag-Howard, M.D., chair of SkinPAC board of advisors. Reporting on the PAC's progress at the AADA business meeting in February, Dr. Yag-Howard urged more dermatologists to give to the PAC. "It is an essential component in the reality of our political system," she said. "Your involvement equals visibility on the Hill. It equals credibility on the Hill and tangible results."

Bioterrorism Referral List

The American Academy of Dermatology is asking dermatologists with an interest or expertise in cutaneous manifestations of bioterrorism to add their names to a list of volunteers who might be called on to help in the evaluation and treatment of bioterrorism victims. The list is being compiled by the AAD's Bioterrorism Task Force, which was formed in October 2001 following the anthrax attacks. The task force members are still compiling names for the list, which they are currently planning to pass along to the Centers for Disease Control and Prevention. As of February, they had nearly 100 volunteers. For more information about the Bioterrorism Task Force or to add your name to the referral list, contact Connie Tegeler of the AAD at 847-240-1733 or e-mail

ctegeler@aad.org

Lip Cancer Awareness

The public is still unaware of the risks of lip cancer from sun exposure, according to a recent survey. While 94% of people surveyed said they were aware that unprotected sun exposure can damage the skin, only 70% said they knew about the risks for lip cancer. Since lip cancer is less prevalent, it has received less attention, even among health care professionals, according to Richard F. Wagner Jr., M.D., a dermatologic surgeon at the University of Texas, Galveston, and coauthor of the study published in the February issue of Dermatologic Surgery. Dr. Wagner and his colleagues surveyed 299 beachgoers and asked them about their awareness of skin cancer and lip cancer.

Eczema Impact

A majority of atopic eczema patients are in a state of constant concern over when their disease will flare up next, according to the results of a multinational survey called the International Study of Life With Atopic Eczema (ISOLATE). The data, which were presented at the annual meeting of the American Academy of Dermatology, are from a subset of 400 U.S. patients and caregivers. Only 24% of patients and 27% of caregivers said they are completely confident that they can manage the condition. The survey was developed by the National Eczema Association for Science and Education (NEASE) and other patient-focused organizations around the world. "This survey demonstrates the seriousness of the condition and the tremendous need for effective treatment options that patients can use safely to control their disease long term," NEASE CEO Vicki Kalabokes said in a statement.

Fiscal 2006 Budget Request

The president's 2006 budget request got mixed reviews from health care groups. Although some groups objected to a lack of appropriate funding for health professions programs, others decried the $60 billion in proposed cuts to Medicaid over the next 10 years. The Association of American Medical Colleges is opposed to cuts "that will further stretch the already taut health care safety net provided by teaching hospitals and medical school physicians," Jordan Cohen, M.D., AAMC president, said in a statement. Although pleased with a $300 million boost for community health centers, Daniel Hawkins of the National Association of Community Health Centers noted that proposed cuts to Medicaid and the National Health Service Corps presented a funding conflict. Not everyone was unhappy with the budget: The American Medical Association praised the budget's efforts to fund tax credit initiatives and expand health savings accounts.

States Meet Their Match

States have been known to recycle payments returned by health care providers to draw down additional federal dollars for Medicaid, and the feds are tired of it. The administration's budget request seeks to curb such tactics by only matching those funds kept by health care providers as payment for services. States also can make Medicaid payments to health care providers that are far in excess of the actual cost of services and then use the additional money to leverage federal reimbursements in excess of their Medicaid matching rate or for other purposes. To halt this misuse of funds, the government proposes to limit reimbursement to no more than the cost of providing services. Both proposals are expected to save $5.9 billion over 5 years. "None of these efforts should affect the way physicians get paid under Medicaid," Department of Health and Human Services spokesman Bill Pierce said in an interview.

