Mary Ellen Schneider

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

The survey, conducted from July through November 2010, is based on phone interviews with a national sample of more than 4,000 U.S. adults aged 19 and older. The analysis is limited to the approximately 3,000 adults aged 19–64 years.

Cost was an issue for those with and without health insurance. About two-thirds of adults who were uninsured during 2010 had trouble accessing care due to cost, as did 31% of insured respondents.

Preventive care also took a hit. Only half of adults reported that they were up to date on five recommended screening tests: blood pressure and cholesterol tests, mammograms, colon cancer screenings, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said during a press conference to release the findings.

Dr. Collins said the controversial Affordable Care Act will help to address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of the Medicaid program and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report also noted worsening trends in coverage and medical debt over the last decade:

▸ About 28% of adults in the United States were uninsured for part of 2010, up from 24% in 2001.

▸ About 40% of adults reported that they had problems paying their medical bills in 2010, up from 34% in 2005.

▸ About 32% of Americans spent 10% or more of their household income on out-of-pocket costs and premiums in 2010, compared with 23% in 2005 and 21% in 2001.

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

The survey, conducted from July through November 2010, is based on phone interviews with a national sample of more than 4,000 U.S. adults aged 19 and older. The analysis is limited to the approximately 3,000 adults aged 19–64 years.

Cost was an issue for those with and without health insurance. About two-thirds of adults who were uninsured during 2010 had trouble accessing care due to cost, as did 31% of insured respondents.

Preventive care also took a hit. Only half of adults reported that they were up to date on five recommended screening tests: blood pressure and cholesterol tests, mammograms, colon cancer screenings, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said during a press conference to release the findings.

Dr. Collins said the controversial Affordable Care Act will help to address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of the Medicaid program and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report also noted worsening trends in coverage and medical debt over the last decade:

▸ About 28% of adults in the United States were uninsured for part of 2010, up from 24% in 2001.

▸ About 40% of adults reported that they had problems paying their medical bills in 2010, up from 34% in 2005.

▸ About 32% of Americans spent 10% or more of their household income on out-of-pocket costs and premiums in 2010, compared with 23% in 2005 and 21% in 2001.

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

The survey, conducted from July through November 2010, is based on phone interviews with a national sample of more than 4,000 U.S. adults aged 19 and older. The analysis is limited to the approximately 3,000 adults aged 19–64 years.

Cost was an issue for those with and without health insurance. About two-thirds of adults who were uninsured during 2010 had trouble accessing care due to cost, as did 31% of insured respondents.

Preventive care also took a hit. Only half of adults reported that they were up to date on five recommended screening tests: blood pressure and cholesterol tests, mammograms, colon cancer screenings, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said during a press conference to release the findings.

Dr. Collins said the controversial Affordable Care Act will help to address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of the Medicaid program and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report also noted worsening trends in coverage and medical debt over the last decade:

▸ About 28% of adults in the United States were uninsured for part of 2010, up from 24% in 2001.

▸ About 40% of adults reported that they had problems paying their medical bills in 2010, up from 34% in 2005.

▸ About 32% of Americans spent 10% or more of their household income on out-of-pocket costs and premiums in 2010, compared with 23% in 2005 and 21% in 2001.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 in women under age 35 years, 2.3 in women aged 35–37 years, and 2.7 in women aged 38–40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35–37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35–37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF unsuccessfully in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% in women under age 35 years and 30% in women aged 35–37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 in women under age 35 years, 2.3 in women aged 35–37 years, and 2.7 in women aged 38–40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35–37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35–37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF unsuccessfully in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% in women under age 35 years and 30% in women aged 35–37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 in women under age 35 years, 2.3 in women aged 35–37 years, and 2.7 in women aged 38–40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35–37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35–37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF unsuccessfully in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% in women under age 35 years and 30% in women aged 35–37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 among women under age 35 years, 2.3 among women aged 35-37 years, and 2.7 among women aged 38-40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35-37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35-37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% among women under age 35 years and 30% among women aged 35-37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said. But the clinic doesn't leave the decision completely in the hands of patients. Dr. Van Voorhis and his colleagues tell patients up front that in cases where there is a good candidate and a high-quality embryo, they will only transfer a single embryo per cycle.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 among women under age 35 years, 2.3 among women aged 35-37 years, and 2.7 among women aged 38-40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35-37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35-37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% among women under age 35 years and 30% among women aged 35-37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said. But the clinic doesn't leave the decision completely in the hands of patients. Dr. Van Voorhis and his colleagues tell patients up front that in cases where there is a good candidate and a high-quality embryo, they will only transfer a single embryo per cycle.

Infertility treatments performed in 2009 resulted in more than 56,000 live births, according to the latest data from the Society for Assisted Reproductive Technology.

In 2009, 367 clinics from around the United States reported data to SART on 142,241 treatment cycles, resulting in 56,778 live births. In vitro fertilization (IVF) made up more than 99% of the treatments performed that year.

The latest figures indicate that infertility specialists are continuing to transfer fewer embryos in each cycle. For example, the average number of fresh embryos transferred from nondonor oocytes was 2.1 among women under age 35 years, 2.3 among women aged 35-37 years, and 2.7 among women aged 38-40 years. These are similar to figures reported in 2008.

More women also are opting for single embryo transfer (SET). In 2009, 7.2% of cycles in women under age 35 years involved elective SET. In women aged 35-37 years, SET made up about 4% of cycles. Comparatively, in 2003, the percentage of cycles with elective SET in women under age 35 years was 0.7%, and that figure was 0.4% in women aged 35-37 years.

The trend toward transferring fewer embryos is encouraging, fertility experts agreed.

