Jane Anderson

Grants Fund Performance Measures

Ten states will receive a total of $100 million in federal grant funds to implement and evaluate provider performance measures and health information technologies in Medicaid and the Children's Health Insurance Program (CHIP). Eight of the states will test a new set of child health quality measures, and with some overlap, seven will use the funds to implement health information technologies, according to the Department of Health and Human Services. Two states plan to develop a new electronic health record format for pediatrics. The grants, which will be awarded over a period of 5 years, were funded by the CHIP reauthorization legislation approved last year. Colorado, Florida, Maine, Maryland, Massachusetts, North Carolina, Oregon, Pennsylvania, South Carolina, and Utah will share the money.

Medicaid Enrollment Up in 2009

Nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 than in the same month in 2008, according to an analysis by the Kaiser Family Foundation. The enrollment increase represented the biggest 1-year hike in enrollment ever, boosting monthly Medicaid enrollment by 7.5% to 46.9 million children and adults. Job losses drove increases in all 50 states, said the foundation's report. A separate Kaiser survey of state Medicaid directors found that 44 states and the District of Columbia are experiencing higher-than-expected program enrollment and increased spending in 2010. And 29 states said they are considering midyear cuts in provider rates and program benefits.

Warning on Omega-3 Supplements

The Federal Trade Commission sent letters to 11 companies that promote various omega-3 fatty acid supplements, warning them not to violate federal law by making baseless claims about how the supplements benefit children's brain and vision function and development. The FTC cautioned the companies that they need scientific evidence to support label claims involving intelligence, cognitive function, learning ability, focus, mood, memory, attention, concentration, visual acuity, and eye health. Without such evidence, the agency warned, it might take enforcement action. One company, Northwest Natural Products Inc., already has altered the label for its L'il Critters Omega-3 Gummy Fish in response to FTC questions, according to the agency.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations, “lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

Pediatricians Join Antiobesity Campaign

The American Academy of Pediatrics is collaborating with First Lady Michelle Obama on her initiative against childhood obesity. At a White House launch of the campaign in February, a high-level Obama administration task force was charged with creating a detailed policy plan by May. For its part, the AAP said it would urge pediatricians to calculate body mass index for every child at every well-child visit. “BMI is a simple but important tool in starting a conversation with families about their children's health and well-being,” AAP President Judith Palfrey said at the launch. In addition, the AAP will prod pediatricians to provide weight and obesity information to parents at all well-child checkups. That should include specifics about how to achieve a healthy weight for children, such as prescriptions for good nutrition and physical activity, Dr. Palfrey said. Said Mrs. Obama, “The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.”

Dissolvable Tobacco Info Sought

The Food and Drug Administration's Center for Tobacco Products got right to work after its launch last August. In February, the center sent letters to several tobacco companies, asking them to submit “a comprehensive and detailed summary” of research on their dissolvable smokeless tobacco products. The products “resemble candy,” according to the letters, and concerns about them include their use by people under age 26, potential misuse of the products, and accidental ingestion. The center said it wants the information to prepare for a meeting of the Tobacco Products Scientific Advisory Committee. The letters expressed concern “that children and adolescents may find dissolvable tobacco products particularly appealing, given the brightly colored packaging, candylike appearance, and easily concealable size of many of these products.”

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

Grants Fund Performance Measures

Ten states will receive a total of $100 million in federal grant funds to implement and evaluate provider performance measures and health information technologies in Medicaid and the Children's Health Insurance Program (CHIP). Eight of the states will test a new set of child health quality measures, and with some overlap, seven will use the funds to implement health information technologies, according to the Department of Health and Human Services. Two states plan to develop a new electronic health record format for pediatrics. The grants, which will be awarded over a period of 5 years, were funded by the CHIP reauthorization legislation approved last year. Colorado, Florida, Maine, Maryland, Massachusetts, North Carolina, Oregon, Pennsylvania, South Carolina, and Utah will share the money.

Medicaid Enrollment Up in 2009

Nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 than in the same month in 2008, according to an analysis by the Kaiser Family Foundation. The enrollment increase represented the biggest 1-year hike in enrollment ever, boosting monthly Medicaid enrollment by 7.5% to 46.9 million children and adults. Job losses drove increases in all 50 states, said the foundation's report. A separate Kaiser survey of state Medicaid directors found that 44 states and the District of Columbia are experiencing higher-than-expected program enrollment and increased spending in 2010. And 29 states said they are considering midyear cuts in provider rates and program benefits.

