Mary Ellen Schneider

Guidance from a coalition of primary care organizations aims to bring cohesion to the multitude of recognition programs that are springing up to accredit patient-centered medical homes.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association released the guidelines, which outline the 13 elements that they consider "essential" to an effective medical home recognition program. For example, the guidelines state that all recognition programs should incorporate the 2007 joint principles for a patient-centered medical home issued by the coalition.

Recognition programs also should address the complete scope of primary care services, align standards with the new federal meaningful-use requirements for electronic health records, and acknowledge care coordination in a "medical neighborhood," the guidelines state.

The groups also called on recognition programs to be transparent in their structure and scoring, to apply reasonable documentation and data collection requirements, and to conduct evaluations of the program’s effectiveness.

"If we are to know the value of a patient-centered medical home’s accreditation, we need to be assured the accrediting program itself has met appropriate standards," Dr. Roland Goertz, AAFP president, said in a statement.

"The consideration of these joint guidelines for [patient-centered medical home] recognition programs will help ensure that recognized practices truly provide patient-centered care that is effectively integrated and of high quality," Dr. J. Fred Ralston Jr., ACP president, said in the same statement.

The guidelines will help to provide consistency among the various accreditation and recognition programs, according to the coalition. That’s important, they noted, because physicians may need to comply with more than one recognition program. Standardization of programs also will help researchers who are studying the impact of the medical home.

The National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC (formerly the Utilization Review Accreditation Commission) already have recognition or accreditation programs related to the medical home. The Joint Commission is slated to launch its own program later this year. In addition, some private and public payers may develop their own recognition programs.

The interest of these large, established organizations in the medical home is encouraging, according to AAP President O. Marion Burton, because it shows that the concept is one that is here to stay. "It does, to some extent, give us some reassurance and validation," he said in an interview.

Guidance from a coalition of primary care organizations aims to bring cohesion to the multitude of recognition programs that are springing up to accredit patient-centered medical homes.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association released the guidelines, which outline the 13 elements that they consider "essential" to an effective medical home recognition program. For example, the guidelines state that all recognition programs should incorporate the 2007 joint principles for a patient-centered medical home issued by the coalition.

Recognition programs also should address the complete scope of primary care services, align standards with the new federal meaningful-use requirements for electronic health records, and acknowledge care coordination in a "medical neighborhood," the guidelines state.

The groups also called on recognition programs to be transparent in their structure and scoring, to apply reasonable documentation and data collection requirements, and to conduct evaluations of the program’s effectiveness.

"If we are to know the value of a patient-centered medical home’s accreditation, we need to be assured the accrediting program itself has met appropriate standards," Dr. Roland Goertz, AAFP president, said in a statement.

"The consideration of these joint guidelines for [patient-centered medical home] recognition programs will help ensure that recognized practices truly provide patient-centered care that is effectively integrated and of high quality," Dr. J. Fred Ralston Jr., ACP president, said in the same statement.

The guidelines will help to provide consistency among the various accreditation and recognition programs, according to the coalition. That’s important, they noted, because physicians may need to comply with more than one recognition program. Standardization of programs also will help researchers who are studying the impact of the medical home.

The National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC (formerly the Utilization Review Accreditation Commission) already have recognition or accreditation programs related to the medical home. The Joint Commission is slated to launch its own program later this year. In addition, some private and public payers may develop their own recognition programs.

The interest of these large, established organizations in the medical home is encouraging, according to AAP President O. Marion Burton, because it shows that the concept is one that is here to stay. "It does, to some extent, give us some reassurance and validation," he said in an interview.

Guidance from a coalition of primary care organizations aims to bring cohesion to the multitude of recognition programs that are springing up to accredit patient-centered medical homes.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association released the guidelines, which outline the 13 elements that they consider "essential" to an effective medical home recognition program. For example, the guidelines state that all recognition programs should incorporate the 2007 joint principles for a patient-centered medical home issued by the coalition.

Recognition programs also should address the complete scope of primary care services, align standards with the new federal meaningful-use requirements for electronic health records, and acknowledge care coordination in a "medical neighborhood," the guidelines state.

The groups also called on recognition programs to be transparent in their structure and scoring, to apply reasonable documentation and data collection requirements, and to conduct evaluations of the program’s effectiveness.

"If we are to know the value of a patient-centered medical home’s accreditation, we need to be assured the accrediting program itself has met appropriate standards," Dr. Roland Goertz, AAFP president, said in a statement.