Asian American Gays Surveyed

More than three-fourths of Asian Pacific American lesbian, gay, bisexual, and transgender (LGBT) people have experienced discrimination based on their sexual orientation, according to a study by the National Gay and Lesbian Task Force, an advocacy organization. As part of the largest study of this group ever undertaken, researchers surveyed 124 attendees at a regional LGBT conference and found that 82% had experienced such discrimination: 82% also had experienced discrimination based on their race or ethnicity, and 96% of respondents agreed that homophobia and transphobia is a problem within the Asian Pacific American community. "The lives of Asian Pacific American [LGBT] people involve a complex web of issues arising from being sexual, racial/ethnic, language, gender, immigrant, and economic minorities," said Glenn D. Magpantay, steering committee member of Gay Asian & Pacific Islander Men of New York.

Cost of New Drug Benefit

National health care spending costs will remain stable during the next 10 years, though public programs will account for half of total spending, in part because of the new Medicare Part D prescription drug benefit, according to a report by the Centers for Medicare and Medicaid Services. The agency claims the drug benefit—which kicks in next January—is expected to "significantly" increase prescription drug use and reduce out-of-pocket spending for older patients without causing any major increase in the health care spending trend. However, the new benefit will result in a significant shift in funding from private payers and Medicaid to Medicare. Medicare spending is projected to grow almost 8% in 2004 and 8.5% in 2005, because of several changes in the program under the Medicare Modernization Act, such as positive physician updates and higher Medicare Advantage payment rates.

SkinPAC Raises $185,000

Dermatologists raised $185,000 in the last election cycle as part of the American Academy of Dermatology Association's political action committee. SkinPAC, which raised the money from 205 AADA members, distributed the funds to 68 congressional candidates. The federal, nonpartisan PAC has focused on addressing physician payment issues, medical liability reform, increasing funding for skin disease research, and enacting indoor tanning legislation, according to Cynthia Yag-Howard, M.D., chair of SkinPAC board of advisors. Reporting on the PAC's progress at the AADA business meeting in February, Dr. Yag-Howard urged more dermatologists to give to the PAC. "It is an essential component in the reality of our political system," she said. "Your involvement equals visibility on the Hill. It equals credibility on the Hill and tangible results."

Bioterrorism Referral List

The American Academy of Dermatology is asking dermatologists with an interest or expertise in cutaneous manifestations of bioterrorism to add their names to a list of volunteers who might be called on to help in the evaluation and treatment of bioterrorism victims. The list is being compiled by the AAD's Bioterrorism Task Force, which was formed in October 2001 following the anthrax attacks. The task force members are still compiling names for the list, which they are currently planning to pass along to the Centers for Disease Control and Prevention. As of February, they had nearly 100 volunteers. For more information about the Bioterrorism Task Force or to add your name to the referral list, contact Connie Tegeler of the AAD at 847-240-1733 or e-mail

ctegeler@aad.org

Lip Cancer Awareness

The public is still unaware of the risks of lip cancer from sun exposure, according to a recent survey. While 94% of people surveyed said they were aware that unprotected sun exposure can damage the skin, only 70% said they knew about the risks for lip cancer. Since lip cancer is less prevalent, it has received less attention, even among health care professionals, according to Richard F. Wagner Jr., M.D., a dermatologic surgeon at the University of Texas, Galveston, and coauthor of the study published in the February issue of Dermatologic Surgery. Dr. Wagner and his colleagues surveyed 299 beachgoers and asked them about their awareness of skin cancer and lip cancer.

Eczema Impact

A majority of atopic eczema patients are in a state of constant concern over when their disease will flare up next, according to the results of a multinational survey called the International Study of Life With Atopic Eczema (ISOLATE). The data, which were presented at the annual meeting of the American Academy of Dermatology, are from a subset of 400 U.S. patients and caregivers. Only 24% of patients and 27% of caregivers said they are completely confident that they can manage the condition. The survey was developed by the National Eczema Association for Science and Education (NEASE) and other patient-focused organizations around the world. "This survey demonstrates the seriousness of the condition and the tremendous need for effective treatment options that patients can use safely to control their disease long term," NEASE CEO Vicki Kalabokes said in a statement.