“The trends are going the right way,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Weill Cornell Medical College and New York Presbyterian Hospital, New York. But while SET is the safest approach, it does result in a lower pregnancy rate. That can make it a tough sell with women, especially if they have tried IVF in the past and have been unsuccessful, he said.

Dr. Brad Van Voorhis, director of the IVF unit at the University of Iowa, Iowa City, said his clinic has made a point of encouraging patients to consider SET, and it has had success. A summary report for 2008 states that the percentage of cycles with elective SET at his clinic was 33.1% among women under age 35 years and 30% among women aged 35-37 years. Part of the solution is to educate women about the potential complications of multiple births. Generally, patients are more accepting if they understand the risks involved, he said. But the clinic doesn't leave the decision completely in the hands of patients. Dr. Van Voorhis and his colleagues tell patients up front that in cases where there is a good candidate and a high-quality embryo, they will only transfer a single embryo per cycle.

Virginia Tightens Abortion Rules

Lawmakers in Virginia passed legislation that would require abortion clinics to follow an array of rules that currently govern only hospitals. The bill (SB 924) passed the state legislature in March and was signed by the governor. Any facility where five or more first-trimester abortions are performed per month would be required to adhere to the standards for construction, maintenance, operation, staffing, equipment, training, and security that hospitals do now. Supporters of the law said it is necessary to address safety concerns, but opponents categorized the bill as an attack on abortion access. The new rules would force many clinics to close, said opponents, while many of these facilities provide basic gynecologic care, preventive health screenings, and immunizations as well as abortions.

Heart Bill Reintroduced

A bill intended to end the shortage of women-specific data on cardiovascular conditions has been introduced again by Sen. Debbie Stabenow (D-Mich.) and Sen. Lisa Murkowski (R-Alaska). The Heart Disease Education, Research and Analysis, and Treatment (HEART) for Women Act would require health data that have been reported to the federal government to be broken down by sex, race, and ethnicity. The bill (S. 438), which the senators have introduced in past congressional sessions without success, would also require the secretary of Health and Human Services to submit an annual report to Congress on women's access to quality care for cardiovascular disease. The government's WISEWOMAN screening program for uninsured and underinsured women would be expanded from 20 states to the entire country. “Unfortunately, a majority of women and even some physicians are unfamiliar with the symptoms, diagnoses, and dangers of heart disease in women,” Sen. Stabenow said in a statement.

Studies Often Exclude Women

A new study shows that cardiovascular-device studies generally fail to include enough women to determine safety and effectiveness in that population. The Food and Drug Administration explicitly requires manufacturers to study how their devices work in women, but Dr. Rita Redberg and her colleagues at the University of California, San Francisco, reported that men made up almost 70% of patients in the trials that disclosed gender breakdowns. Participants' sex was not reported in 28% of the studies, the researchers reported in the March issue of Circulation: Cardiovascular Quality and Outcomes. They looked at 123 studies submitted with approval applications for 78 high-risk cardiovascular devices that the FDA approved in 2000-2007. Manufacturers are required to explain whether the proportions of men and women in a trial reflect the proportional effect of a condition on the general population. But such a statement was included in only 41% of the studies, the researchers found. Dr. Redberg is a member of the FDA's Circulatory System Devices Panel.

Infant Mortality Decreased

Rates of infant mortality and neonatal mortality both dropped slightly in 2009, according to preliminary figures from the federal government's National Center for Health Statistics. In 2009, the infant morality rate was 6.42 deaths per 1,000 live births, a 2.6% drop from 2008. Similarly, the rate of deaths among infants younger than 28 days fell from 4.27 deaths per 1,000 live births in 2008 to 4.19 deaths in 2009, but that decrease was not statistically significant. The top cause of infant mortality was congenital malformations, deformations, and chromosomal abnormalities. Disorders related to short gestation and low birth weight, sudden infant death syndrome, and maternal pregnancy complications were also leading causes of death, according to the report. But there were fewer deaths caused by maternal complications of pregnancy in 2009. The infant mortality rate for pregnancy complications decreased 7.5% from 2008 and 2009.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than men did in 2008, but it's not clear why, according to a study in the journal Health Affairs. The gap in pay has been growing steadily since 1999, the study showed. Income inequity persisted even after the researchers accounted for gender differences in such factors as medical specialty, hours worked, and practice type. “It's not surprising to say that women physicians make less than male physicians, because women traditionally choose lower-paying jobs in primary care fields or they choose to work fewer hours,” lead author Anthony LoSasso, Ph.D., of the University of Illinois at Chicago said in a statement. However, it is surprising that the gap persists after accounting for other factors, he added. Women may be paid less because they're trading salary for greater flexibility and family-friendly benefits, such as not being on call after certain hours, the researcher said.

Virginia Tightens Abortion Rules

Lawmakers in Virginia passed legislation that would require abortion clinics to follow an array of rules that currently govern only hospitals. The bill (SB 924) passed the state legislature in March and was signed by the governor. Any facility where five or more first-trimester abortions are performed per month would be required to adhere to the standards for construction, maintenance, operation, staffing, equipment, training, and security that hospitals do now. Supporters of the law said it is necessary to address safety concerns, but opponents categorized the bill as an attack on abortion access. The new rules would force many clinics to close, said opponents, while many of these facilities provide basic gynecologic care, preventive health screenings, and immunizations as well as abortions.

