Mary Ellen Schneider

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.

State medical boards are eyeing ways to overhaul the relicensure process so that it better measures a physician's efforts to stay abreast of clinical developments.

Currently, while the public assumes that state licensure means that a physician remains competent, that's just not the case, according to Richard A. Whitehouse, the executive director of the State Medical Board of Ohio.

“There is really no measure once someone is initially licensed and has met the threshold requirements for licensure,” he said. “Absent CME requirements, there's really nothing you can point to, to say that this person is maintaining their competency.”

Officials involved in the redesign process, however, emphasize that the new requirements won't be a burden on practicing physicians and that most doctors are already doing enough to meet the standards under development.

The Federation of State Medical Boards (FSMB), which represents the nation's state medical boards, has been promoting the need to make relicensure a more robust process for several years.

Last spring, the organization's House of Delegates approved a framework that lays out what the maintenance of licensure process would look like in general. And over the past few months, an implementation group made up of physicians and medical board officials has been filling in the details.

The expectation is that new maintenance of licensure requirements will involve three major components: a reflective self-assessment that calls for physicians to complete a certain number of accredited continuing medical education courses; an assessment of knowledge and skills, which could be a formal exam; and some measurement of performance in practice, in which physicians would compare their practice data to those for peers and to national benchmarks.

Dr. Humayun Chaudhry, president and CEO of the FSMB, said that one of the goals in redesigning the relicensure process is to minimize the burden on practicing physicians. To that end, the FSMB implementation group's draft report calls on state medical boards to accept participation in maintenance of certification through the American Board of Medical Specialties, or osteopathic continuous certification through the American Osteopathic Association, as substantially meeting the requirements for maintenance of licensure. “That's a big advance because a significant plurality of physicians are involved in those programs,” Dr. Chaudhry said.

More than 300,000 physicians are engaged in maintenance of certification through the various boards of the American Board of Medical Specialties, and that number increases by about 50,000 physicians each year, according to Dr. Kevin B. Weiss, ABMS president and CEO.

Officials at the ABMS have been working closely with states for years on the issue of maintenance of licensure and plan to continue to be involved as states begin to pilot the concept over the next several months to ensure that board-certified physicians aren't asked to do any “double work,” Dr. Weiss said. “We're going to be very active in trying to help our physician community on a state-by-state basis.”

Officials at the FSMB are being careful to point out that maintenance of licensure and maintenance of certification are not meant to be equivalent. While maintenance of certification and osteopathic continuous certification could comply with the more robust relicensure requirements, board certification goes “above and beyond” basic licensure, Dr. Chaudhry said.

For the hundreds of thousands of physicians who aren't engaged in some type of maintenance of certification process, the FSMB is working with states to develop alternative pathways to demonstrate ongoing clinical competence.

The timeline for the new requirements is fairly long, Dr. Chaudhry said. The FSMB is recommending that state medical boards implement the new approach in phases that in total could take up to 10 years. The first step for any state medical board that plans to go forward with maintenance of licensure is to spend the first year educating physicians, the public, and lawmakers about what is planned and why. And each of the three components of the process should take another 2–3 years to implement, he said.

“The vast majority of physicians are already doing things to stay up to date,” Dr. Chaudhry said. “In that sense, [maintenance of licensure] is simply a means by which those physicians can demonstrate what it is that they are doing.”

Mr. Whitehouse, who also serves on the FSMB's implementation group on maintenance of licensure, agrees that the process will not be onerous for physicians who are making an effort to keep their clinical skills current.

FSMB CEO Dr. Humayun Chaudhry (right) discusses the Maintenance of Licensure initiative with Frances Cain, Director of the FSMB's Post-Licensure Assessment System.

Source Courtesy Rick Dalton

State medical boards are eyeing ways to overhaul the relicensure process so that it better measures a physician's efforts to stay abreast of clinical developments.

Currently, while the public assumes that state licensure means that a physician remains competent, that's just not the case, according to Richard A. Whitehouse, the executive director of the State Medical Board of Ohio.

“There is really no measure once someone is initially licensed and has met the threshold requirements for licensure,” he said. “Absent CME requirements, there's really nothing you can point to, to say that this person is maintaining their competency.”

Officials involved in the redesign process, however, emphasize that the new requirements won't be a burden on practicing physicians and that most doctors are already doing enough to meet the standards under development.

The Federation of State Medical Boards (FSMB), which represents the nation's state medical boards, has been promoting the need to make relicensure a more robust process for several years.

Last spring, the organization's House of Delegates approved a framework that lays out what the maintenance of licensure process would look like in general. And over the past few months, an implementation group made up of physicians and medical board officials has been filling in the details.

The expectation is that new maintenance of licensure requirements will involve three major components: a reflective self-assessment that calls for physicians to complete a certain number of accredited continuing medical education courses; an assessment of knowledge and skills, which could be a formal exam; and some measurement of performance in practice, in which physicians would compare their practice data to those for peers and to national benchmarks.

Dr. Humayun Chaudhry, president and CEO of the FSMB, said that one of the goals in redesigning the relicensure process is to minimize the burden on practicing physicians. To that end, the FSMB implementation group's draft report calls on state medical boards to accept participation in maintenance of certification through the American Board of Medical Specialties, or osteopathic continuous certification through the American Osteopathic Association, as substantially meeting the requirements for maintenance of licensure. “That's a big advance because a significant plurality of physicians are involved in those programs,” Dr. Chaudhry said.

More than 300,000 physicians are engaged in maintenance of certification through the various boards of the American Board of Medical Specialties, and that number increases by about 50,000 physicians each year, according to Dr. Kevin B. Weiss, ABMS president and CEO.

Officials at the ABMS have been working closely with states for years on the issue of maintenance of licensure and plan to continue to be involved as states begin to pilot the concept over the next several months to ensure that board-certified physicians aren't asked to do any “double work,” Dr. Weiss said. “We're going to be very active in trying to help our physician community on a state-by-state basis.”

Officials at the FSMB are being careful to point out that maintenance of licensure and maintenance of certification are not meant to be equivalent. While maintenance of certification and osteopathic continuous certification could comply with the more robust relicensure requirements, board certification goes “above and beyond” basic licensure, Dr. Chaudhry said.

For the hundreds of thousands of physicians who aren't engaged in some type of maintenance of certification process, the FSMB is working with states to develop alternative pathways to demonstrate ongoing clinical competence.