Warning on Omega-3 Supplements

The Federal Trade Commission sent letters to 11 companies that promote various omega-3 fatty acid supplements, warning them not to violate federal law by making baseless claims about how the supplements benefit children's brain and vision function and development. The FTC cautioned the companies that they need scientific evidence to support label claims involving intelligence, cognitive function, learning ability, focus, mood, memory, attention, concentration, visual acuity, and eye health. Without such evidence, the agency warned, it might take enforcement action. One company, Northwest Natural Products Inc., already has altered the label for its L'il Critters Omega-3 Gummy Fish in response to FTC questions, according to the agency.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations, “lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

Pediatricians Join Antiobesity Campaign

The American Academy of Pediatrics is collaborating with First Lady Michelle Obama on her initiative against childhood obesity. At a White House launch of the campaign in February, a high-level Obama administration task force was charged with creating a detailed policy plan by May. For its part, the AAP said it would urge pediatricians to calculate body mass index for every child at every well-child visit. “BMI is a simple but important tool in starting a conversation with families about their children's health and well-being,” AAP President Judith Palfrey said at the launch. In addition, the AAP will prod pediatricians to provide weight and obesity information to parents at all well-child checkups. That should include specifics about how to achieve a healthy weight for children, such as prescriptions for good nutrition and physical activity, Dr. Palfrey said. Said Mrs. Obama, “The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.”

Dissolvable Tobacco Info Sought

The Food and Drug Administration's Center for Tobacco Products got right to work after its launch last August. In February, the center sent letters to several tobacco companies, asking them to submit “a comprehensive and detailed summary” of research on their dissolvable smokeless tobacco products. The products “resemble candy,” according to the letters, and concerns about them include their use by people under age 26, potential misuse of the products, and accidental ingestion. The center said it wants the information to prepare for a meeting of the Tobacco Products Scientific Advisory Committee. The letters expressed concern “that children and adolescents may find dissolvable tobacco products particularly appealing, given the brightly colored packaging, candylike appearance, and easily concealable size of many of these products.”

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

Grants Fund Performance Measures

Ten states will receive a total of $100 million in federal grant funds to implement and evaluate provider performance measures and health information technologies in Medicaid and the Children's Health Insurance Program (CHIP). Eight of the states will test a new set of child health quality measures, and with some overlap, seven will use the funds to implement health information technologies, according to the Department of Health and Human Services. Two states plan to develop a new electronic health record format for pediatrics. The grants, which will be awarded over a period of 5 years, were funded by the CHIP reauthorization legislation approved last year. Colorado, Florida, Maine, Maryland, Massachusetts, North Carolina, Oregon, Pennsylvania, South Carolina, and Utah will share the money.

Medicaid Enrollment Up in 2009

Nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 than in the same month in 2008, according to an analysis by the Kaiser Family Foundation. The enrollment increase represented the biggest 1-year hike in enrollment ever, boosting monthly Medicaid enrollment by 7.5% to 46.9 million children and adults. Job losses drove increases in all 50 states, said the foundation's report. A separate Kaiser survey of state Medicaid directors found that 44 states and the District of Columbia are experiencing higher-than-expected program enrollment and increased spending in 2010. And 29 states said they are considering midyear cuts in provider rates and program benefits.

Warning on Omega-3 Supplements

The Federal Trade Commission sent letters to 11 companies that promote various omega-3 fatty acid supplements, warning them not to violate federal law by making baseless claims about how the supplements benefit children's brain and vision function and development. The FTC cautioned the companies that they need scientific evidence to support label claims involving intelligence, cognitive function, learning ability, focus, mood, memory, attention, concentration, visual acuity, and eye health. Without such evidence, the agency warned, it might take enforcement action. One company, Northwest Natural Products Inc., already has altered the label for its L'il Critters Omega-3 Gummy Fish in response to FTC questions, according to the agency.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations, “lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

Pediatricians Join Antiobesity Campaign

The American Academy of Pediatrics is collaborating with First Lady Michelle Obama on her initiative against childhood obesity. At a White House launch of the campaign in February, a high-level Obama administration task force was charged with creating a detailed policy plan by May. For its part, the AAP said it would urge pediatricians to calculate body mass index for every child at every well-child visit. “BMI is a simple but important tool in starting a conversation with families about their children's health and well-being,” AAP President Judith Palfrey said at the launch. In addition, the AAP will prod pediatricians to provide weight and obesity information to parents at all well-child checkups. That should include specifics about how to achieve a healthy weight for children, such as prescriptions for good nutrition and physical activity, Dr. Palfrey said. Said Mrs. Obama, “The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.”