Heart Bill Reintroduced

A bill intended to end the shortage of women-specific data on cardiovascular conditions has been introduced again by Sen. Debbie Stabenow (D-Mich.) and Sen. Lisa Murkowski (R-Alaska). The Heart Disease Education, Research and Analysis, and Treatment (HEART) for Women Act would require health data that have been reported to the federal government to be broken down by sex, race, and ethnicity. The bill (S. 438), which the senators have introduced in past congressional sessions without success, would also require the secretary of Health and Human Services to submit an annual report to Congress on women's access to quality care for cardiovascular disease. The government's WISEWOMAN screening program for uninsured and underinsured women would be expanded from 20 states to the entire country. “Unfortunately, a majority of women and even some physicians are unfamiliar with the symptoms, diagnoses, and dangers of heart disease in women,” Sen. Stabenow said in a statement.

Studies Often Exclude Women

A new study shows that cardiovascular-device studies generally fail to include enough women to determine safety and effectiveness in that population. The Food and Drug Administration explicitly requires manufacturers to study how their devices work in women, but Dr. Rita Redberg and her colleagues at the University of California, San Francisco, reported that men made up almost 70% of patients in the trials that disclosed gender breakdowns. Participants' sex was not reported in 28% of the studies, the researchers reported in the March issue of Circulation: Cardiovascular Quality and Outcomes. They looked at 123 studies submitted with approval applications for 78 high-risk cardiovascular devices that the FDA approved in 2000-2007. Manufacturers are required to explain whether the proportions of men and women in a trial reflect the proportional effect of a condition on the general population. But such a statement was included in only 41% of the studies, the researchers found. Dr. Redberg is a member of the FDA's Circulatory System Devices Panel.

Infant Mortality Decreased

Rates of infant mortality and neonatal mortality both dropped slightly in 2009, according to preliminary figures from the federal government's National Center for Health Statistics. In 2009, the infant morality rate was 6.42 deaths per 1,000 live births, a 2.6% drop from 2008. Similarly, the rate of deaths among infants younger than 28 days fell from 4.27 deaths per 1,000 live births in 2008 to 4.19 deaths in 2009, but that decrease was not statistically significant. The top cause of infant mortality was congenital malformations, deformations, and chromosomal abnormalities. Disorders related to short gestation and low birth weight, sudden infant death syndrome, and maternal pregnancy complications were also leading causes of death, according to the report. But there were fewer deaths caused by maternal complications of pregnancy in 2009. The infant mortality rate for pregnancy complications decreased 7.5% from 2008 and 2009.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than men did in 2008, but it's not clear why, according to a study in the journal Health Affairs. The gap in pay has been growing steadily since 1999, the study showed. Income inequity persisted even after the researchers accounted for gender differences in such factors as medical specialty, hours worked, and practice type. “It's not surprising to say that women physicians make less than male physicians, because women traditionally choose lower-paying jobs in primary care fields or they choose to work fewer hours,” lead author Anthony LoSasso, Ph.D., of the University of Illinois at Chicago said in a statement. However, it is surprising that the gap persists after accounting for other factors, he added. Women may be paid less because they're trading salary for greater flexibility and family-friendly benefits, such as not being on call after certain hours, the researcher said.

Virginia Tightens Abortion Rules

Lawmakers in Virginia passed legislation that would require abortion clinics to follow an array of rules that currently govern only hospitals. The bill (SB 924) passed the state legislature in March and was signed by the governor. Any facility where five or more first-trimester abortions are performed per month would be required to adhere to the standards for construction, maintenance, operation, staffing, equipment, training, and security that hospitals do now. Supporters of the law said it is necessary to address safety concerns, but opponents categorized the bill as an attack on abortion access. The new rules would force many clinics to close, said opponents, while many of these facilities provide basic gynecologic care, preventive health screenings, and immunizations as well as abortions.

Heart Bill Reintroduced

A bill intended to end the shortage of women-specific data on cardiovascular conditions has been introduced again by Sen. Debbie Stabenow (D-Mich.) and Sen. Lisa Murkowski (R-Alaska). The Heart Disease Education, Research and Analysis, and Treatment (HEART) for Women Act would require health data that have been reported to the federal government to be broken down by sex, race, and ethnicity. The bill (S. 438), which the senators have introduced in past congressional sessions without success, would also require the secretary of Health and Human Services to submit an annual report to Congress on women's access to quality care for cardiovascular disease. The government's WISEWOMAN screening program for uninsured and underinsured women would be expanded from 20 states to the entire country. “Unfortunately, a majority of women and even some physicians are unfamiliar with the symptoms, diagnoses, and dangers of heart disease in women,” Sen. Stabenow said in a statement.

Studies Often Exclude Women

A new study shows that cardiovascular-device studies generally fail to include enough women to determine safety and effectiveness in that population. The Food and Drug Administration explicitly requires manufacturers to study how their devices work in women, but Dr. Rita Redberg and her colleagues at the University of California, San Francisco, reported that men made up almost 70% of patients in the trials that disclosed gender breakdowns. Participants' sex was not reported in 28% of the studies, the researchers reported in the March issue of Circulation: Cardiovascular Quality and Outcomes. They looked at 123 studies submitted with approval applications for 78 high-risk cardiovascular devices that the FDA approved in 2000-2007. Manufacturers are required to explain whether the proportions of men and women in a trial reflect the proportional effect of a condition on the general population. But such a statement was included in only 41% of the studies, the researchers found. Dr. Redberg is a member of the FDA's Circulatory System Devices Panel.