The timeline for the new requirements is fairly long, Dr. Chaudhry said. The FSMB is recommending that state medical boards implement the new approach in phases that in total could take up to 10 years. The first step for any state medical board that plans to go forward with maintenance of licensure is to spend the first year educating physicians, the public, and lawmakers about what is planned and why. And each of the three components of the process should take another 2–3 years to implement, he said.

“The vast majority of physicians are already doing things to stay up to date,” Dr. Chaudhry said. “In that sense, [maintenance of licensure] is simply a means by which those physicians can demonstrate what it is that they are doing.”

Mr. Whitehouse, who also serves on the FSMB's implementation group on maintenance of licensure, agrees that the process will not be onerous for physicians who are making an effort to keep their clinical skills current.

FSMB CEO Dr. Humayun Chaudhry (right) discusses the Maintenance of Licensure initiative with Frances Cain, Director of the FSMB's Post-Licensure Assessment System.

Source Courtesy Rick Dalton

State medical boards are eyeing ways to overhaul the relicensure process so that it better measures a physician's efforts to stay abreast of clinical developments.

Currently, while the public assumes that state licensure means that a physician remains competent, that's just not the case, according to Richard A. Whitehouse, the executive director of the State Medical Board of Ohio.

“There is really no measure once someone is initially licensed and has met the threshold requirements for licensure,” he said. “Absent CME requirements, there's really nothing you can point to, to say that this person is maintaining their competency.”

Officials involved in the redesign process, however, emphasize that the new requirements won't be a burden on practicing physicians and that most doctors are already doing enough to meet the standards under development.

The Federation of State Medical Boards (FSMB), which represents the nation's state medical boards, has been promoting the need to make relicensure a more robust process for several years.

Last spring, the organization's House of Delegates approved a framework that lays out what the maintenance of licensure process would look like in general. And over the past few months, an implementation group made up of physicians and medical board officials has been filling in the details.

The expectation is that new maintenance of licensure requirements will involve three major components: a reflective self-assessment that calls for physicians to complete a certain number of accredited continuing medical education courses; an assessment of knowledge and skills, which could be a formal exam; and some measurement of performance in practice, in which physicians would compare their practice data to those for peers and to national benchmarks.

Dr. Humayun Chaudhry, president and CEO of the FSMB, said that one of the goals in redesigning the relicensure process is to minimize the burden on practicing physicians. To that end, the FSMB implementation group's draft report calls on state medical boards to accept participation in maintenance of certification through the American Board of Medical Specialties, or osteopathic continuous certification through the American Osteopathic Association, as substantially meeting the requirements for maintenance of licensure. “That's a big advance because a significant plurality of physicians are involved in those programs,” Dr. Chaudhry said.

More than 300,000 physicians are engaged in maintenance of certification through the various boards of the American Board of Medical Specialties, and that number increases by about 50,000 physicians each year, according to Dr. Kevin B. Weiss, ABMS president and CEO.

Officials at the ABMS have been working closely with states for years on the issue of maintenance of licensure and plan to continue to be involved as states begin to pilot the concept over the next several months to ensure that board-certified physicians aren't asked to do any “double work,” Dr. Weiss said. “We're going to be very active in trying to help our physician community on a state-by-state basis.”

Officials at the FSMB are being careful to point out that maintenance of licensure and maintenance of certification are not meant to be equivalent. While maintenance of certification and osteopathic continuous certification could comply with the more robust relicensure requirements, board certification goes “above and beyond” basic licensure, Dr. Chaudhry said.

For the hundreds of thousands of physicians who aren't engaged in some type of maintenance of certification process, the FSMB is working with states to develop alternative pathways to demonstrate ongoing clinical competence.

The timeline for the new requirements is fairly long, Dr. Chaudhry said. The FSMB is recommending that state medical boards implement the new approach in phases that in total could take up to 10 years. The first step for any state medical board that plans to go forward with maintenance of licensure is to spend the first year educating physicians, the public, and lawmakers about what is planned and why. And each of the three components of the process should take another 2–3 years to implement, he said.

“The vast majority of physicians are already doing things to stay up to date,” Dr. Chaudhry said. “In that sense, [maintenance of licensure] is simply a means by which those physicians can demonstrate what it is that they are doing.”

Mr. Whitehouse, who also serves on the FSMB's implementation group on maintenance of licensure, agrees that the process will not be onerous for physicians who are making an effort to keep their clinical skills current.

FSMB CEO Dr. Humayun Chaudhry (right) discusses the Maintenance of Licensure initiative with Frances Cain, Director of the FSMB's Post-Licensure Assessment System.

Source Courtesy Rick Dalton

Arthritis Takes Toll on Hispanics

At least one in five Hispanic Americans experiences severe joint pain and limitations resulting from arthritis, according to data from the Centers for Disease Control and Prevention. For the first time, the CDC analyzed the prevalence of arthritis among seven Hispanic subgroups in the United States: Puerto Ricans, Mexicans, Mexican Americans, South and Central Americans, Dominicans, and Cubans. Overall, about 3.1 million Hispanics have been diagnosed with arthritis, and at least 20% of those in each subgroup said they experienced severe joint pain and activity and work limitations. Puerto Ricans had the highest diagnosed prevalence (22%), whereas Cubans had the lowest (12%). “These findings suggest a critical need to expand the reach of effective strategies aimed at arthritis prevention and management, particularly among underserved populations,” Dr. John H. Klippel, president and CEO of the Arthritis Foundation, said in a statement.

Arthritis Tweets From the NIH

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is now on Twitter (@NIH_NIAMS). Officials at NIAMS are posting weekly, with links to new publications, research advances, and other content on the institute's Web site. Twitter “will allow us to spread the word quickly when we have new information to share with our partners and the public,” Dr. Stephen Katz, NIAMS director, said in a statement.

Bill to Prevent Drug Shortages

Federal legislation aims to prevent shortages of critical prescription drugs by giving more information to the Food and Drug Administration. The bill would require drug manufacturers to notify the FDA early of any problems that could lead to a shortage of medications. Those factors might include changes to raw material supplies, adjustments to manufacturing capabilities, and business changes such as mergers. “Physicians, pharmacists, and patients are currently among the last to know when an essential drug will no longer be available – that's not right,” Sen. Amy Klobuchar (D-Minn.), one of the sponsors of the bill, said in a statement. The “Preserving Access to Life-Saving Medications Act” (S. 296) also directs the FDA to notify the public of shortages and what the agency is doing to address them.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than did men in 2008, but it's not clear why, according to a study in 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., professor at the University of Illinois at Chicago, said in a statement. However, it is surprising that the gap persists after other factors are accounted for, 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.

