Mary Ellen Schneider

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 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 the November issue of the journal Epilepsy & Behavior (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. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less viable option.

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.

“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 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 the November issue of the journal Epilepsy & Behavior (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. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less viable option.

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.

“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 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 the November issue of the journal Epilepsy & Behavior (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. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less viable option.

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.

“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.

Absorptiometry Checks Coming

Physicians who performed dual-energy x-ray absorptiometry scans between January and July of 2010 should be getting extra payments from the federal government. Under the Affordable Care Act, Medicare increased its rate for DXA from about $62 to $98 per scan beginning July 1, 2010. The law also stated that the increase would be retroactive to the first of the year. But officials at the Centers for Medicare and Medicaid Services did not send those checks last year because the agency did not have the money to reprocess the 350 million or so claims. Last December, Congress passed the Medicare and Medicaid Extenders Act, insisting that the CMS pay out the delayed reimbursements without physicians having to request them. At press time, the CMS had not announced when the checks would go out.

Rheumatoid Risks Calculated

Researchers at the Mayo Clinic in Rochester, Minn., have created a lifetime risk estimate for rheumatoid arthritis and six other autoimmune rheumatic diseases that can be used by physicians to counsel patients. The Mayo team studied a cohort of 1,179 patients who had been diagnosed with the conditions during 1955-2007 in the Rochester Epidemiology Project and determined that the adult lifetime risk of having an inflammatory autoimmune disease is 8.4% for women and 5.1% for men. This is a substantial risk, said the researchers. Risks for individual conditions were rheumatoid arthritis, 3.6% for women and 1.7% for men; systemic lupus erythematosus, 0.9% for women and 0.2% for men; and psoriatic arthritis, 0.5% for women and 0.6% for men. The research, supported by the National Institutes of Health, appeared online in the Mayo Clinic newsletter.

Inpatient Surgery Yields Fines

Seven U.S. hospitals have agreed to pay $6.3 million to the federal government to settle charges that from 2000 to 2008 they overcharged Medicare for performing inpatient kyphoplasty operations that could have been done safely as outpatient procedures. The government alleged that the hospitals performed the minimally invasive surgeries on an inpatient basis just to increase the amount they could charge Medicare. The settlement is part of a larger crackdown. In 2009 and 2010, the federal government reached settlements with 18 other hospitals over Medicare claims involving the osteoporosis-fractures procedure. In May 2008, Medtronic Spine agreed to pay $75 million to settle allegations that the company counseled hospitals to perform kyphoplasty as an inpatient procedure.

NFL Funds Spinal Research

Armed with a $100,000 grant from the National Football League, researchers at Cornell University and Weill Cornell Medical College are attempting to bioengineer a living intervertebral disk that can be put into patients who suffer degenerative disk disease. Today's surgeries often do not restore patients to the function they had before injury. By creating a living disk, the researchers said they hope to create an implant that can “grow, adapt, and integrate” to restore function to the spine. The researchers will first create the disks from sheep cells and tissues and test them in animals.

State to Review Rate Hike

California's new insurance commissioner said he will review health insurance rate hikes of up to 59% for Blue Shield of California customers, but he warned that he does not have the power to reverse those hikes. Blue Shield, which is raising its rates for the third time since October, declined to delay the timing of the latest increase, currently scheduled for March 1. “Despite Blue Shield's unwillingness to delay their rate increase, the Department of Insurance will conduct a full and complete review of their rate filing,” Insurance Commissioner Dave Jones said in a statement. “The Blue Shield rate increase underscores the need for the legislature to give the insurance commissioner the authority to reject excessive premium increases. I do not have that authority now,” said Mr. Jones. Blue Shield Chief Executive Bruce Bodaken said in a statement that the increases reflect “the actual cost of providing medical care.”

Medicare Use is Uneven

The amount of Medicare service used by beneficiaries varies substantially across the country, with beneficiaries in high service-use areas getting Medicare-funded care about 30% more than beneficiaries in low-service areas, according to a report from the Medicare Payment Advisory Commission. This regional variation is particularly high for postacute care, such as home health, the MEDPAC report said. However, a region with high utilization for one group of services typically has high utilization overall, the report said. For instance, areas that have high service use among Medicare beneficiaries during the year before their deaths tend to have high utilization overall. Medicare drug plans also tend to have similar a similar pattern of utilization. “In short, the pattern of high use often extends across different services and different groups of beneficiaries,” the report said.