Infant Mortality Decreased

Rates of infant mortality and neonatal mortality both dropped slightly in 2009, according to preliminary figures from the federal government's National Center for Health Statistics. In 2009, the infant morality rate was 6.42 deaths per 1,000 live births, a 2.6% drop from 2008. Similarly, the rate of deaths among infants younger than 28 days fell from 4.27 deaths per 1,000 live births in 2008 to 4.19 deaths in 2009, but that decrease was not statistically significant. The top cause of infant mortality was congenital malformations, deformations, and chromosomal abnormalities. Disorders related to short gestation and low birth weight, sudden infant death syndrome, and maternal pregnancy complications were also leading causes of death, according to the report. But there were fewer deaths caused by maternal complications of pregnancy in 2009. The infant mortality rate for pregnancy complications decreased 7.5% from 2008 and 2009.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than men did in 2008, but it's not clear why, according to a study in the journal Health Affairs. The gap in pay has been growing steadily since 1999, the study showed. Income inequity persisted even after the researchers accounted for gender differences in such factors as medical specialty, hours worked, and practice type. “It's not surprising to say that women physicians make less than male physicians, because women traditionally choose lower-paying jobs in primary care fields or they choose to work fewer hours,” lead author Anthony LoSasso, Ph.D., of the University of Illinois at Chicago said in a statement. However, it is surprising that the gap persists after accounting for other factors, he added. Women may be paid less because they're trading salary for greater flexibility and family-friendly benefits, such as not being on call after certain hours, the researcher said.

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

Telephone calls to a nationally representative sample of more than 4,000 U.S. adults were made from July through November 2010. The analysis is limited to the approximately 3,000 adults, aged 19-64 years, who responded to the survey.

Cost was an issue for those with and without health insurance. Two-thirds of adults who were uninsured during 2010 said they had trouble accessing care due to cost; 31% of insured respondents reported the same problem.

Half of the respondents said they were up to date on five recommended screening tests: blood pressure and cholesterol, mammograms, colon cancer, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of the federal poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said at a press conference. She said the Affordable Care Act will address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of Medicaid and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report noted worsening national trends in insurance coverage and medical debt over the last decade. About 28% of adults were uninsured for part of 2010, up from 24% in 2001. Forty percent reported having problems paying medical bills in 2010, up from 34% in 2005. About 32% spent 10% or more of household income on out-of-pocket costs and premiums in 2010, up from 23% in 2005 and 21% in 2001.

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

Telephone calls to a nationally representative sample of more than 4,000 U.S. adults were made from July through November 2010. The analysis is limited to the approximately 3,000 adults, aged 19-64 years, who responded to the survey.

Cost was an issue for those with and without health insurance. Two-thirds of adults who were uninsured during 2010 said they had trouble accessing care due to cost; 31% of insured respondents reported the same problem.

Half of the respondents said they were up to date on five recommended screening tests: blood pressure and cholesterol, mammograms, colon cancer, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of the federal poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said at a press conference. She said the Affordable Care Act will address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of Medicaid and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report noted worsening national trends in insurance coverage and medical debt over the last decade. About 28% of adults were uninsured for part of 2010, up from 24% in 2001. Forty percent reported having problems paying medical bills in 2010, up from 34% in 2005. About 32% spent 10% or more of household income on out-of-pocket costs and premiums in 2010, up from 23% in 2005 and 21% in 2001.

More than 40% of adults in the United States went without necessary medical care in 2010 due to cost, up from 29% a decade ago, according to the Commonwealth Fund's Biennial Health Insurance Survey.

Skipping needed care such as prescription drugs, specialist visits, and follow-up treatment is even more common among moderate- and low-income groups. For example, 56% of Americans with household incomes under 200% of the federal poverty level went without necessary care last year, according to the survey.

Telephone calls to a nationally representative sample of more than 4,000 U.S. adults were made from July through November 2010. The analysis is limited to the approximately 3,000 adults, aged 19-64 years, who responded to the survey.

Cost was an issue for those with and without health insurance. Two-thirds of adults who were uninsured during 2010 said they had trouble accessing care due to cost; 31% of insured respondents reported the same problem.

Half of the respondents said they were up to date on five recommended screening tests: blood pressure and cholesterol, mammograms, colon cancer, and Pap tests. Those with lower incomes were less likely to get screened: While 65% of adults with a household income at or above 400% of the federal poverty level were up to date, only 36% of adults at less than 133% of the federal poverty level were.

“The survey findings paint a dire picture of the degree to which low- and moderate-income families are currently burdened by costs of care and the degree to which a severe economic crisis can affect the health security of working families,” Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund, said at a press conference. She said the Affordable Care Act will address some of the problems highlighted in the survey by alleviating the cost burden on the lowest-income Americans. She cited the expansion of Medicaid and federal subsidies to purchase private health coverage, both of which begin in 2014, as ways to reduce out-of-pocket costs and improve access to care.

The Commonwealth Fund report noted worsening national trends in insurance coverage and medical debt over the last decade. About 28% of adults were uninsured for part of 2010, up from 24% in 2001. Forty percent reported having problems paying medical bills in 2010, up from 34% in 2005. About 32% spent 10% or more of household income on out-of-pocket costs and premiums in 2010, up from 23% in 2005 and 21% in 2001.

A U.S. District Court judge in Florida ruled that the federal government can continue to implement the Affordable Care Act, despite his own earlier judgment voiding the entire law.

In a 20-page ruling full of twists and turns, Judge Roger Vinson clarified his Jan. 31 decision, in which he ruled as unconstitutional the law's provision requiring individuals to obtain insurance – known as the individual mandate – and threw out the remainder of the law because its provisions could not be severed.

In the clarification, Judge Vinson wrote that he had meant for the Jan. 31 ruling to have the force of an injunction and had expected the federal government to halt its implementation of the law.

However, since implementation has continued, Judge Vinson decided to issue the government a “stay,” which would allow officials to continue moving forward with the law.