AMA: Insurers Lack Competition

Almost all commercial health insurance markets in the United States are dominated by just one or two health insurers, potentially causing higher premiums for patients and unfavorable contract terms for physicians, according to a study from the American Medical Association. The AMA found that 99% of health insurance markets are “highly concentrated,” as defined by federal government guidelines on business mergers. In nearly half of metropolitan areas, one insurer had a market share of 50% or more, the report said. Meanwhile, the AMA report found that physicians are the least-concentrated segment of the health care sector, with 78% of office-based physicians working in practices with nine physicians or fewer. Most of these physicians are either in solo practices or in practices with two to four physicians, the report said.

FDA Accelerates Device Reviews

The FDA has proposed an accelerated review program for what it terms “breakthrough medical devices” as part of a broader effort to encourage cutting-edge technologies among device manufacturers. The FDA could conduct reviews within 150 days – about half the time it now takes – on devices that are submitted under the new Innovation Pathway. However, enrollment in the program won't change the standards the agency currently uses to evaluate medical devices, the FDA said. A brain-controlled, upper-extremity prosthesis will serve as the first submission to the Innovation Pathway program, the agency said. However, the FDA also is asking for public comment on the program and plans to hold a hearing this month before finalizing the rules.

Arthritis Takes Toll on Hispanics

At least one in five Hispanic Americans experiences severe joint pain and limitations resulting from arthritis, according to data from the Centers for Disease Control and Prevention. For the first time, the CDC analyzed the prevalence of arthritis among seven Hispanic subgroups in the United States: Puerto Ricans, Mexicans, Mexican Americans, South and Central Americans, Dominicans, and Cubans. Overall, about 3.1 million Hispanics have been diagnosed with arthritis, and at least 20% of those in each subgroup said they experienced severe joint pain and activity and work limitations. Puerto Ricans had the highest diagnosed prevalence (22%), whereas Cubans had the lowest (12%). “These findings suggest a critical need to expand the reach of effective strategies aimed at arthritis prevention and management, particularly among underserved populations,” Dr. John H. Klippel, president and CEO of the Arthritis Foundation, said in a statement.

Arthritis Tweets From the NIH

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is now on Twitter (@NIH_NIAMS). Officials at NIAMS are posting weekly, with links to new publications, research advances, and other content on the institute's Web site. Twitter “will allow us to spread the word quickly when we have new information to share with our partners and the public,” Dr. Stephen Katz, NIAMS director, said in a statement.

Bill to Prevent Drug Shortages

Federal legislation aims to prevent shortages of critical prescription drugs by giving more information to the Food and Drug Administration. The bill would require drug manufacturers to notify the FDA early of any problems that could lead to a shortage of medications. Those factors might include changes to raw material supplies, adjustments to manufacturing capabilities, and business changes such as mergers. “Physicians, pharmacists, and patients are currently among the last to know when an essential drug will no longer be available – that's not right,” Sen. Amy Klobuchar (D-Minn.), one of the sponsors of the bill, said in a statement. The “Preserving Access to Life-Saving Medications Act” (S. 296) also directs the FDA to notify the public of shortages and what the agency is doing to address them.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than did men in 2008, but it's not clear why, according to a study in 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., professor at the University of Illinois at Chicago, said in a statement. However, it is surprising that the gap persists after other factors are accounted for, 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.

AMA: Insurers Lack Competition

Almost all commercial health insurance markets in the United States are dominated by just one or two health insurers, potentially causing higher premiums for patients and unfavorable contract terms for physicians, according to a study from the American Medical Association. The AMA found that 99% of health insurance markets are “highly concentrated,” as defined by federal government guidelines on business mergers. In nearly half of metropolitan areas, one insurer had a market share of 50% or more, the report said. Meanwhile, the AMA report found that physicians are the least-concentrated segment of the health care sector, with 78% of office-based physicians working in practices with nine physicians or fewer. Most of these physicians are either in solo practices or in practices with two to four physicians, the report said.

FDA Accelerates Device Reviews

The FDA has proposed an accelerated review program for what it terms “breakthrough medical devices” as part of a broader effort to encourage cutting-edge technologies among device manufacturers. The FDA could conduct reviews within 150 days – about half the time it now takes – on devices that are submitted under the new Innovation Pathway. However, enrollment in the program won't change the standards the agency currently uses to evaluate medical devices, the FDA said. A brain-controlled, upper-extremity prosthesis will serve as the first submission to the Innovation Pathway program, the agency said. However, the FDA also is asking for public comment on the program and plans to hold a hearing this month before finalizing the rules.

Arthritis Takes Toll on Hispanics

At least one in five Hispanic Americans experiences severe joint pain and limitations resulting from arthritis, according to data from the Centers for Disease Control and Prevention. For the first time, the CDC analyzed the prevalence of arthritis among seven Hispanic subgroups in the United States: Puerto Ricans, Mexicans, Mexican Americans, South and Central Americans, Dominicans, and Cubans. Overall, about 3.1 million Hispanics have been diagnosed with arthritis, and at least 20% of those in each subgroup said they experienced severe joint pain and activity and work limitations. Puerto Ricans had the highest diagnosed prevalence (22%), whereas Cubans had the lowest (12%). “These findings suggest a critical need to expand the reach of effective strategies aimed at arthritis prevention and management, particularly among underserved populations,” Dr. John H. Klippel, president and CEO of the Arthritis Foundation, said in a statement.

Arthritis Tweets From the NIH

The National Institute of Arthritis and Musculoskeletal and Skin Diseases is now on Twitter (@NIH_NIAMS). Officials at NIAMS are posting weekly, with links to new publications, research advances, and other content on the institute's Web site. Twitter “will allow us to spread the word quickly when we have new information to share with our partners and the public,” Dr. Stephen Katz, NIAMS director, said in a statement.