Fiscal 2006 Budget Request

The president's 2006 budget request got mixed reviews from health care groups. Although some groups objected to a lack of appropriate funding for health professions programs, others decried the $60 billion in proposed cuts to Medicaid over the next 10 years. The Association of American Medical Colleges is opposed to cuts "that will further stretch the already taut health care safety net provided by teaching hospitals and medical school physicians," Jordan Cohen, M.D., AAMC president, said in a statement. Although pleased with a $300 million boost for community health centers, Daniel Hawkins of the National Association of Community Health Centers noted that proposed cuts to Medicaid and the National Health Service Corps presented a funding conflict. Not everyone was unhappy with the budget: The American Medical Association praised the budget's efforts to fund tax credit initiatives and expand health savings accounts.

States Meet Their Match

States have been known to recycle payments returned by health care providers to draw down additional federal dollars for Medicaid, and the feds are tired of it. The administration's budget request seeks to curb such tactics by only matching those funds kept by health care providers as payment for services. States also can make Medicaid payments to health care providers that are far in excess of the actual cost of services and then use the additional money to leverage federal reimbursements in excess of their Medicaid matching rate or for other purposes. To halt this misuse of funds, the government proposes to limit reimbursement to no more than the cost of providing services. Both proposals are expected to save $5.9 billion over 5 years. "None of these efforts should affect the way physicians get paid under Medicaid," Department of Health and Human Services spokesman Bill Pierce said in an interview.

Asian American Gays Surveyed

More than three-fourths of Asian Pacific American lesbian, gay, bisexual, and transgender (LGBT) people have experienced discrimination based on their sexual orientation, according to a study by the National Gay and Lesbian Task Force, an advocacy organization. As part of the largest study of this group ever undertaken, researchers surveyed 124 attendees at a regional LGBT conference and found that 82% had experienced such discrimination: 82% also had experienced discrimination based on their race or ethnicity, and 96% of respondents agreed that homophobia and transphobia is a problem within the Asian Pacific American community. "The lives of Asian Pacific American [LGBT] people involve a complex web of issues arising from being sexual, racial/ethnic, language, gender, immigrant, and economic minorities," said Glenn D. Magpantay, steering committee member of Gay Asian & Pacific Islander Men of New York.

Cost of New Drug Benefit

National health care spending costs will remain stable during the next 10 years, though public programs will account for half of total spending, in part because of the new Medicare Part D prescription drug benefit, according to a report by the Centers for Medicare and Medicaid Services. The agency claims the drug benefit—which kicks in next January—is expected to "significantly" increase prescription drug use and reduce out-of-pocket spending for older patients without causing any major increase in the health care spending trend. However, the new benefit will result in a significant shift in funding from private payers and Medicaid to Medicare. Medicare spending is projected to grow almost 8% in 2004 and 8.5% in 2005, because of several changes in the program under the Medicare Modernization Act, such as positive physician updates and higher Medicare Advantage payment rates.

SkinPAC Raises $185,000

Dermatologists raised $185,000 in the last election cycle as part of the American Academy of Dermatology Association's political action committee. SkinPAC, which raised the money from 205 AADA members, distributed the funds to 68 congressional candidates. The federal, nonpartisan PAC has focused on addressing physician payment issues, medical liability reform, increasing funding for skin disease research, and enacting indoor tanning legislation, according to Cynthia Yag-Howard, M.D., chair of SkinPAC board of advisors. Reporting on the PAC's progress at the AADA business meeting in February, Dr. Yag-Howard urged more dermatologists to give to the PAC. "It is an essential component in the reality of our political system," she said. "Your involvement equals visibility on the Hill. It equals credibility on the Hill and tangible results."