But the stay was conditional. After Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review the Justice Department sent its request to the 11th Circuit Court of Appeals on March 8.

A U.S. District Court judge in Florida ruled that the federal government can continue to implement the Affordable Care Act, despite his own earlier judgment voiding the entire law.

In a 20-page ruling full of twists and turns, Judge Roger Vinson clarified his Jan. 31 decision, in which he ruled as unconstitutional the law's provision requiring individuals to obtain insurance – known as the individual mandate – and threw out the remainder of the law because its provisions could not be severed.

In the clarification, Judge Vinson wrote that he had meant for the Jan. 31 ruling to have the force of an injunction and had expected the federal government to halt its implementation of the law.

However, since implementation has continued, Judge Vinson decided to issue the government a “stay,” which would allow officials to continue moving forward with the law.

But the stay was conditional. After Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review the Justice Department sent its request to the 11th Circuit Court of Appeals on March 8.

A U.S. District Court judge in Florida ruled that the federal government can continue to implement the Affordable Care Act, despite his own earlier judgment voiding the entire law.

In a 20-page ruling full of twists and turns, Judge Roger Vinson clarified his Jan. 31 decision, in which he ruled as unconstitutional the law's provision requiring individuals to obtain insurance – known as the individual mandate – and threw out the remainder of the law because its provisions could not be severed.

In the clarification, Judge Vinson wrote that he had meant for the Jan. 31 ruling to have the force of an injunction and had expected the federal government to halt its implementation of the law.

However, since implementation has continued, Judge Vinson decided to issue the government a “stay,” which would allow officials to continue moving forward with the law.

But the stay was conditional. After Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review the Justice Department sent its request to the 11th Circuit Court of Appeals on March 8.

Court Passes on 'Pay for Delay'

The Supreme Court has refused to consider whether drug companies violate antitrust laws when they pay generic competitors to stay out of the marketplace. The high court's rejection of the case in March allowed companies to continue the practice, known as “pay for delay.” In this case, Bayer AG, which makes the antibiotic Cipro, paid generic competitor Barr Laboratories $398 million to not make a version of the drug. Before this, such deals have come under increased scrutiny. Last year, the Federal Trade Commission condemned the deals, and estimated that they will cost consumers about $35 billion over the next decade. There is also legislation pending in Congress (S. 27) to ban pay for delay.

Psoriatic Arthritis Awareness

The Arthritis Foundation has joined the National Psoriasis Foundation and drug makers Amgen and Pfizer to educate patients about psoriatic arthritis. The centerpiece of the “Joint Smart Coalition” effort is the new Web site

BeJointSmart.org

Research Volunteers Sought

Researchers are asking rheumatoid arthritis patients aged 18-75 years to help test the effect of two tumor necrosis factor–blocking agents on memory B lymphocytes. The phase IV, multicenter study is being sponsored by the National Institute of Allergy and Infectious Diseases. Participants will be randomized to receive subcutaneous injections of either etanercept (weekly) or adalimumab (every 2 weeks). The study is slated to last 24 weeks. The research centers are located in Birmingham, Ala.; San Francisco; Chicago; Manhasset, N.Y.; Rochester, N.Y.; and Charleston, S.C. More information about the study is available at

www.clinicaltrials.gov

HIT Benefits Emerging

Both small physician practices and large health care organizations that quickly adopted health information technology (HIT) are already benefiting, according to Health and Human Services officials reporting in the journal Health Affairs. They reviewed recent peer-reviewed literature on HIT and found that nearly two-thirds of studies showed improvements in at least one aspect of care, ranging from patient mortality to practice efficiency, with none deemed worse because of HIT. Another 30% of the literature indicated some positive effects but also at least one negative to HIT, mainly related to transitioning to electronic records. Dissatisfied providers generally blamed problems with the technology or inadequate support for the obstruction of care improvements with HIT, according to the review from the Office of the National Coordinator for Health Information Technology.

Doctors' Tweets Could Improve

Physicians are using the social networking service Twitter to share medical information with the public, which could have a positive effect on people's health, according to a letter published in JAMA. Few of the 5,156 physicians' tweets studied exhibited ethical breaches, reported researchers led by Dr. Katherine C. Chretien of the Washington DC VA Medical Center. They analyzed tweets sent by self-identified physicians in May 2010. About half of the tweets were health related, 12% were considered “self-promotional,” and 1% recommended a medical product or proprietary service. The researchers reported that just 3% of the total were “unprofessional,” mainly because of patient-privacy violations, profanity, sexually explicit material, inaccurate medical information, or discriminatory statements.

Tobacco Firms Sue Over Bias

Two large tobacco firms have sued the Food and Drug Administration to remove from a tobacco advisory committee three members who have ties to antitobacco litigation. Lorillard and R.J. Reynolds Tobacco asked the U.S. District Court in Washington to bar the FDA from heeding advisory committee recommendations until Dr. Neal Benowitz, Dr. Jonathan Samet, and Jack Henningfield, Ph.D., have been replaced by members that the companies deem to be unbiased. The suit also asked the court to prevent the FDA from providing any confidential document to the committee until then. The three committee members “have made tens of thousands of dollars as paid expert witnesses in litigation against tobacco products manufacturers” and have “continuing financial relationships with pharmaceutical companies that make smoking-cessation products,” the two companies said in a statement.