Bill to Prevent Drug Shortages

Federal legislation aims to prevent shortages of critical prescription drugs by giving more information to the Food and Drug Administration. The bill would require drug manufacturers to notify the FDA early of any problems that could lead to a shortage of medications. Those factors might include changes to raw material supplies, adjustments to manufacturing capabilities, and business changes such as mergers. “Physicians, pharmacists, and patients are currently among the last to know when an essential drug will no longer be available – that's not right,” Sen. Amy Klobuchar (D-Minn.), one of the sponsors of the bill, said in a statement. The “Preserving Access to Life-Saving Medications Act” (S. 296) also directs the FDA to notify the public of shortages and what the agency is doing to address them.

Salary Gender Gap Identified

Newly trained female physicians made nearly $17,000 less than did men in 2008, but it's not clear why, according to a study in 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., professor at the University of Illinois at Chicago, said in a statement. However, it is surprising that the gap persists after other factors are accounted for, 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.

AMA: Insurers Lack Competition

Almost all commercial health insurance markets in the United States are dominated by just one or two health insurers, potentially causing higher premiums for patients and unfavorable contract terms for physicians, according to a study from the American Medical Association. The AMA found that 99% of health insurance markets are “highly concentrated,” as defined by federal government guidelines on business mergers. In nearly half of metropolitan areas, one insurer had a market share of 50% or more, the report said. Meanwhile, the AMA report found that physicians are the least-concentrated segment of the health care sector, with 78% of office-based physicians working in practices with nine physicians or fewer. Most of these physicians are either in solo practices or in practices with two to four physicians, the report said.

FDA Accelerates Device Reviews

The FDA has proposed an accelerated review program for what it terms “breakthrough medical devices” as part of a broader effort to encourage cutting-edge technologies among device manufacturers. The FDA could conduct reviews within 150 days – about half the time it now takes – on devices that are submitted under the new Innovation Pathway. However, enrollment in the program won't change the standards the agency currently uses to evaluate medical devices, the FDA said. A brain-controlled, upper-extremity prosthesis will serve as the first submission to the Innovation Pathway program, the agency said. However, the FDA also is asking for public comment on the program and plans to hold a hearing this month before finalizing the rules.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association President Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgy, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka said he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found 61% of physicians aged 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association President Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgy, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka said he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found 61% of physicians aged 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association President Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

“This is no slam dunk,” said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California's Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped reduce premiums and improve access for patients. For example, 90% of the state's physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scarce specialties including obstetrics, orthopedic surgy, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka said he's getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but said he's doubtful that President Obama's vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found 61% of physicians aged 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

The Senate signaled its intention to repeal from the health reform law a tax-reporting requirement that has been labeled as overly burdensome by the medical and business communities.

The Affordable Care Act currently includes a provision requiring businesses – including physician practices – to file a 1099 tax form with the Internal Revenue Service for all vendor payments of more than $600 per year. The requirement is set to take effect in 2012.

Sen. Debbie Stabenow (D-Mich.) proposed repealing the 1099 requirement as an amendment to the FAA Air Transportation Modernization and Safety Improvement Act (S. 223).

Last month, the amendment was passed by a vote of 81-17.

The American Medical Association has been lobbying against the 1099 requirement, noting that compliance would be expensive and would negatively impact physicians' practices.

“It is estimated that paperwork already takes up as much as a third of a physician's workday – time that could be better spent with patients – and this provision would only increase that burden,” AMA President Cecil B. Wilson said in a statement. The reporting requirement is one of the few potential changes to the Affordable Care Act on which Democrats and Republicans can agree. In his State of the Union address last week, President Obama singled out the repeal of the 1099 requirement as a change he would support. The mention drew a standing ovation from members of Congress.

The Senate signaled its intention to repeal from the health reform law a tax-reporting requirement that has been labeled as overly burdensome by the medical and business communities.

The Affordable Care Act currently includes a provision requiring businesses – including physician practices – to file a 1099 tax form with the Internal Revenue Service for all vendor payments of more than $600 per year. The requirement is set to take effect in 2012.

Sen. Debbie Stabenow (D-Mich.) proposed repealing the 1099 requirement as an amendment to the FAA Air Transportation Modernization and Safety Improvement Act (S. 223).

Last month, the amendment was passed by a vote of 81-17.

The American Medical Association has been lobbying against the 1099 requirement, noting that compliance would be expensive and would negatively impact physicians' practices.

“It is estimated that paperwork already takes up as much as a third of a physician's workday – time that could be better spent with patients – and this provision would only increase that burden,” AMA President Cecil B. Wilson said in a statement. The reporting requirement is one of the few potential changes to the Affordable Care Act on which Democrats and Republicans can agree. In his State of the Union address last week, President Obama singled out the repeal of the 1099 requirement as a change he would support. The mention drew a standing ovation from members of Congress.

The Senate signaled its intention to repeal from the health reform law a tax-reporting requirement that has been labeled as overly burdensome by the medical and business communities.

The Affordable Care Act currently includes a provision requiring businesses – including physician practices – to file a 1099 tax form with the Internal Revenue Service for all vendor payments of more than $600 per year. The requirement is set to take effect in 2012.

Sen. Debbie Stabenow (D-Mich.) proposed repealing the 1099 requirement as an amendment to the FAA Air Transportation Modernization and Safety Improvement Act (S. 223).

Last month, the amendment was passed by a vote of 81-17.

The American Medical Association has been lobbying against the 1099 requirement, noting that compliance would be expensive and would negatively impact physicians' practices.

“It is estimated that paperwork already takes up as much as a third of a physician's workday – time that could be better spent with patients – and this provision would only increase that burden,” AMA President Cecil B. Wilson said in a statement. The reporting requirement is one of the few potential changes to the Affordable Care Act on which Democrats and Republicans can agree. In his State of the Union address last week, President Obama singled out the repeal of the 1099 requirement as a change he would support. The mention drew a standing ovation from members of Congress.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called “dinner talks.”

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck. “No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in November (Epilepsy Behav. 2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom makes physicians less likely to want to give the talks, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration. “While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement.

The open letter offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make. Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program. Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this.

But other physicians see CME talks as a better alternative for physician education. Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called “dinner talks.”

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck. “No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in November (Epilepsy Behav. 2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom makes physicians less likely to want to give the talks, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration. “While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement.

The open letter offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make. Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program. Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this.

But other physicians see CME talks as a better alternative for physician education. Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called “dinner talks.”