Absorptiometry Checks Coming

Physicians who performed dual-energy x-ray absorptiometry scans between January and July of 2010 should be getting extra payments from the federal government. Under the Affordable Care Act, Medicare increased its rate for DXA from about $62 to $98 per scan beginning July 1, 2010. The law also stated that the increase would be retroactive to the first of the year. But officials at the Centers for Medicare and Medicaid Services did not send those checks last year because the agency did not have the money to reprocess the 350 million or so claims. Last December, Congress passed the Medicare and Medicaid Extenders Act, insisting that the CMS pay out the delayed reimbursements without physicians having to request them. At press time, the CMS had not announced when the checks would go out.

Rheumatoid Risks Calculated

Researchers at the Mayo Clinic in Rochester, Minn., have created a lifetime risk estimate for rheumatoid arthritis and six other autoimmune rheumatic diseases that can be used by physicians to counsel patients. The Mayo team studied a cohort of 1,179 patients who had been diagnosed with the conditions during 1955-2007 in the Rochester Epidemiology Project and determined that the adult lifetime risk of having an inflammatory autoimmune disease is 8.4% for women and 5.1% for men. This is a substantial risk, said the researchers. Risks for individual conditions were rheumatoid arthritis, 3.6% for women and 1.7% for men; systemic lupus erythematosus, 0.9% for women and 0.2% for men; and psoriatic arthritis, 0.5% for women and 0.6% for men. The research, supported by the National Institutes of Health, appeared online in the Mayo Clinic newsletter.

Inpatient Surgery Yields Fines

Seven U.S. hospitals have agreed to pay $6.3 million to the federal government to settle charges that from 2000 to 2008 they overcharged Medicare for performing inpatient kyphoplasty operations that could have been done safely as outpatient procedures. The government alleged that the hospitals performed the minimally invasive surgeries on an inpatient basis just to increase the amount they could charge Medicare. The settlement is part of a larger crackdown. In 2009 and 2010, the federal government reached settlements with 18 other hospitals over Medicare claims involving the osteoporosis-fractures procedure. In May 2008, Medtronic Spine agreed to pay $75 million to settle allegations that the company counseled hospitals to perform kyphoplasty as an inpatient procedure.

NFL Funds Spinal Research

Armed with a $100,000 grant from the National Football League, researchers at Cornell University and Weill Cornell Medical College are attempting to bioengineer a living intervertebral disk that can be put into patients who suffer degenerative disk disease. Today's surgeries often do not restore patients to the function they had before injury. By creating a living disk, the researchers said they hope to create an implant that can “grow, adapt, and integrate” to restore function to the spine. The researchers will first create the disks from sheep cells and tissues and test them in animals.

State to Review Rate Hike

California's new insurance commissioner said he will review health insurance rate hikes of up to 59% for Blue Shield of California customers, but he warned that he does not have the power to reverse those hikes. Blue Shield, which is raising its rates for the third time since October, declined to delay the timing of the latest increase, currently scheduled for March 1. “Despite Blue Shield's unwillingness to delay their rate increase, the Department of Insurance will conduct a full and complete review of their rate filing,” Insurance Commissioner Dave Jones said in a statement. “The Blue Shield rate increase underscores the need for the legislature to give the insurance commissioner the authority to reject excessive premium increases. I do not have that authority now,” said Mr. Jones. Blue Shield Chief Executive Bruce Bodaken said in a statement that the increases reflect “the actual cost of providing medical care.”

Medicare Use is Uneven

The amount of Medicare service used by beneficiaries varies substantially across the country, with beneficiaries in high service-use areas getting Medicare-funded care about 30% more than beneficiaries in low-service areas, according to a report from the Medicare Payment Advisory Commission. This regional variation is particularly high for postacute care, such as home health, the MEDPAC report said. However, a region with high utilization for one group of services typically has high utilization overall, the report said. For instance, areas that have high service use among Medicare beneficiaries during the year before their deaths tend to have high utilization overall. Medicare drug plans also tend to have similar a similar pattern of utilization. “In short, the pattern of high use often extends across different services and different groups of beneficiaries,” the report said.

Absorptiometry Checks Coming

Physicians who performed dual-energy x-ray absorptiometry scans between January and July of 2010 should be getting extra payments from the federal government. Under the Affordable Care Act, Medicare increased its rate for DXA from about $62 to $98 per scan beginning July 1, 2010. The law also stated that the increase would be retroactive to the first of the year. But officials at the Centers for Medicare and Medicaid Services did not send those checks last year because the agency did not have the money to reprocess the 350 million or so claims. Last December, Congress passed the Medicare and Medicaid Extenders Act, insisting that the CMS pay out the delayed reimbursements without physicians having to request them. At press time, the CMS had not announced when the checks would go out.