Court Passes on 'Pay for Delay'

The Supreme Court has refused to consider whether drug companies violate antitrust laws when they pay generic competitors to stay out of the marketplace. The high court's rejection of the case in March allowed companies to continue the practice, known as “pay for delay.” In this case, Bayer AG, which makes the antibiotic Cipro, paid generic competitor Barr Laboratories $398 million to not make a version of the drug. Before this, such deals have come under increased scrutiny. Last year, the Federal Trade Commission condemned the deals, and estimated that they will cost consumers about $35 billion over the next decade. There is also legislation pending in Congress (S. 27) to ban pay for delay.

Psoriatic Arthritis Awareness

The Arthritis Foundation has joined the National Psoriasis Foundation and drug makers Amgen and Pfizer to educate patients about psoriatic arthritis. The centerpiece of the “Joint Smart Coalition” effort is the new Web site

BeJointSmart.org

Research Volunteers Sought

Researchers are asking rheumatoid arthritis patients aged 18-75 years to help test the effect of two tumor necrosis factor–blocking agents on memory B lymphocytes. The phase IV, multicenter study is being sponsored by the National Institute of Allergy and Infectious Diseases. Participants will be randomized to receive subcutaneous injections of either etanercept (weekly) or adalimumab (every 2 weeks). The study is slated to last 24 weeks. The research centers are located in Birmingham, Ala.; San Francisco; Chicago; Manhasset, N.Y.; Rochester, N.Y.; and Charleston, S.C. More information about the study is available at

www.clinicaltrials.gov

HIT Benefits Emerging

Both small physician practices and large health care organizations that quickly adopted health information technology (HIT) are already benefiting, according to Health and Human Services officials reporting in the journal Health Affairs. They reviewed recent peer-reviewed literature on HIT and found that nearly two-thirds of studies showed improvements in at least one aspect of care, ranging from patient mortality to practice efficiency, with none deemed worse because of HIT. Another 30% of the literature indicated some positive effects but also at least one negative to HIT, mainly related to transitioning to electronic records. Dissatisfied providers generally blamed problems with the technology or inadequate support for the obstruction of care improvements with HIT, according to the review from the Office of the National Coordinator for Health Information Technology.

Doctors' Tweets Could Improve

Physicians are using the social networking service Twitter to share medical information with the public, which could have a positive effect on people's health, according to a letter published in JAMA. Few of the 5,156 physicians' tweets studied exhibited ethical breaches, reported researchers led by Dr. Katherine C. Chretien of the Washington DC VA Medical Center. They analyzed tweets sent by self-identified physicians in May 2010. About half of the tweets were health related, 12% were considered “self-promotional,” and 1% recommended a medical product or proprietary service. The researchers reported that just 3% of the total were “unprofessional,” mainly because of patient-privacy violations, profanity, sexually explicit material, inaccurate medical information, or discriminatory statements.

Tobacco Firms Sue Over Bias

Two large tobacco firms have sued the Food and Drug Administration to remove from a tobacco advisory committee three members who have ties to antitobacco litigation. Lorillard and R.J. Reynolds Tobacco asked the U.S. District Court in Washington to bar the FDA from heeding advisory committee recommendations until Dr. Neal Benowitz, Dr. Jonathan Samet, and Jack Henningfield, Ph.D., have been replaced by members that the companies deem to be unbiased. The suit also asked the court to prevent the FDA from providing any confidential document to the committee until then. The three committee members “have made tens of thousands of dollars as paid expert witnesses in litigation against tobacco products manufacturers” and have “continuing financial relationships with pharmaceutical companies that make smoking-cessation products,” the two companies said in a statement.

Court Passes on 'Pay for Delay'

The Supreme Court has refused to consider whether drug companies violate antitrust laws when they pay generic competitors to stay out of the marketplace. The high court's rejection of the case in March allowed companies to continue the practice, known as “pay for delay.” In this case, Bayer AG, which makes the antibiotic Cipro, paid generic competitor Barr Laboratories $398 million to not make a version of the drug. Before this, such deals have come under increased scrutiny. Last year, the Federal Trade Commission condemned the deals, and estimated that they will cost consumers about $35 billion over the next decade. There is also legislation pending in Congress (S. 27) to ban pay for delay.

Psoriatic Arthritis Awareness

The Arthritis Foundation has joined the National Psoriasis Foundation and drug makers Amgen and Pfizer to educate patients about psoriatic arthritis. The centerpiece of the “Joint Smart Coalition” effort is the new Web site

BeJointSmart.org

Research Volunteers Sought

Researchers are asking rheumatoid arthritis patients aged 18-75 years to help test the effect of two tumor necrosis factor–blocking agents on memory B lymphocytes. The phase IV, multicenter study is being sponsored by the National Institute of Allergy and Infectious Diseases. Participants will be randomized to receive subcutaneous injections of either etanercept (weekly) or adalimumab (every 2 weeks). The study is slated to last 24 weeks. The research centers are located in Birmingham, Ala.; San Francisco; Chicago; Manhasset, N.Y.; Rochester, N.Y.; and Charleston, S.C. More information about the study is available at

www.clinicaltrials.gov

HIT Benefits Emerging

Both small physician practices and large health care organizations that quickly adopted health information technology (HIT) are already benefiting, according to Health and Human Services officials reporting in the journal Health Affairs. They reviewed recent peer-reviewed literature on HIT and found that nearly two-thirds of studies showed improvements in at least one aspect of care, ranging from patient mortality to practice efficiency, with none deemed worse because of HIT. Another 30% of the literature indicated some positive effects but also at least one negative to HIT, mainly related to transitioning to electronic records. Dissatisfied providers generally blamed problems with the technology or inadequate support for the obstruction of care improvements with HIT, according to the review from the Office of the National Coordinator for Health Information Technology.