Dissolvable Tobacco Info Sought

The Food and Drug Administration's Center for Tobacco Products got right to work after its launch last August. In February, the center sent letters to several tobacco companies, asking them to submit “a comprehensive and detailed summary” of research on their dissolvable smokeless tobacco products. The products “resemble candy,” according to the letters, and concerns about them include their use by people under age 26, potential misuse of the products, and accidental ingestion. The center said it wants the information to prepare for a meeting of the Tobacco Products Scientific Advisory Committee. The letters expressed concern “that children and adolescents may find dissolvable tobacco products particularly appealing, given the brightly colored packaging, candylike appearance, and easily concealable size of many of these products.”

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Discloses MD Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers, including Pfizer Inc., will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA Must Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money.

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

Baby Text Program Launched

Pregnant women and new mothers will receive text messages with health information and tips as part of a campaign sponsored by several government agencies, health insurers, and advocacy groups. The program, Text4baby, is the first-ever free national mobile health service in the United States, according to its sponsors. By texting BABY to 511411 (or BEBE for the Spanish version), women will receive three free texts per week, timed to their due date or baby's date of birth. The messages focus on a variety of topics, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health, and safe sleep, according to the program's sponsors, who note that they hope the program can help cut the infant mortality rate in the United States, which is one of the highest in the industrialized world.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared to fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose 170% in that decade, from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single gastrointestinal prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription.

—Jane Anderson

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Discloses MD Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers, including Pfizer Inc., will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA Must Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money.

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

Baby Text Program Launched

Pregnant women and new mothers will receive text messages with health information and tips as part of a campaign sponsored by several government agencies, health insurers, and advocacy groups. The program, Text4baby, is the first-ever free national mobile health service in the United States, according to its sponsors. By texting BABY to 511411 (or BEBE for the Spanish version), women will receive three free texts per week, timed to their due date or baby's date of birth. The messages focus on a variety of topics, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health, and safe sleep, according to the program's sponsors, who note that they hope the program can help cut the infant mortality rate in the United States, which is one of the highest in the industrialized world.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared to fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose 170% in that decade, from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single gastrointestinal prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription.

—Jane Anderson

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Discloses MD Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers, including Pfizer Inc., will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA Must Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money.

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

Baby Text Program Launched

Pregnant women and new mothers will receive text messages with health information and tips as part of a campaign sponsored by several government agencies, health insurers, and advocacy groups. The program, Text4baby, is the first-ever free national mobile health service in the United States, according to its sponsors. By texting BABY to 511411 (or BEBE for the Spanish version), women will receive three free texts per week, timed to their due date or baby's date of birth. The messages focus on a variety of topics, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health, and safe sleep, according to the program's sponsors, who note that they hope the program can help cut the infant mortality rate in the United States, which is one of the highest in the industrialized world.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared to fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose 170% in that decade, from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single gastrointestinal prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription.

—Jane Anderson

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: CT, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Reveals M.D. Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA to Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money. The binding arbitration between the state and FEMA was mandated by language inserted into the federal stimulus bill last year by Louisiana Sen. Mary Landrieu (D).

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. “A revolution in biotechnology continues, expanding potentially dangerous dual-use capabilities across the globe.” The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared with fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single GI prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription. Those aged 65 years and older were most likely to use prescription gastrointestinal drugs, the AHRQ report said.

FDA Warns Lilly on Promos

The FDA has warned Eli Lilly and United Therapeutics that a Web page and two patient videos were in violation of the agency's promotional rules. Adcirca (tadalafil) is indicated for improving exercise ability in pulmonary artery hypertension patients. The FDA cited the Web page for failing to include any contraindications, warnings, or precautions for the drug, which “misleadingly suggests that Adcirca is safer than has been demonstrated,” said the warning letter. The two patient videos “seriously misrepresent what is known about the efficacy of Adcirca,” the FDA said.