Bioterrorism Referral List

The American Academy of Dermatology is asking dermatologists with an interest or expertise in cutaneous manifestations of bioterrorism to add their names to a list of volunteers who might be called on to help in the evaluation and treatment of bioterrorism victims. The list is being compiled by the AAD's Bioterrorism Task Force, which was formed in October 2001 following the anthrax attacks. The task force members are still compiling names for the list, which they are currently planning to pass along to the Centers for Disease Control and Prevention. As of February, they had nearly 100 volunteers. For more information about the Bioterrorism Task Force or to add your name to the referral list, contact Connie Tegeler of the AAD at 847-240-1733 or e-mail

ctegeler@aad.org

Lip Cancer Awareness

The public is still unaware of the risks of lip cancer from sun exposure, according to a recent survey. While 94% of people surveyed said they were aware that unprotected sun exposure can damage the skin, only 70% said they knew about the risks for lip cancer. Since lip cancer is less prevalent, it has received less attention, even among health care professionals, according to Richard F. Wagner Jr., M.D., a dermatologic surgeon at the University of Texas, Galveston, and coauthor of the study published in the February issue of Dermatologic Surgery. Dr. Wagner and his colleagues surveyed 299 beachgoers and asked them about their awareness of skin cancer and lip cancer.

Eczema Impact

A majority of atopic eczema patients are in a state of constant concern over when their disease will flare up next, according to the results of a multinational survey called the International Study of Life With Atopic Eczema (ISOLATE). The data, which were presented at the annual meeting of the American Academy of Dermatology, are from a subset of 400 U.S. patients and caregivers. Only 24% of patients and 27% of caregivers said they are completely confident that they can manage the condition. The survey was developed by the National Eczema Association for Science and Education (NEASE) and other patient-focused organizations around the world. "This survey demonstrates the seriousness of the condition and the tremendous need for effective treatment options that patients can use safely to control their disease long term," NEASE CEO Vicki Kalabokes said in a statement.

Fiscal 2006 Budget Request

The president's 2006 budget request got mixed reviews from health care groups. Although some groups objected to a lack of appropriate funding for health professions programs, others decried the $60 billion in proposed cuts to Medicaid over the next 10 years. The Association of American Medical Colleges is opposed to cuts "that will further stretch the already taut health care safety net provided by teaching hospitals and medical school physicians," Jordan Cohen, M.D., AAMC president, said in a statement. Although pleased with a $300 million boost for community health centers, Daniel Hawkins of the National Association of Community Health Centers noted that proposed cuts to Medicaid and the National Health Service Corps presented a funding conflict. Not everyone was unhappy with the budget: The American Medical Association praised the budget's efforts to fund tax credit initiatives and expand health savings accounts.

States Meet Their Match

States have been known to recycle payments returned by health care providers to draw down additional federal dollars for Medicaid, and the feds are tired of it. The administration's budget request seeks to curb such tactics by only matching those funds kept by health care providers as payment for services. States also can make Medicaid payments to health care providers that are far in excess of the actual cost of services and then use the additional money to leverage federal reimbursements in excess of their Medicaid matching rate or for other purposes. To halt this misuse of funds, the government proposes to limit reimbursement to no more than the cost of providing services. Both proposals are expected to save $5.9 billion over 5 years. "None of these efforts should affect the way physicians get paid under Medicaid," Department of Health and Human Services spokesman Bill Pierce said in an interview.

Asian American Gays Surveyed

More than three-fourths of Asian Pacific American lesbian, gay, bisexual, and transgender (LGBT) people have experienced discrimination based on their sexual orientation, according to a study by the National Gay and Lesbian Task Force, an advocacy organization. As part of the largest study of this group ever undertaken, researchers surveyed 124 attendees at a regional LGBT conference and found that 82% had experienced such discrimination: 82% also had experienced discrimination based on their race or ethnicity, and 96% of respondents agreed that homophobia and transphobia is a problem within the Asian Pacific American community. "The lives of Asian Pacific American [LGBT] people involve a complex web of issues arising from being sexual, racial/ethnic, language, gender, immigrant, and economic minorities," said Glenn D. Magpantay, steering committee member of Gay Asian & Pacific Islander Men of New York.

Cost of New Drug Benefit

National health care spending costs will remain stable during the next 10 years, though public programs will account for half of total spending, in part because of the new Medicare Part D prescription drug benefit, according to a report by the Centers for Medicare and Medicaid Services. The agency claims the drug benefit—which kicks in next January—is expected to "significantly" increase prescription drug use and reduce out-of-pocket spending for older patients without causing any major increase in the health care spending trend. However, the new benefit will result in a significant shift in funding from private payers and Medicaid to Medicare. Medicare spending is projected to grow almost 8% in 2004 and 8.5% in 2005, because of several changes in the program under the Medicare Modernization Act, such as positive physician updates and higher Medicare Advantage payment rates.