Doctors' Tweets Could Improve

Physicians are using the social networking service Twitter to share medical information with the public, which could have a positive effect on people's health, according to a letter published in JAMA. Few of the 5,156 physicians' tweets studied exhibited ethical breaches, reported researchers led by Dr. Katherine C. Chretien of the Washington DC VA Medical Center. They analyzed tweets sent by self-identified physicians in May 2010. About half of the tweets were health related, 12% were considered “self-promotional,” and 1% recommended a medical product or proprietary service. The researchers reported that just 3% of the total were “unprofessional,” mainly because of patient-privacy violations, profanity, sexually explicit material, inaccurate medical information, or discriminatory statements.

Tobacco Firms Sue Over Bias

Two large tobacco firms have sued the Food and Drug Administration to remove from a tobacco advisory committee three members who have ties to antitobacco litigation. Lorillard and R.J. Reynolds Tobacco asked the U.S. District Court in Washington to bar the FDA from heeding advisory committee recommendations until Dr. Neal Benowitz, Dr. Jonathan Samet, and Jack Henningfield, Ph.D., have been replaced by members that the companies deem to be unbiased. The suit also asked the court to prevent the FDA from providing any confidential document to the committee until then. The three committee members “have made tens of thousands of dollars as paid expert witnesses in litigation against tobacco products manufacturers” and have “continuing financial relationships with pharmaceutical companies that make smoking-cessation products,” the two companies said in a statement.

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. The ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

Dr. Samuels said that office-based ultrasound offers a number of advantages: it's painless and does not induce claustrophobia or anxiety. There's also no need for patients to be still for long period of time and no radiation exposure.

Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to evaluate multiple joints from a number of views in a single imaging session, he said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis (OA).

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than conventional radiography (Arthritis. Rheum. 2000;43:2762-70).

Ultrasound can also identify and determine whether it is necessary to aspirate a joint effusion in patients with knee OA. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.

Ultrasound (left) shows cartilage wear in knee oseoarthritis. An ultrasound of a metacarpophalangeal joint (right), which was expected to show synovial effusion/synovitis, instead revealed a subcutaneous cyst and a normal MCP.

Source Courtesy Dr. Jonathan Samuels

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. The ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

Dr. Samuels said that office-based ultrasound offers a number of advantages: it's painless and does not induce claustrophobia or anxiety. There's also no need for patients to be still for long period of time and no radiation exposure.

Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to evaluate multiple joints from a number of views in a single imaging session, he said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis (OA).

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than conventional radiography (Arthritis. Rheum. 2000;43:2762-70).

Ultrasound can also identify and determine whether it is necessary to aspirate a joint effusion in patients with knee OA. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.

Ultrasound (left) shows cartilage wear in knee oseoarthritis. An ultrasound of a metacarpophalangeal joint (right), which was expected to show synovial effusion/synovitis, instead revealed a subcutaneous cyst and a normal MCP.

Source Courtesy Dr. Jonathan Samuels

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. The ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

Dr. Samuels said that office-based ultrasound offers a number of advantages: it's painless and does not induce claustrophobia or anxiety. There's also no need for patients to be still for long period of time and no radiation exposure.

Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to evaluate multiple joints from a number of views in a single imaging session, he said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis (OA).

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than conventional radiography (Arthritis. Rheum. 2000;43:2762-70).

Ultrasound can also identify and determine whether it is necessary to aspirate a joint effusion in patients with knee OA. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.

Ultrasound (left) shows cartilage wear in knee oseoarthritis. An ultrasound of a metacarpophalangeal joint (right), which was expected to show synovial effusion/synovitis, instead revealed a subcutaneous cyst and a normal MCP.

Source Courtesy Dr. Jonathan Samuels

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document released Jan. 18, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change.

They also recommend that students work with health coaches who support the care of patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology to support their own continuing education.

The report also recommends that medical schools teach students about various physician payment methodologies and current trends in health care costs.

For many medical schools this will be a shift, said Dr. O. Marion Burton, president of the American Academy of Pediatrics and associate dean for clinical affairs at the University of South Carolina, Columbia.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, he said.

Dr. Burton said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so.

The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts.

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

“I don't see this as [happening] overnight,” Dr. Burton said in an interview.

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document released Jan. 18, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change.

They also recommend that students work with health coaches who support the care of patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology to support their own continuing education.

The report also recommends that medical schools teach students about various physician payment methodologies and current trends in health care costs.

For many medical schools this will be a shift, said Dr. O. Marion Burton, president of the American Academy of Pediatrics and associate dean for clinical affairs at the University of South Carolina, Columbia.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, he said.

Dr. Burton said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so.

The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts.

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

“I don't see this as [happening] overnight,” Dr. Burton said in an interview.

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document released Jan. 18, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change.

They also recommend that students work with health coaches who support the care of patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology to support their own continuing education.

The report also recommends that medical schools teach students about various physician payment methodologies and current trends in health care costs.

For many medical schools this will be a shift, said Dr. O. Marion Burton, president of the American Academy of Pediatrics and associate dean for clinical affairs at the University of South Carolina, Columbia.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, he said.

Dr. Burton said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so.

The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts.

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

“I don't see this as [happening] overnight,” Dr. Burton said in an interview.

After months of deliberation, officials at the Centers for Medicare and Medicaid Services released on March 31 a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the savings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group practice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service payments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the program. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.

"ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare," Dr. Donald Berwick, CMS administrator, said during a press conference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the program, but that the level of interest is "enormous."

Since the Affordable Care Act was passed last year, the health care community has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the proposal allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to receive only shared savings for 2 years before assuming risk. More mature organizations can assume risk immediately but be eligible for greater levels of shared savings. "Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with," Dr. Berwick said.