Rheumatoid Risks Calculated

Researchers at the Mayo Clinic in Rochester, Minn., have created a lifetime risk estimate for rheumatoid arthritis and six other autoimmune rheumatic diseases that can be used by physicians to counsel patients. The Mayo team studied a cohort of 1,179 patients who had been diagnosed with the conditions during 1955-2007 in the Rochester Epidemiology Project and determined that the adult lifetime risk of having an inflammatory autoimmune disease is 8.4% for women and 5.1% for men. This is a substantial risk, said the researchers. Risks for individual conditions were rheumatoid arthritis, 3.6% for women and 1.7% for men; systemic lupus erythematosus, 0.9% for women and 0.2% for men; and psoriatic arthritis, 0.5% for women and 0.6% for men. The research, supported by the National Institutes of Health, appeared online in the Mayo Clinic newsletter.

Inpatient Surgery Yields Fines

Seven U.S. hospitals have agreed to pay $6.3 million to the federal government to settle charges that from 2000 to 2008 they overcharged Medicare for performing inpatient kyphoplasty operations that could have been done safely as outpatient procedures. The government alleged that the hospitals performed the minimally invasive surgeries on an inpatient basis just to increase the amount they could charge Medicare. The settlement is part of a larger crackdown. In 2009 and 2010, the federal government reached settlements with 18 other hospitals over Medicare claims involving the osteoporosis-fractures procedure. In May 2008, Medtronic Spine agreed to pay $75 million to settle allegations that the company counseled hospitals to perform kyphoplasty as an inpatient procedure.

NFL Funds Spinal Research

Armed with a $100,000 grant from the National Football League, researchers at Cornell University and Weill Cornell Medical College are attempting to bioengineer a living intervertebral disk that can be put into patients who suffer degenerative disk disease. Today's surgeries often do not restore patients to the function they had before injury. By creating a living disk, the researchers said they hope to create an implant that can “grow, adapt, and integrate” to restore function to the spine. The researchers will first create the disks from sheep cells and tissues and test them in animals.

State to Review Rate Hike

California's new insurance commissioner said he will review health insurance rate hikes of up to 59% for Blue Shield of California customers, but he warned that he does not have the power to reverse those hikes. Blue Shield, which is raising its rates for the third time since October, declined to delay the timing of the latest increase, currently scheduled for March 1. “Despite Blue Shield's unwillingness to delay their rate increase, the Department of Insurance will conduct a full and complete review of their rate filing,” Insurance Commissioner Dave Jones said in a statement. “The Blue Shield rate increase underscores the need for the legislature to give the insurance commissioner the authority to reject excessive premium increases. I do not have that authority now,” said Mr. Jones. Blue Shield Chief Executive Bruce Bodaken said in a statement that the increases reflect “the actual cost of providing medical care.”

Medicare Use is Uneven

The amount of Medicare service used by beneficiaries varies substantially across the country, with beneficiaries in high service-use areas getting Medicare-funded care about 30% more than beneficiaries in low-service areas, according to a report from the Medicare Payment Advisory Commission. This regional variation is particularly high for postacute care, such as home health, the MEDPAC report said. However, a region with high utilization for one group of services typically has high utilization overall, the report said. For instance, areas that have high service use among Medicare beneficiaries during the year before their deaths tend to have high utilization overall. Medicare drug plans also tend to have similar a similar pattern of utilization. “In short, the pattern of high use often extends across different services and different groups of beneficiaries,” the report said.

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” 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.

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

Women shouldn't be made to feel guilty if they choose not to breastfeed.

Source DR. BENJAMIN

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” 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.

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

Women shouldn't be made to feel guilty if they choose not to breastfeed.

Source DR. BENJAMIN

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” 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.

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

Women shouldn't be made to feel guilty if they choose not to breastfeed.

Source DR. BENJAMIN

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

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

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

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

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

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

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

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

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

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

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

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches.

And it may take another year to integrate the subject matter into the existing curriculum, he said.

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

Dr. Boyd R. Buser, vice president and dean of the Pikeville (Ky.) College School of Osteopathic Medicine, said that he believes it will be challenging to find faculty with expertise in the medical home elements.

Students, however, should not have a problem with the medical home concept, he said, adding that medical students are likely to be much more comfortable with the technology of the medical home, from using electronic health records to providing e-visits. “I think the students will embrace it,” he said in an interview.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The challenge for medical school officials, Dr. Barr said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

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

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

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

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

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

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

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

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

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

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

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

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches.

And it may take another year to integrate the subject matter into the existing curriculum, he said.

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

Dr. Boyd R. Buser, vice president and dean of the Pikeville (Ky.) College School of Osteopathic Medicine, said that he believes it will be challenging to find faculty with expertise in the medical home elements.