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.

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

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

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

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

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

But the problem isn't how much money is being spent on the system, he said; it's the way the system is organized. Currently, most individuals receive their health coverage either through their employer or through Medicare, Medicaid, or the Department of Veterans Affairs.

If they don't fit into one of these eligible groups, or their employer doesn't provide coverage, they are unlikely to be insured.

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

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

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

Under such a system, if 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.

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

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

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

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

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

But the problem isn't how much money is being spent on the system, he said; it's the way the system is organized. Currently, most individuals receive their health coverage either through their employer or through Medicare, Medicaid, or the Department of Veterans Affairs.

If they don't fit into one of these eligible groups, or their employer doesn't provide coverage, they are unlikely to be insured.

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

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

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

Under such a system, if 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.

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

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

Alcohol Use During Pregnancy

Pregnant women and women who may become pregnant should abstain from alcohol consumption to prevent the effects of fetal alcohol spectrum disorders, the Surgeon General has advised. This updates the 1981 Surgeon General advisory that suggested that pregnant women limit the amount of alcohol they drink. “We do not know what, if any, amount of alcohol is safe,” U.S. Surgeon General Richard H. Carmona, M.D., said in a statement. “But we do know that the risk of a baby being born with any of the fetal alcohol spectrum disorders increases with the amount of alcohol a pregnant woman drinks, as does the likely severity of the condition. And when a pregnant women drinks alcohol, so does her baby. Therefore, it's in the child's best interest for a pregnant woman to simply not drink alcohol.” Since studies indicate that a baby could be affected by alcohol consumption within the earliest weeks after conception, the Surgeon General recommends that women who are considering becoming pregnant should abstain from alcohol. Women of childbearing age should consult their physicians and take steps to reduce the possibility of prenatal alcohol exposure. In addition, the Surgeon General recommended that health professionals routinely inquire about alcohol consumption by women of childbearing age and advise them not to drink alcoholic beverages during pregnancy.

Investigating Cesarean Rates

The American College of Nurse-Midwives is calling on Congress to investigate what it calls the “alarming” increases in the rate of cesarean births in the United States. “ACNM feels strongly that the cesarean rate is heading in the wrong direction,” the group's president, Katherine Camacho Carr, Ph.D., said in a letter to Sen. Mike Enzi (R-Wyo.), chairman of the Senate Health, Education, Labor & Pensions Committee, and Rep. Joe Barton (R-Tex.), chairman of the House Energy and Commerce Committee. ACNM noted that more than 27% of all births in 2003 were delivered via cesarean section. The group is asking Congress to examine the long-term implications for women's health and the costs of obstetric care.

Increasing HIV Screening

HIV screening efforts should be expanded, according to the Society for Women's Health Research. The group echoed the conclusions of two studies in the Feb. 10 issue of the New England Journal of Medicine on expanding screening on the basis of cost and clinical effectiveness. “So many adult women in the United States, including those over the age of 50 do not realize that they are at risk,” Phyllis Greenberger, president of the Society for Women's Health Research, said in a statement. “HIV infection rates among heterosexual women, especially minority women, are rising. The increased availability of voluntary screening in clinics and doctors' offices will raise awareness of the issue and provide opportunities for early intervention if the virus is present.” Increased screening will be a positive addition, Ms. Greenberger said, as long as the screening is voluntary and private, and as long as patients are protected from discrimination.

Legislating Sex Education

Democrats in Congress are offering an alternative to the Bush Administration's proposal to spend $206 million on abstinence-only education. Rep. Barbara Lee (D-Calif.) and Sen. Frank Lautenberg (D-N.J.) have introduced the “Responsible Education About Life” Act (H.R. 768) that would provide funding to states for programs that include information about both abstinence and contraception. The bill would create a grant program administered by the Health and Human Services Department that would award $206 million each year to states for comprehensive sex education. There are three federal programs that fund abstinence-only-until-marriage programs, but no federal funding currently exists specifically for comprehensive programs, according to Rep. Lee.