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: CT, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Reveals M.D. Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA to Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money. The binding arbitration between the state and FEMA was mandated by language inserted into the federal stimulus bill last year by Louisiana Sen. Mary Landrieu (D).

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. “A revolution in biotechnology continues, expanding potentially dangerous dual-use capabilities across the globe.” The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared with fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single GI prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription. Those aged 65 years and older were most likely to use prescription gastrointestinal drugs, the AHRQ report said.

FDA Warns Lilly on Promos

The FDA has warned Eli Lilly and United Therapeutics that a Web page and two patient videos were in violation of the agency's promotional rules. Adcirca (tadalafil) is indicated for improving exercise ability in pulmonary artery hypertension patients. The FDA cited the Web page for failing to include any contraindications, warnings, or precautions for the drug, which “misleadingly suggests that Adcirca is safer than has been demonstrated,” said the warning letter. The two patient videos “seriously misrepresent what is known about the efficacy of Adcirca,” the FDA said.

FDA: Reduce Radiation Exposure

The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: CT, nuclear medicine studies, and fluoroscopy. The FDA said it will issue targeted requirements for device manufacturers to develop safer technologies and to provide training to support safe use. In addition, the agency said it will help develop a patient medical imaging history card for patients to track their own medical imaging history and share it with their physicians. The FDA also recommended that professional societies continue to develop diagnostic radiation reference levels for medical imaging procedures and increase their efforts to develop one or more national registries for radiation doses. “The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks,” Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, said in a statement.

Cephalon Reveals M.D. Payments

Drug manufacturer Cephalon said it paid more than 900 physicians for speaking services or consulting in 2009. Most physicians received less than $10,000, while 17 earned more than $100,000, the drug company said in its online disclosure. Although the 2009 figures include only fees for speaking and consulting for Cephalon, the company said it has begun tracking other “items of value” it provides to health care professionals, including meals, educational items, and payments for research studies, and will disclose those online beginning in March 2011. In posting the payments online, Cephalon became the first drug manufacturer to report payments to physicians under a corporate integrity agreement with the Department of Justice. The 2008 agreement resulted from a $425 million settlement of charges that Cephalon marketed three drugs for unapproved uses. Other drug makers will be disclosing payments to physicians under similar corporate integrity agreements.

FEMA to Pay $475 Million to La.

A federal arbitration panel has ruled that the Federal Emergency Management Agency must pay nearly $475 million to replace Charity Hospital in New Orleans, which sustained massive damage in Hurricane Katrina. The panel's decision, which is binding, gave Louisiana nearly all the money it had requested and means the state can afford to build the new $1.2 billion academic medical center it wants to replace Charity Hospital. Louisiana officials had pressed FEMA for 4 years to agree to replace Charity rather than repair the facility, but FEMA had argued that the state could repair the hospital for much less money. The binding arbitration between the state and FEMA was mandated by language inserted into the federal stimulus bill last year by Louisiana Sen. Mary Landrieu (D).

Report: U.S. Not Ready for Attack

The United States is unprepared for a major attack with biological weapons and has fallen behind in its capability to rapidly produce vaccines and therapeutics, which are essential for responding to a biological threat, a congressionally appointed commission said. “H1N1 came with months of warning. But even with time to prepare, the epidemic peaked before most Americans had access to vaccine. A bioattack will come with no such warning,” said the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. “A revolution in biotechnology continues, expanding potentially dangerous dual-use capabilities across the globe.” The commission gave the government an “F” grade for failing to develop the capability to effectively counter a biological attack.

More Americans Buy GI Drugs

Almost 10% of Americans purchased at least one prescription gastrointestinal drug in 2007, compared with fewer than 7% in 1997, according to the Agency for Healthcare Research and Quality. Total expenses for prescription GI drugs rose from $7 billion in 1997 to $18.9 billion in 2007. The total number of prescriptions filled increased from nearly 78 million in 1997 to more than 158 million in 2007, the report said. The average expenditure for a single GI prescription drug increased from $90 to $120, and the average annual expense per person rose from $386 to $653 for those with at least one GI-related prescription. Those aged 65 years and older were most likely to use prescription gastrointestinal drugs, the AHRQ report said.