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck. “No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in November (Epilepsy Behav. 2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom makes physicians less likely to want to give the talks, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration. “While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement.

The open letter offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make. Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program. Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this.

But other physicians see CME talks as a better alternative for physician education. Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

The National Committee for Quality Assurance has released new standards for practices seeking recognition as a medical home.

The standards require practices to demonstrate continuity of care by allowing patients to select a personal physician, offering after-hour access to appointments and medical advice, and having interpreters available and making sure forms and other documents are in the patient's preferred language. The standards were redesigned to better echo the requirements of the new Medicare and Medicaid programs offering incentives for the implementation of electronic health records.

Most practices are still physician centric, said Dr. Xavier Sevilla, a pediatrician in Lakewood Ranch, Fla., and a member of the NCQA Patient-Centered Medical Home Advisory Committee. For example, practices typically open their doors when it's convenient for physicians and offer standard 15-minute appointments for the same reason.

With some of the new standards, NCQA officials are looking to get physicians thinking about things from the patient's point of view, he said.

“There is a big gap between where we want to go, which is that advanced primary care patient-centered medical home, and what we have right now,” Dr. Sevilla said in an interview.

This is the first time the standards have been revamped since they were issued in January 2008. As with the earlier version of the recognition program, the NCQA offers practices three levels of recognition based on points earned for each element of the standards. However, all recognition levels require practices to comply with six “must-pass” elements: access during office hours, using data for population management, care management, supporting the self-care process, tracking referrals and follow-up, and implementing continuous quality improvement.

Starting in 2012, participating practices will receive extra credit if they report the results of a new, standardized patient experience survey. The survey is being developed in collaboration with the Agency for Healthcare Research and Quality and will be a medical home version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey. It is expected to be released later this year.

Practices will get credit for reporting in 2012, but the NCQA expects to evaluate practices on results in the future.

The updated standards also include more requirements for the use of health information technology and are closely modeled on the federal EHR incentive program that began earlier this year.

For example, the NCQA standards require practices to use an electronic prescribing system that generates and transmits at least 40% of eligible prescriptions to pharmacies. The NCQA also calls on practices to use an electronic system to record up-to-date problem lists, allergies and adverse reactions, smoking status, and a list of prescription medications.

The revised standards are a “paragon of 21st century primary care,” NCQA President Margaret E. O'Kane said in a statement. “By emphasizing access, health information technology, and partnerships between clinicians and patients to improve health, these new standards raise the bar in defining high-quality care.”

The NCQA rewrote the standards to be more clear and specific, but also to be more challenging. Dr. Sevilla, who chairs the American Academy of Pediatrics Steering Committee of Quality Improvement and Management, advises practices to try to qualify for NCQA recognition in terms of where they are now as a medical home, then use the standards as a “road map” for continuing to improve. But earning 100 points from the start will be very difficult, he said.

The medical home recognition program is the NCQA's fastest growing program. Since December 2008, the number of clinicians recognized through the program has climbed from 214 to 7,676 at the end of 2010. Over the same period, the number of practices recognized as medical homes has risen from 28 to 1,506.

The 2011 standards are available at www.ncqa.org/view-pcmh2011

The National Committee for Quality Assurance has released new standards for practices seeking recognition as a medical home.

The standards require practices to demonstrate continuity of care by allowing patients to select a personal physician, offering after-hour access to appointments and medical advice, and having interpreters available and making sure forms and other documents are in the patient's preferred language. The standards were redesigned to better echo the requirements of the new Medicare and Medicaid programs offering incentives for the implementation of electronic health records.

Most practices are still physician centric, said Dr. Xavier Sevilla, a pediatrician in Lakewood Ranch, Fla., and a member of the NCQA Patient-Centered Medical Home Advisory Committee. For example, practices typically open their doors when it's convenient for physicians and offer standard 15-minute appointments for the same reason.

With some of the new standards, NCQA officials are looking to get physicians thinking about things from the patient's point of view, he said.

“There is a big gap between where we want to go, which is that advanced primary care patient-centered medical home, and what we have right now,” Dr. Sevilla said in an interview.

This is the first time the standards have been revamped since they were issued in January 2008. As with the earlier version of the recognition program, the NCQA offers practices three levels of recognition based on points earned for each element of the standards. However, all recognition levels require practices to comply with six “must-pass” elements: access during office hours, using data for population management, care management, supporting the self-care process, tracking referrals and follow-up, and implementing continuous quality improvement.

Starting in 2012, participating practices will receive extra credit if they report the results of a new, standardized patient experience survey. The survey is being developed in collaboration with the Agency for Healthcare Research and Quality and will be a medical home version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey. It is expected to be released later this year.

Practices will get credit for reporting in 2012, but the NCQA expects to evaluate practices on results in the future.

The updated standards also include more requirements for the use of health information technology and are closely modeled on the federal EHR incentive program that began earlier this year.

For example, the NCQA standards require practices to use an electronic prescribing system that generates and transmits at least 40% of eligible prescriptions to pharmacies. The NCQA also calls on practices to use an electronic system to record up-to-date problem lists, allergies and adverse reactions, smoking status, and a list of prescription medications.

The revised standards are a “paragon of 21st century primary care,” NCQA President Margaret E. O'Kane said in a statement. “By emphasizing access, health information technology, and partnerships between clinicians and patients to improve health, these new standards raise the bar in defining high-quality care.”

The NCQA rewrote the standards to be more clear and specific, but also to be more challenging. Dr. Sevilla, who chairs the American Academy of Pediatrics Steering Committee of Quality Improvement and Management, advises practices to try to qualify for NCQA recognition in terms of where they are now as a medical home, then use the standards as a “road map” for continuing to improve. But earning 100 points from the start will be very difficult, he said.

The medical home recognition program is the NCQA's fastest growing program. Since December 2008, the number of clinicians recognized through the program has climbed from 214 to 7,676 at the end of 2010. Over the same period, the number of practices recognized as medical homes has risen from 28 to 1,506.

The 2011 standards are available at www.ncqa.org/view-pcmh2011

The National Committee for Quality Assurance has released new standards for practices seeking recognition as a medical home.

The standards require practices to demonstrate continuity of care by allowing patients to select a personal physician, offering after-hour access to appointments and medical advice, and having interpreters available and making sure forms and other documents are in the patient's preferred language. The standards were redesigned to better echo the requirements of the new Medicare and Medicaid programs offering incentives for the implementation of electronic health records.