Perceptions of the Drug Industry

Prescription drugs may be improving patients' lives, but 70% of 1,201 adults polled in a Kaiser Family Foundation survey thought the drug industry cared more about profits than people. Only 24% thought the companies were most concerned with developing new drugs that save lives and improve quality of life. Nearly 60% said prescription drugs increased overall medical costs because they were so expensive, compared with the 23% who said drugs lowered medical costs by reducing the need for expensive medical procedures and hospitalizations. In an earlier poll, Kaiser found that people were more likely to cite drug company profits than other causes as the major cost of rising health care. While not as popular as physicians or hospitals, drug companies were viewed more favorably than oil or tobacco companies, according to the survey.

Alcohol Use During Pregnancy

Pregnant women and women who may become pregnant should abstain from alcohol consumption to prevent the effects of fetal alcohol spectrum disorders, the Surgeon General has advised. This updates the 1981 Surgeon General advisory that suggested that pregnant women limit the amount of alcohol they drink. “We do not know what, if any, amount of alcohol is safe,” U.S. Surgeon General Richard H. Carmona, M.D., said in a statement. “But we do know that the risk of a baby being born with any of the fetal alcohol spectrum disorders increases with the amount of alcohol a pregnant woman drinks, as does the likely severity of the condition. And when a pregnant women drinks alcohol, so does her baby. Therefore, it's in the child's best interest for a pregnant woman to simply not drink alcohol.” Since studies indicate that a baby could be affected by alcohol consumption within the earliest weeks after conception, the Surgeon General recommends that women who are considering becoming pregnant should abstain from alcohol. Women of childbearing age should consult their physicians and take steps to reduce the possibility of prenatal alcohol exposure. In addition, the Surgeon General recommended that health professionals routinely inquire about alcohol consumption by women of childbearing age and advise them not to drink alcoholic beverages during pregnancy.

Investigating Cesarean Rates

The American College of Nurse-Midwives is calling on Congress to investigate what it calls the “alarming” increases in the rate of cesarean births in the United States. “ACNM feels strongly that the cesarean rate is heading in the wrong direction,” the group's president, Katherine Camacho Carr, Ph.D., said in a letter to Sen. Mike Enzi (R-Wyo.), chairman of the Senate Health, Education, Labor & Pensions Committee, and Rep. Joe Barton (R-Tex.), chairman of the House Energy and Commerce Committee. ACNM noted that more than 27% of all births in 2003 were delivered via cesarean section. The group is asking Congress to examine the long-term implications for women's health and the costs of obstetric care.

Increasing HIV Screening

HIV screening efforts should be expanded, according to the Society for Women's Health Research. The group echoed the conclusions of two studies in the Feb. 10 issue of the New England Journal of Medicine on expanding screening on the basis of cost and clinical effectiveness. “So many adult women in the United States, including those over the age of 50 do not realize that they are at risk,” Phyllis Greenberger, president of the Society for Women's Health Research, said in a statement. “HIV infection rates among heterosexual women, especially minority women, are rising. The increased availability of voluntary screening in clinics and doctors' offices will raise awareness of the issue and provide opportunities for early intervention if the virus is present.” Increased screening will be a positive addition, Ms. Greenberger said, as long as the screening is voluntary and private, and as long as patients are protected from discrimination.

Legislating Sex Education

Democrats in Congress are offering an alternative to the Bush Administration's proposal to spend $206 million on abstinence-only education. Rep. Barbara Lee (D-Calif.) and Sen. Frank Lautenberg (D-N.J.) have introduced the “Responsible Education About Life” Act (H.R. 768) that would provide funding to states for programs that include information about both abstinence and contraception. The bill would create a grant program administered by the Health and Human Services Department that would award $206 million each year to states for comprehensive sex education. There are three federal programs that fund abstinence-only-until-marriage programs, but no federal funding currently exists specifically for comprehensive programs, according to Rep. Lee.