Students, however, should not have a problem with the medical home concept, he said, adding that medical students are likely to be much more comfortable with the technology of the medical home, from using electronic health records to providing e-visits. “I think the students will embrace it,” he said in an interview.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The challenge for medical school officials, Dr. Barr said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

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

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

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

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

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

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

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

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

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

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

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

The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches.

And it may take another year to integrate the subject matter into the existing curriculum, he said.

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

Dr. Boyd R. Buser, vice president and dean of the Pikeville (Ky.) College School of Osteopathic Medicine, said that he believes it will be challenging to find faculty with expertise in the medical home elements.

Students, however, should not have a problem with the medical home concept, he said, adding that medical students are likely to be much more comfortable with the technology of the medical home, from using electronic health records to providing e-visits. “I think the students will embrace it,” he said in an interview.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The challenge for medical school officials, Dr. Barr said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

Medicare officials launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

“The new Physician CTRompare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

“The new Physician CTRompare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

“The new Physician CTRompare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records has been launched, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

While the federal government has promoting these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, but informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they currently use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those that have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

The big question is how many physicians will be able to convert their interest in the program into the ability to achieve meaningful use of EHRs, he added.

Dr. Waldren said most physicians will be able to meet the current thresholds for functions like electronic prescribing, which are outlined in the meaningful use criteria. However, the greater challenge will come in capturing and reporting that data to the government, he said.

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup.

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records has been launched, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

While the federal government has promoting these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, but informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they currently use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those that have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

The big question is how many physicians will be able to convert their interest in the program into the ability to achieve meaningful use of EHRs, he added.

Dr. Waldren said most physicians will be able to meet the current thresholds for functions like electronic prescribing, which are outlined in the meaningful use criteria. However, the greater challenge will come in capturing and reporting that data to the government, he said.

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup.

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records has been launched, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

While the federal government has promoting these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, but informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they currently use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those that have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

The big question is how many physicians will be able to convert their interest in the program into the ability to achieve meaningful use of EHRs, he added.

Dr. Waldren said most physicians will be able to meet the current thresholds for functions like electronic prescribing, which are outlined in the meaningful use criteria. However, the greater challenge will come in capturing and reporting that data to the government, he said.

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new online tool is called Physician Compare. It is modeled after the Hospital Compare Web site, which allows consumers to compare hospitals based on quality data and patient evaluations. Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know if the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System, a voluntary program for reporting quality metrics on Medicare patients. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

"The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers," Dr. Donald Berwick, CMS administrator, said in a statement. "This helps to pave the way for consumers" to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new online tool is called Physician Compare. It is modeled after the Hospital Compare Web site, which allows consumers to compare hospitals based on quality data and patient evaluations. Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know if the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System, a voluntary program for reporting quality metrics on Medicare patients. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

"The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers," Dr. Donald Berwick, CMS administrator, said in a statement. "This helps to pave the way for consumers" to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new online tool is called Physician Compare. It is modeled after the Hospital Compare Web site, which allows consumers to compare hospitals based on quality data and patient evaluations. Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know if the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System, a voluntary program for reporting quality metrics on Medicare patients. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

"The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers," Dr. Donald Berwick, CMS administrator, said in a statement. "This helps to pave the way for consumers" to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

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 the November issue of the journal Epilepsy & Behavior (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. "At the end of the day, [the FDA] expects and demands compliance, and rightly so."

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren’t advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. "These talks serve a purpose, I think, for the companies and for us and for the community."

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don’t attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

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 the November issue of the journal Epilepsy & Behavior (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. "At the end of the day, [the FDA] expects and demands compliance, and rightly so."

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren’t advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. "These talks serve a purpose, I think, for the companies and for us and for the community."

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don’t attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

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 the November issue of the journal Epilepsy & Behavior (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. "At the end of the day, [the FDA] expects and demands compliance, and rightly so."

The open letter published in Epilepsy & Behavior 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. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials. Meanwhile, other companies have signaled their willingness to allow speakers to create different talks and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren’t advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. "These talks serve a purpose, I think, for the companies and for us and for the community."

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.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don’t attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

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 on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website. 

The National Committee for Quality Assurance on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website. 

The National Committee for Quality Assurance on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website. 

The National Committee for Quality Assurance on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website. 

The National Committee for Quality Assurance on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website. 

The National Committee for Quality Assurance on Jan. 31 released new standards for practices seeking recognition as a medical home.

The standards now 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 also 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."

Officials at the NCQA rewrote the standards to be clearer and more specific, but also to be more challenging. Dr. Sevilla, who also serves as chair of 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 today 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 NCQA’s medical home recognition program is the organization’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.

Check out the 2011 standards on NCQA's website.