Most practices are still physician centric, said Dr. Xavier Sevilla, a pediatrician in Lakewood Ranch, Fla., and a member of the NCQA Patient-Centered Medical Home Advisory Committee. For example, practices typically open their doors when it's convenient for physicians and offer standard 15-minute appointments for the same reason.

With some of the new standards, NCQA officials are looking to get physicians thinking about things from the patient's point of view, he said.

“There is a big gap between where we want to go, which is that advanced primary care patient-centered medical home, and what we have right now,” Dr. Sevilla said in an interview.

This is the first time the standards have been revamped since they were issued in January 2008. As with the earlier version of the recognition program, the NCQA offers practices three levels of recognition based on points earned for each element of the standards. However, all recognition levels require practices to comply with six “must-pass” elements: access during office hours, using data for population management, care management, supporting the self-care process, tracking referrals and follow-up, and implementing continuous quality improvement.

Starting in 2012, participating practices will receive extra credit if they report the results of a new, standardized patient experience survey. The survey is being developed in collaboration with the Agency for Healthcare Research and Quality and will be a medical home version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey. It is expected to be released later this year.

Practices will get credit for reporting in 2012, but the NCQA expects to evaluate practices on results in the future.

The updated standards also include more requirements for the use of health information technology and are closely modeled on the federal EHR incentive program that began earlier this year.

For example, the NCQA standards require practices to use an electronic prescribing system that generates and transmits at least 40% of eligible prescriptions to pharmacies. The NCQA also calls on practices to use an electronic system to record up-to-date problem lists, allergies and adverse reactions, smoking status, and a list of prescription medications.

The revised standards are a “paragon of 21st century primary care,” NCQA President Margaret E. O'Kane said in a statement. “By emphasizing access, health information technology, and partnerships between clinicians and patients to improve health, these new standards raise the bar in defining high-quality care.”

The NCQA rewrote the standards to be more clear and specific, but also to be more challenging. Dr. Sevilla, who chairs the American Academy of Pediatrics Steering Committee of Quality Improvement and Management, advises practices to try to qualify for NCQA recognition in terms of where they are now as a medical home, then use the standards as a “road map” for continuing to improve. But earning 100 points from the start will be very difficult, he said.

The medical home recognition program is the NCQA's fastest growing program. Since December 2008, the number of clinicians recognized through the program has climbed from 214 to 7,676 at the end of 2010. Over the same period, the number of practices recognized as medical homes has risen from 28 to 1,506.

The 2011 standards are available at www.ncqa.org/view-pcmh2011

It's been about a year since enactment of the Affordable Care Act. At the time, no one proclaimed it a perfect piece of legislation, but supporters avowed that the law made important progress toward of the goal of covering more Americans and that the law itself could be improved over time. President Obama reiterated that message during this most recent State of the Union address, promising to work with Congress  on changes that would make health care better and more affordable. With that in mind, Skin & Allergy News asked several medical societies to tell us what they see as the biggest flaw in the ACA and what Congress and the president should do it fix it.

Dr. Marta VanBeek, congressional policy committee chair, American Academy of Dermatology

"One of the more concerning issues in the Affordable Care Act is the Independent Payment Advisory Board, which usurps congressional authority over Medicare physician payment. It bestows enormous power to a board that is not publicly accountable. As it stands now, hospitals are exempt for the first several years, whereas physician fees are not. Specifically, Congress could revise the authority that the body has, or address the timeline of when the board puts forth an agenda to when Congress needs to respond to it.

"Congress also needs to address the Sustainable Growth Rate formula and replace it with a more stable and responsive payment system. The ability of physicians to implement other aspects of the ACA, such as integrating electronic medical records and reporting quality measures, depends on having a stable payment system."

Dr. Cecil B. Wilson, president, American Medical Association

"As the nation's largest physician organization, the AMA is working during the implementation of the health reform law to ensure the best outcomes for patients and physicians. The AMA is advocating for expanded medical liability reforms, major changes in the [Independent Payment Advisory Board] framework, and the elimination of the IRS 1099 reporting requirement. We are also committed to engaging physicians in the development of new payment models, including accountable care organizations. The AMA is working on regulatory changes to ensure physicians across the spectrum of practice settings can both lead and participate successfully in these new models of care. The AMA will continue working with members of Congress on both sides of the aisle for a long-term solution to the broken Medicare physician payment system that will better reflect the costs and practice of 21st-century medicine and protect patients' access to physician care."

Dr. J. Fred Ralston Jr., president, American College of Physicians

"We recognize that the legislation can and should be improved, and hope there can be bipartisan common ground on a plan to permanently repeal the Sustainable Growth Rate (SGR) formula, to further support the value of primary care in Medicare payments, and to enact meaningful tort reform.

"We hope that there can be broader understanding of the need for healthier lifestyles, better prevention, and a larger primary care work force to meet the additional demands of our newly insured and increased needs of aging baby boomers. We look for additional support for innovative programs like the patient-centered medical home as an opportunity to bend the cost curve and improve outcomes while at the same time increasing satisfaction for patients, staff, and physicians. Currently, small businesses – the greatest incubator of new jobs – struggle to find insurance coverage at all and usually pay much higher prices than large companies. The insurance exchanges for individuals and small business are a crucial provision of the ACA and need to be retained. We hope to keep what is great about American medicine but deliver it to everyone in a way that we can all afford."

It's been about a year since enactment of the Affordable Care Act. At the time, no one proclaimed it a perfect piece of legislation, but supporters avowed that the law made important progress toward of the goal of covering more Americans and that the law itself could be improved over time. President Obama reiterated that message during this most recent State of the Union address, promising to work with Congress  on changes that would make health care better and more affordable. With that in mind, Skin & Allergy News asked several medical societies to tell us what they see as the biggest flaw in the ACA and what Congress and the president should do it fix it.

Dr. Marta VanBeek, congressional policy committee chair, American Academy of Dermatology

"One of the more concerning issues in the Affordable Care Act is the Independent Payment Advisory Board, which usurps congressional authority over Medicare physician payment. It bestows enormous power to a board that is not publicly accountable. As it stands now, hospitals are exempt for the first several years, whereas physician fees are not. Specifically, Congress could revise the authority that the body has, or address the timeline of when the board puts forth an agenda to when Congress needs to respond to it.