Perceptions of the Drug Industry

Prescription drugs may be improving patients' lives, but 70% of 1,201 adults polled in a Kaiser Family Foundation survey thought the drug industry cared more about profits than people. Only 24% thought the companies were most concerned with developing new drugs that save lives and improve quality of life. Nearly 60% said prescription drugs increased overall medical costs because they were so expensive, compared with the 23% who said drugs lowered medical costs by reducing the need for expensive medical procedures and hospitalizations. In an earlier poll, Kaiser found that people were more likely to cite drug company profits than other causes as the major cost of rising health care. While not as popular as physicians or hospitals, drug companies were viewed more favorably than oil or tobacco companies, according to the survey.

Alcohol Use During Pregnancy

Pregnant women and women who may become pregnant should abstain from alcohol consumption to prevent the effects of fetal alcohol spectrum disorders, the Surgeon General has advised. This updates the 1981 Surgeon General advisory that suggested that pregnant women limit the amount of alcohol they drink. “We do not know what, if any, amount of alcohol is safe,” U.S. Surgeon General Richard H. Carmona, M.D., said in a statement. “But we do know that the risk of a baby being born with any of the fetal alcohol spectrum disorders increases with the amount of alcohol a pregnant woman drinks, as does the likely severity of the condition. And when a pregnant women drinks alcohol, so does her baby. Therefore, it's in the child's best interest for a pregnant woman to simply not drink alcohol.” Since studies indicate that a baby could be affected by alcohol consumption within the earliest weeks after conception, the Surgeon General recommends that women who are considering becoming pregnant should abstain from alcohol. Women of childbearing age should consult their physicians and take steps to reduce the possibility of prenatal alcohol exposure. In addition, the Surgeon General recommended that health professionals routinely inquire about alcohol consumption by women of childbearing age and advise them not to drink alcoholic beverages during pregnancy.

Investigating Cesarean Rates

The American College of Nurse-Midwives is calling on Congress to investigate what it calls the “alarming” increases in the rate of cesarean births in the United States. “ACNM feels strongly that the cesarean rate is heading in the wrong direction,” the group's president, Katherine Camacho Carr, Ph.D., said in a letter to Sen. Mike Enzi (R-Wyo.), chairman of the Senate Health, Education, Labor & Pensions Committee, and Rep. Joe Barton (R-Tex.), chairman of the House Energy and Commerce Committee. ACNM noted that more than 27% of all births in 2003 were delivered via cesarean section. The group is asking Congress to examine the long-term implications for women's health and the costs of obstetric care.

Increasing HIV Screening

HIV screening efforts should be expanded, according to the Society for Women's Health Research. The group echoed the conclusions of two studies in the Feb. 10 issue of the New England Journal of Medicine on expanding screening on the basis of cost and clinical effectiveness. “So many adult women in the United States, including those over the age of 50 do not realize that they are at risk,” Phyllis Greenberger, president of the Society for Women's Health Research, said in a statement. “HIV infection rates among heterosexual women, especially minority women, are rising. The increased availability of voluntary screening in clinics and doctors' offices will raise awareness of the issue and provide opportunities for early intervention if the virus is present.” Increased screening will be a positive addition, Ms. Greenberger said, as long as the screening is voluntary and private, and as long as patients are protected from discrimination.

Legislating Sex Education

Democrats in Congress are offering an alternative to the Bush Administration's proposal to spend $206 million on abstinence-only education. Rep. Barbara Lee (D-Calif.) and Sen. Frank Lautenberg (D-N.J.) have introduced the “Responsible Education About Life” Act (H.R. 768) that would provide funding to states for programs that include information about both abstinence and contraception. The bill would create a grant program administered by the Health and Human Services Department that would award $206 million each year to states for comprehensive sex education. There are three federal programs that fund abstinence-only-until-marriage programs, but no federal funding currently exists specifically for comprehensive programs, according to Rep. Lee.