"The consideration of these joint guidelines for [patient-centered medical home] recognition programs will help ensure that recognized practices truly provide patient-centered care that is effectively integrated and of high quality," Dr. J. Fred Ralston Jr., ACP president, said in the same statement.

The guidelines will help to provide consistency among the various accreditation and recognition programs, according to the coalition. That’s important, they noted, because physicians may need to comply with more than one recognition program. Standardization of programs also will help researchers who are studying the impact of the medical home.

The National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC (formerly the Utilization Review Accreditation Commission) already have recognition or accreditation programs related to the medical home. The Joint Commission is slated to launch its own program later this year. In addition, some private and public payers may develop their own recognition programs.

The interest of these large, established organizations in the medical home is encouraging, according to AAP President O. Marion Burton, because it shows that the concept is one that is here to stay. "It does, to some extent, give us some reassurance and validation," he said in an interview.

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. In 2008 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. In 2008 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. In 2008 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. In 2008 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. In 2008 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. In 2008 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.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

A U.S. District Court judge in Florida ruled March 3 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 is conditional. Judge Vinson wrote that the government must file an appeal of his original ruling within 7 calendar days and seek an expedited appellate review either to the Court of Appeals or to the Supreme Court.

"Almost everyone agrees that the Constitutionality of the Act is an issue that will ultimately have to be decided by the Supreme Court of the United States," Judge Vinson wrote in his March 3 decision. "It is very important to everyone in this country that this case move forward as soon as practically possible."

The constitutionality of the Affordable Care Act is being challenged in courts around the country. So far, judges in Virginia and Florida have ruled that all or part of the law should be thrown out, while other judges in Michigan and Virginia have upheld the law.

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians' Desk Reference, and are advertised in medical journals.

Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA's Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what's in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it's unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA's list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today's action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians' Desk Reference, and are advertised in medical journals.

Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA's Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what's in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it's unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA's list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today's action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians' Desk Reference, and are advertised in medical journals.

Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA's Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what's in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it's unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA's list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today's action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians’ Desk Reference, and are advertised in medical journals. Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA’s Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what’s in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it’s unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said that the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA’s list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today’s action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians’ Desk Reference, and are advertised in medical journals. Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA’s Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what’s in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it’s unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said that the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA’s list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today’s action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."

Drug manufacturers have 90 days to stop making unapproved prescription medications to treat cold, cough, and allergy symptoms, officials at the Food and Drug Administration announced on March 2.

The FDA issued a list of about 500 unapproved prescription products that should be pulled from the market. These products were never evaluated by the FDA but continue to be prescribed. In many cases, they have been on the market for years, are listed in the Physicians’ Desk Reference, and are advertised in medical journals. Physicians may not be aware that the drugs were not approved, Deborah M. Autor, director of the Office of Compliance at the FDA’s Center for Drug Evaluation and Research, said during a press conference.

"This action is necessary to protect consumers from the potential risks posed by unapproved drugs because we don’t know what’s in them, whether they work properly, or how they are made," Ms. Autor said.

The FDA announcement is part of a broader crackdown on unapproved drugs that began in 2006. But Ms. Autor said that agency officials have particular concerns about these cold, cough, and allergy medications. For example, some of the drugs are labeled as time-release formulations, but without evaluation by the FDA, it’s unclear whether the drugs are delivering their active ingredients as labeled, Ms. Autor said. The active ingredient may be released too slowly, too quickly, or not at all, she said.

Ms. Autor said that the FDA is also concerned because some of the unapproved drugs are labeled for use in children younger than age 2 years. Some of the unapproved drugs also have names that are similar to the names of other drugs, which could lead to confusion when prescriptions are filled. And some of the drugs on the FDA’s list contain combinations of the same types of ingredients, such as two or more antihistamines, which can lead to oversedation.

If a company has registered its unapproved products with the FDA, it will have 90 days to stop manufacturing and 180 days to stop shipping all products. However, FDA officials said there are likely more unapproved prescription drugs that have never been registered with the agency. Those products must be pulled from the market immediately.

"We do not anticipate today’s action will have a major negative impact on consumers or health professionals because there are multiple other products available to treat cough, cold, and allergy symptoms, either as an FDA-approved prescription drug or an over-the-counter drug that follows appropriate FDA standards," Ms. Autor said. "We do anticipate that today’s action will have a significant positive impact by improving the safety of the American drug supply."