"Congress also needs to address the Sustainable Growth Rate formula and replace it with a more stable and responsive payment system. The ability of physicians to implement other aspects of the ACA, such as integrating electronic medical records and reporting quality measures, depends on having a stable payment system."

Dr. Cecil B. Wilson, president, American Medical Association

"As the nation's largest physician organization, the AMA is working during the implementation of the health reform law to ensure the best outcomes for patients and physicians. The AMA is advocating for expanded medical liability reforms, major changes in the [Independent Payment Advisory Board] framework, and the elimination of the IRS 1099 reporting requirement. We are also committed to engaging physicians in the development of new payment models, including accountable care organizations. The AMA is working on regulatory changes to ensure physicians across the spectrum of practice settings can both lead and participate successfully in these new models of care. The AMA will continue working with members of Congress on both sides of the aisle for a long-term solution to the broken Medicare physician payment system that will better reflect the costs and practice of 21st-century medicine and protect patients' access to physician care."

Dr. J. Fred Ralston Jr., president, American College of Physicians

"We recognize that the legislation can and should be improved, and hope there can be bipartisan common ground on a plan to permanently repeal the Sustainable Growth Rate (SGR) formula, to further support the value of primary care in Medicare payments, and to enact meaningful tort reform.

"We hope that there can be broader understanding of the need for healthier lifestyles, better prevention, and a larger primary care work force to meet the additional demands of our newly insured and increased needs of aging baby boomers. We look for additional support for innovative programs like the patient-centered medical home as an opportunity to bend the cost curve and improve outcomes while at the same time increasing satisfaction for patients, staff, and physicians. Currently, small businesses – the greatest incubator of new jobs – struggle to find insurance coverage at all and usually pay much higher prices than large companies. The insurance exchanges for individuals and small business are a crucial provision of the ACA and need to be retained. We hope to keep what is great about American medicine but deliver it to everyone in a way that we can all afford."

It's been about a year since enactment of the Affordable Care Act. At the time, no one proclaimed it a perfect piece of legislation, but supporters avowed that the law made important progress toward of the goal of covering more Americans and that the law itself could be improved over time. President Obama reiterated that message during this most recent State of the Union address, promising to work with Congress  on changes that would make health care better and more affordable. With that in mind, Skin & Allergy News asked several medical societies to tell us what they see as the biggest flaw in the ACA and what Congress and the president should do it fix it.

Dr. Marta VanBeek, congressional policy committee chair, American Academy of Dermatology

"One of the more concerning issues in the Affordable Care Act is the Independent Payment Advisory Board, which usurps congressional authority over Medicare physician payment. It bestows enormous power to a board that is not publicly accountable. As it stands now, hospitals are exempt for the first several years, whereas physician fees are not. Specifically, Congress could revise the authority that the body has, or address the timeline of when the board puts forth an agenda to when Congress needs to respond to it.

"Congress also needs to address the Sustainable Growth Rate formula and replace it with a more stable and responsive payment system. The ability of physicians to implement other aspects of the ACA, such as integrating electronic medical records and reporting quality measures, depends on having a stable payment system."

Dr. Cecil B. Wilson, president, American Medical Association

"As the nation's largest physician organization, the AMA is working during the implementation of the health reform law to ensure the best outcomes for patients and physicians. The AMA is advocating for expanded medical liability reforms, major changes in the [Independent Payment Advisory Board] framework, and the elimination of the IRS 1099 reporting requirement. We are also committed to engaging physicians in the development of new payment models, including accountable care organizations. The AMA is working on regulatory changes to ensure physicians across the spectrum of practice settings can both lead and participate successfully in these new models of care. The AMA will continue working with members of Congress on both sides of the aisle for a long-term solution to the broken Medicare physician payment system that will better reflect the costs and practice of 21st-century medicine and protect patients' access to physician care."

Dr. J. Fred Ralston Jr., president, American College of Physicians

"We recognize that the legislation can and should be improved, and hope there can be bipartisan common ground on a plan to permanently repeal the Sustainable Growth Rate (SGR) formula, to further support the value of primary care in Medicare payments, and to enact meaningful tort reform.

"We hope that there can be broader understanding of the need for healthier lifestyles, better prevention, and a larger primary care work force to meet the additional demands of our newly insured and increased needs of aging baby boomers. We look for additional support for innovative programs like the patient-centered medical home as an opportunity to bend the cost curve and improve outcomes while at the same time increasing satisfaction for patients, staff, and physicians. Currently, small businesses – the greatest incubator of new jobs – struggle to find insurance coverage at all and usually pay much higher prices than large companies. The insurance exchanges for individuals and small business are a crucial provision of the ACA and need to be retained. We hope to keep what is great about American medicine but deliver it to everyone in a way that we can all afford."

Everyone from employers to husbands should help new mothers overcome obstacles to breastfeeding, according to a new report from the U.S. Surgeon General.

The "Call to Action," which was released on Jan. 20, identifies ways that the people around new mothers can help them to stick with breastfeeding. For example, clinicians can do their part by getting trained to care for breastfeeding mothers and babies, and by ensuring that mothers receive proper advice on how to breastfeed.

"Many barriers exist for mothers who want to breastfeed," Dr. Regina M. Benjamin, the U.S. Surgeon General, said in a statement. "They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed."

About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. The number of women who exclusively breastfeed their babies at the end of 6 months is even lower, at 13%.

But Dr. Benjamin said that breastfeeding is a personal decision and women shouldn’t be made to feel guilty if they choose not to breastfeed.

The report details a number of steps that can help support new mothers in their decision to choose and continue breastfeeding:

• Organizations can offer breastfeeding classes that target not just pregnant women and new mothers, but also fathers and grandmothers.

• Physicians can encourage breastfeeding by not handing out notepads and growth charts with formula company logos on them. Displaying products from the formula companies can imply to patients that physicians favor formula feeding over breastfeeding, according to the report.

• Providers of undergraduate and graduate medical education can incorporate content on breastfeeding because health professionals in all specialties encounter breastfeeding mothers and children.

• Insurance companies can include lactation services in their standard benefit package for women and children.

• Employers can include lactation support as part of their basic employee benefits package.

Everyone from employers to husbands should help new mothers overcome obstacles to breastfeeding, according to a new report from the U.S. Surgeon General.