Perceptions of the Drug Industry

Prescription drugs may be improving patients' lives, but 70% of 1,201 adults polled in a Kaiser Family Foundation survey thought the drug industry cared more about profits than people. Only 24% thought the companies were most concerned with developing new drugs that save lives and improve quality of life. Nearly 60% said prescription drugs increased overall medical costs because they were so expensive, compared with the 23% who said drugs lowered medical costs by reducing the need for expensive medical procedures and hospitalizations. In an earlier poll, Kaiser found that people were more likely to cite drug company profits than other causes as the major cost of rising health care. While not as popular as physicians or hospitals, drug companies were viewed more favorably than oil or tobacco companies, according to the survey.

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

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

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it more attractive for physicians to do so. “These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

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

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

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

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

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

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

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

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

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

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

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

“We do believe that this is a transitional technology,” he said. The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

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

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

In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it more attractive for physicians to do so. “These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

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

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

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

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

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

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

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

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

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

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

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

“We do believe that this is a transitional technology,” he said. The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

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

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

In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department will accept comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008.

Electronic prescribing is voluntary for physicians, but the aim of the standards is to make it more attractive for physicians to do so. “These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities,” HHS Secretary Mike Leavitt said in a statement.

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

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

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

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

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

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

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

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

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

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

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

“We do believe that this is a transitional technology,” he said. The project, which is the largest of its kind, could be a model for how to drive adoption of this technology, Dr. Mandel said.

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

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

Dr. Henke noted that ob.gyns. are already under pressure to drop obstetrics due to high premiums, low managed care payments, and now aggressive sanctioning of physicians by the state board.

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

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

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

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

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

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

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

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

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

“There was a lot of heat put on the state board,” said Dave Kittrell, M.D., chair of the Texas section of the American College of Obstetricians and Gynecologists.

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

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

Once the state medical board begins to meddle in clinical decision making, there could be dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board. But there is a sense that some investigations have been “heavy handed” toward physicians, he said.

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

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

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

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months. “This process is not one day you get a complaint and the next day you're in chains,” he said.

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

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

“The point is that it is a balancing act. Many cases are balancing acts. It's a tension between the doctors and the public,” he said.

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

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

Dr. Henke noted that ob.gyns. are already under pressure to drop obstetrics due to high premiums, low managed care payments, and now aggressive sanctioning of physicians by the state board.

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

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

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

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

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

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

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

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

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

“There was a lot of heat put on the state board,” said Dave Kittrell, M.D., chair of the Texas section of the American College of Obstetricians and Gynecologists.

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

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

Once the state medical board begins to meddle in clinical decision making, there could be dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board. But there is a sense that some investigations have been “heavy handed” toward physicians, he said.

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

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

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

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months. “This process is not one day you get a complaint and the next day you're in chains,” he said.

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

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

“The point is that it is a balancing act. Many cases are balancing acts. It's a tension between the doctors and the public,” he said.

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

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

Dr. Henke noted that ob.gyns. are already under pressure to drop obstetrics due to high premiums, low managed care payments, and now aggressive sanctioning of physicians by the state board.

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

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

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

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

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

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

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

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

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

“There was a lot of heat put on the state board,” said Dave Kittrell, M.D., chair of the Texas section of the American College of Obstetricians and Gynecologists.

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

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

Once the state medical board begins to meddle in clinical decision making, there could be dangerous consequences, he said.

The Texas Medical Association has pushed for a strong state medical board and wanted the board to have increased funding and better investigative powers, said Paul B. Handel, M.D., a member of the Texas Medical Association's board of trustees and chair of the ad hoc committee on Sunset Review of the State Board of Medical Examiners, which has spent the last year assessing the board. But there is a sense that some investigations have been “heavy handed” toward physicians, he said.

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

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

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

But Dr. Patrick maintains that the new system provides more opportunities than ever for the physician to offer evidence in their defense. The process is deliberative and takes about 9 months. “This process is not one day you get a complaint and the next day you're in chains,” he said.

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

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

“The point is that it is a balancing act. Many cases are balancing acts. It's a tension between the doctors and the public,” he said.