Mary Ellen Schneider

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician's care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

GRAPEVINE, TEX.  – Hospitalist salaries continue to rise, according to new data from a survey of more than 400 community hospitalist practices.

Nationally, hospitalist compensation was up 3% in 2010, with hospitalists earning on average between $212,000 and $246,000 depending on the area of the country where they worked.

The change from 2009 isn’t especially significant, Dr. John Nelson, a past president of the Society of Hospital Medicine, said in an interview. But it continues the trend over the past decade of rising salaries. That rise has been fueled partially because the demand for hospitalists continues to outstrip the supply, he said. Hospitalists’ productivity has also generally been increasing over the years, leading to greater compensation. And some of the rise is simply the result of cost of living increases and inflation, said Dr. Nelson, who presented the survey data at the SHM annual meeting.

The survey findings provide some interesting macro-level trend data, but compensation is usually determined by market forces on a "micro" level, Dr. Robert Bessler, president and CEO of Sound Physicians, said during a discussion on the survey findings at the annual meeting. He said it’s unlikely that salaries will decline anytime soon since demand for high-quality physicians is likely to remain high.

The survey, which was conducted jointly by SHM and the Medical Group Management Association, includes responses from 414 hospital medicine practices, representing 4,666 adult hospitalists. For the first time, the survey does not include academic practices. The survey, which includes 2010 fiscal year data, asked respondents to report their total compensation, including bonuses. Additional data will be released in September.

The survey also sheds some light on how productive hospitalists were in 2010. The figures are about the same as in 2009. Hospitalists in the Northeast and Southeast did the most work, as measured by billable encounters and work relative value units (RVUs). In the Northeast, hospitalists on average had 2,297 billable encounters annually with 4,092 work RVUs. In the Southeast, hospitalists reported 2,747 annual encounters on average, with 4,931 work RVUs. Annual productivity was slightly lower in the West and Midwest regions, where hospitalists reported on average 1,745 encounters (3,892 work RVUs) and 1,928 encounters (3,858 work RVUs) respectively.

The productivity figures also help to put the salary numbers in perspective, Dr. Nelson explained. By combining the productivity and salary figures, Dr. Nelson explained the "juice-to-squeeze" ratio or the compensation per work RVU. While hospitalists in the Southeast earn the highest annual salaries on average at $246,000, they also have the highest number of work RVUs. That means that hospitalists in the Southeast region actually have the lowest compensation for each unit of work at $52/work RVU. Hospitalists in the Midwest did the best under the juice-to-squeeze ratio at $56/work RVU, even though they in the middle of the pack salary wise at $224,000 annually.

Hospitalists in the Northeast and the West had similar salaries and earnings per work RVU. Those working in the Northeast had average salaries of $212,000 a year or $54/work RVU; while hospitalists in the West earned $213,000 a year or $55/unit of work.

Dr. Nelson said not enough people take the work component into account when evaluating salaries. "It would be like focusing on someone’s weight without also considering their height," he said in an interview. "You have to put both numbers together if you really want to know the situation."

The survey also looked at support for hospitalist programs. In 2010, the level of hospital support reached $132,000 annually for each full-time employee, up from $98,000 in 2009. Dr. Nelson said he’s unsure why the support figured jumped so much in a single year. The economic downturn and the increase in uninsured patients could result for part of that increase, he said. Since, in most cases, hospitals make up the difference between what programs bring in and what’s needed to operate, a drop in collections might explain some of the change. But some of the increase may simply be due to a change in the survey between 2009 and 2010, he said.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that was released by the Health and Human Services Department on May 19 and required under the Affordable Care Act. The final regulation will be published in the Federal Register on May 23. The regulation does not apply to the large group insurance market or to small and individual plans that have "grandfather" status under the ACA.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don’t have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers. Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov. The information will include the factors behind the rate increase and in cases where the increase was found to be "unreasonable," it will also include a justification by the insurance company. The health plan will also make the justification information available on its own website.

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

"Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases," Mr. Larsen said at a press conference May 19 to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

"We’re confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes," HHS Secretary Kathleen Sebelius said. "This means millions of Americans will see savings to their own bottom lines."

But America’s Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation.

"Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers," AHIP President and CEO Karen Ignagni said in a statement. "The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage."

Ms. Ignani also criticized the 10% threshold for review, saying that creating a "de facto presumption of unreasonableness" can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.