The "Call to Action," which was released on Jan. 20, identifies ways that the people around new mothers can help them to stick with breastfeeding. For example, clinicians can do their part by getting trained to care for breastfeeding mothers and babies, and by ensuring that mothers receive proper advice on how to breastfeed.

"Many barriers exist for mothers who want to breastfeed," Dr. Regina M. Benjamin, the U.S. Surgeon General, said in a statement. "They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed."

About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. The number of women who exclusively breastfeed their babies at the end of 6 months is even lower, at 13%.

But Dr. Benjamin said that breastfeeding is a personal decision and women shouldn’t be made to feel guilty if they choose not to breastfeed.

The report details a number of steps that can help support new mothers in their decision to choose and continue breastfeeding:

• Organizations can offer breastfeeding classes that target not just pregnant women and new mothers, but also fathers and grandmothers.

• Physicians can encourage breastfeeding by not handing out notepads and growth charts with formula company logos on them. Displaying products from the formula companies can imply to patients that physicians favor formula feeding over breastfeeding, according to the report.

• Providers of undergraduate and graduate medical education can incorporate content on breastfeeding because health professionals in all specialties encounter breastfeeding mothers and children.

• Insurance companies can include lactation services in their standard benefit package for women and children.

• Employers can include lactation support as part of their basic employee benefits package.

Everyone from employers to husbands should help new mothers overcome obstacles to breastfeeding, according to a new report from the U.S. Surgeon General.

The "Call to Action," which was released on Jan. 20, identifies ways that the people around new mothers can help them to stick with breastfeeding. For example, clinicians can do their part by getting trained to care for breastfeeding mothers and babies, and by ensuring that mothers receive proper advice on how to breastfeed.

"Many barriers exist for mothers who want to breastfeed," Dr. Regina M. Benjamin, the U.S. Surgeon General, said in a statement. "They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed."

About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. The number of women who exclusively breastfeed their babies at the end of 6 months is even lower, at 13%.

But Dr. Benjamin said that breastfeeding is a personal decision and women shouldn’t be made to feel guilty if they choose not to breastfeed.

The report details a number of steps that can help support new mothers in their decision to choose and continue breastfeeding:

• Organizations can offer breastfeeding classes that target not just pregnant women and new mothers, but also fathers and grandmothers.

• Physicians can encourage breastfeeding by not handing out notepads and growth charts with formula company logos on them. Displaying products from the formula companies can imply to patients that physicians favor formula feeding over breastfeeding, according to the report.

• Providers of undergraduate and graduate medical education can incorporate content on breastfeeding because health professionals in all specialties encounter breastfeeding mothers and children.

• Insurance companies can include lactation services in their standard benefit package for women and children.

• Employers can include lactation support as part of their basic employee benefits package.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

"This is no slam dunk," said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California’s Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state’s physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scare specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he’s getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he’s doubtful that President Obama’s vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

"This is no slam dunk," said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California’s Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state’s physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scare specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he’s getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he’s doubtful that President Obama’s vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.

The issue of medical liability reform is back in the headlines since President Obama said he would consider some type of reform to curb frivolous lawsuits. But physicians say there are plenty of political obstacles to making meaningful changes to the tort system.

One of the major hurdles, according to Texas Medical Association president Susan Rudd Bailey, will be getting a bill passed by the Democratic-controlled Senate. Democrats have historically opposed capping noneconomic damages, otherwise known as pain and suffering awards, which have been at the heart of the tort reforms passed in Texas and California.

"This is no slam dunk," said Dr. Bailey, an allergist in Fort Worth.

The Texas Medical Association is one of more than 100 state and national medical organizations that have endorsed new federal legislation aimed at reducing medical liability lawsuits. The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, H.R. 5, is modeled after California’s Medical Injury Compensation Reform Act (MICRA), which has been in place for about 30 years. The new federal legislation would place a $250,000 cap on noneconomic damages and would require that medical liability suits must be filed within 3 years of the injury in most cases.

The cap on noneconomic damages is the cornerstone of the Texas medical liability reform law enacted in 2003. The cap, Dr. Bailey said, has helped to reduce premiums and improve access for patients. For example, 90% of the state’s physicians have seen their malpractice insurance rates cut by 30% or more, according to the Texas Medical Association.

In 2001– before the legislation was enacted – the number of newly licensed physicians in Texas was at a decade-long low of 2,088. By 2008, that number had risen to 3,621. And since enactment, the number of physicians practicing in previously scare specialties including obstetrics, orthopedic surgery, neurosurgery, emergency medicine, and cardiovascular surgery has increased, according to figures from the Texas Medical Association.

Dr. Alex Valadka, a neurosurgeon at the Seton Brain and Spine Institute in Austin, said the 2003 tort law has dramatically improved the practice climate in the state. Anecdotally, Dr. Valadka says he’s getting fewer calls from other physicians seeking consultations on complicated cases because there are more neurosurgeons to take on the work. Dr. Valadka said he hopes that similar reforms can be passed at the federal level, but he said he’s doubtful that President Obama’s vision for tort reform will look like the Texas statute.

So far, the President has been light on specifics. In 2009, as Congress was considering the Affordable Care Act, the President told the American Medical Association that he did not favor capping noneconomic damages because it can be unfair to patients.

The AMA has been pushing to get medical liability reform back at the top of the congressional agenda after it was left out of the ACA.

Dr. Ardis Dee Hoven, AMA chairwoman, recently testified before the House Judiciary Committee about the pressure physicians face from malpractice suits.

An AMA survey found that 61% of physicians age 55 and older had been sued at least once in their careers, with an average of 1.6 claims per doctor. But certain specialties, like obstetrics-gynecology and surgery, had much higher rates.

Many of the lawsuits are without merit, Dr. Hoven testified to the committee. The AMA survey found that 65% of claims were dropped, dismissed, or withdrawn. But it still cost about $20,000 per claim to defend the suits that were ultimately dropped, according to the report.

The American College of Physicians, which also supports the HEALTH Act, is calling on Congress to consider other reforms to reduce defensive medicine, such as health courts. The ACP is asking Congress to pass legislation that would allow for pilot testing of health courts on a national scale.

Health courts are a no-fault system in which cases are heard by specially trained judges with access to independent medical experts. Health court judges would be able to authorize awards based on the damages incurred.