CMS officials estimate that the program could result in as much as $960 million in Medicare savings over 3 years.

Although federal officials said that they expect the coordinated care to pay dividends in savings to Medicare, ACOs will not be set up like HMOs. Medicare beneficiaries will continue to be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients that they are receiving care within an ACO.

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospitals that form an ACO can steer clear of antitrust laws. Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, and the Internal Revenue Service has issued new guidance for tax-exempt hospitals seeking to participate in the program.

The CMS will be accepting comments on the proposed rule for 60 days. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.

At press time, the American Medical Association said that it was reviewing the proposed rule and the policy statements from the Federal Trade Commission and the Department of Justice. In a statement, Dr. Jeremy A. Lazarus, the speaker of the AMA House of Delegates, said that ACOs offer "great promise" but that there are still a number of barriers to success, including the large capital requirements to fund an ACO and to make the necessary changes to individual physician practices.

After months of deliberation, officials at the Centers for Medicare and Medicaid Services released on March 31 a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the savings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group practice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service payments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the program. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.

"ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare," Dr. Donald Berwick, CMS administrator, said during a press conference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the program, but that the level of interest is "enormous."

Since the Affordable Care Act was passed last year, the health care community has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the proposal allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to receive only shared savings for 2 years before assuming risk. More mature organizations can assume risk immediately but be eligible for greater levels of shared savings. "Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with," Dr. Berwick said.

CMS officials estimate that the program could result in as much as $960 million in Medicare savings over 3 years.

Although federal officials said that they expect the coordinated care to pay dividends in savings to Medicare, ACOs will not be set up like HMOs. Medicare beneficiaries will continue to be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients that they are receiving care within an ACO.

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospitals that form an ACO can steer clear of antitrust laws. Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, and the Internal Revenue Service has issued new guidance for tax-exempt hospitals seeking to participate in the program.

The CMS will be accepting comments on the proposed rule for 60 days. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.

At press time, the American Medical Association said that it was reviewing the proposed rule and the policy statements from the Federal Trade Commission and the Department of Justice. In a statement, Dr. Jeremy A. Lazarus, the speaker of the AMA House of Delegates, said that ACOs offer "great promise" but that there are still a number of barriers to success, including the large capital requirements to fund an ACO and to make the necessary changes to individual physician practices.

After months of deliberation, officials at the Centers for Medicare and Medicaid Services released on March 31 a proposed rule outlining how physicians, hospitals, and long-term care facilities can work together to form accountable care organizations and share in the savings they achieve for Medicare.

The voluntary program was created under the Affordable Care Act and will begin in Jan. 2012. Under the proposal, accountable care organizations (ACOs) could include physicians in group practice, networks of individual practices, hospitals that employ physicians, and partnerships among these entities, as well as other providers. The idea is for ACOs to be a partnership among a range of physicians, including specialists and primary care providers. However, only primary care providers will be able to form an ACO, according to CMS.

According to the proposed rule, providers in the ACO would continue to receive their regular fee-for-service payments under Medicare, but they could also qualify for additional payment if their care resulted in savings to the program. The proposed framework requires that ACOs meet certain quality standards and demonstrate that they have reduced costs in order to be eligible to share in any savings. The proposal outlines 65 quality measures in five quality domains: patient experience, care coordination, patient safety, preventive health, and care of at-risk and frail elderly populations.

"ACOs aren’t just a new way to pay for care; they’re a new model for the organization and delivery of the care under Medicare," Dr. Donald Berwick, CMS administrator, said during a press conference to announce the proposed rule.

Dr. Berwick said he doesn’t know how many ACOs will form under the program, but that the level of interest is "enormous."

Since the Affordable Care Act was passed last year, the health care community has been buzzing about how ACOs might be structured and if they could succeed in reducing health care costs. Integrated care organizations like Geisinger Health System in Danville, Pa., are considered to have a leg up because their hospital and outpatient care is already coordinated.

But Dr. Berwick said that the proposal allows for ACOs at various levels of development to participate. For example, less developed ACOs can choose to receive only shared savings for 2 years before assuming risk. More mature organizations can assume risk immediately but be eligible for greater levels of shared savings. "Our aim is to create on-ramps that will allow many to participate, depending on the different levels of maturity they are starting with," Dr. Berwick said.

CMS officials estimate that the program could result in as much as $960 million in Medicare savings over 3 years.

Although federal officials said that they expect the coordinated care to pay dividends in savings to Medicare, ACOs will not be set up like HMOs. Medicare beneficiaries will continue to be able to see their choice of providers under fee-for-service Medicare. Providers will be the ones that enroll in ACOs and must notify patients that they are receiving care within an ACO.

In addition to the ACO proposed rule, the Department of Justice and the Federal Trade Commission have also issued guidance on how physicians and hospitals that form an ACO can steer clear of antitrust laws. Officials at the CMS and the Office of the Inspector General have also issued a notice on potential waivers that could be granted in connection with the shared savings program, and the Internal Revenue Service has issued new guidance for tax-exempt hospitals seeking to participate in the program.

The CMS will be accepting comments on the proposed rule for 60 days. The agency also plans a series of open-door forums and listening sessions to explain the proposal and to get feedback from the public.

At press time, the American Medical Association said that it was reviewing the proposed rule and the policy statements from the Federal Trade Commission and the Department of Justice. In a statement, Dr. Jeremy A. Lazarus, the speaker of the AMA House of Delegates, said that ACOs offer "great promise" but that there are still a number of barriers to success, including the large capital requirements to fund an ACO and to make the necessary changes to individual physician practices.