FDA Warns Lilly on Promos

The FDA has warned Eli Lilly and United Therapeutics that a Web page and two patient videos were in violation of the agency's promotional rules. Adcirca (tadalafil) is indicated for improving exercise ability in pulmonary artery hypertension patients. The FDA cited the Web page for failing to include any contraindications, warnings, or precautions for the drug, which “misleadingly suggests that Adcirca is safer than has been demonstrated,” said the warning letter. The two patient videos “seriously misrepresent what is known about the efficacy of Adcirca,” the FDA said.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income groups. In a survey of the 27 New Orleans clinics, the nonprofit group found that clinic patients were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, whereas studies of the general U.S. adult population have found that one-third of patients report such inefficiencies.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.–based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, general practitioners, and primary osteopaths qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care. Big Blue also announced a new wellness incentive that would give $150 to each employee who uses online tools to monitor sleep habits, tame stress, and follow a healthier diet. The company claims that it has been a leader in the drive to develop the patient-centered medical home.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get timely appointments when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals ages 50-64. MedPAC also voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011. They also pushed for pay increases specifically for primary care services.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” the report's author, Devon Herrick, said.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. It's not clear how many MA plans engage in inappropriate marketing. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June, after the e-cigarette shipments in this case had been halted.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income groups. In a survey of the 27 New Orleans clinics, the nonprofit group found that clinic patients were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, whereas studies of the general U.S. adult population have found that one-third of patients report such inefficiencies.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.–based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, general practitioners, and primary osteopaths qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care. Big Blue also announced a new wellness incentive that would give $150 to each employee who uses online tools to monitor sleep habits, tame stress, and follow a healthier diet. The company claims that it has been a leader in the drive to develop the patient-centered medical home.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get timely appointments when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals ages 50-64. MedPAC also voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011. They also pushed for pay increases specifically for primary care services.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” the report's author, Devon Herrick, said.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. It's not clear how many MA plans engage in inappropriate marketing. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June, after the e-cigarette shipments in this case had been halted.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income groups. In a survey of the 27 New Orleans clinics, the nonprofit group found that clinic patients were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, whereas studies of the general U.S. adult population have found that one-third of patients report such inefficiencies.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.–based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, general practitioners, and primary osteopaths qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care. Big Blue also announced a new wellness incentive that would give $150 to each employee who uses online tools to monitor sleep habits, tame stress, and follow a healthier diet. The company claims that it has been a leader in the drive to develop the patient-centered medical home.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get timely appointments when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals ages 50-64. MedPAC also voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011. They also pushed for pay increases specifically for primary care services.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” the report's author, Devon Herrick, said.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. It's not clear how many MA plans engage in inappropriate marketing. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June, after the e-cigarette shipments in this case had been halted.

When Medicare managed care plans raise outpatient co-payments, they experience fewer outpatient visits but also more hospitalizations and longer inpatient stays, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

The study, “Increased Ambulatory Care Copayments and Hospitalizations Among the Elderly,” concluded that increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory co-payments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I. “Therefore, increasing such co-payments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased co-payments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean co-payment increases were from about $7 to $14 for outpatient primary and about $12 to $22 outpatient specialty care, while the control plans kept co-payments at about $8 for a primary care visit and $11 for specialty care.

In the year after a plan would increase co-payments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional inpatient hospital admissions per 100 enrollees, adding about 13 additional inpatient days—compared with plans not increasing co-payments.

The study noted that the effect of increased co-payments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of co-payment increases also was magnified among Medicare managed care enrollees diagnosed with hypertension or diabetes and those who had histories of acute myocardial infarction, the study said.

The authors reported no conflicts of interest.

When Medicare managed care plans raise outpatient co-payments, they experience fewer outpatient visits but also more hospitalizations and longer inpatient stays, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

The study, “Increased Ambulatory Care Copayments and Hospitalizations Among the Elderly,” concluded that increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory co-payments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I. “Therefore, increasing such co-payments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased co-payments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean co-payment increases were from about $7 to $14 for outpatient primary and about $12 to $22 outpatient specialty care, while the control plans kept co-payments at about $8 for a primary care visit and $11 for specialty care.

In the year after a plan would increase co-payments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional inpatient hospital admissions per 100 enrollees, adding about 13 additional inpatient days—compared with plans not increasing co-payments.

The study noted that the effect of increased co-payments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of co-payment increases also was magnified among Medicare managed care enrollees diagnosed with hypertension or diabetes and those who had histories of acute myocardial infarction, the study said.

The authors reported no conflicts of interest.

When Medicare managed care plans raise outpatient co-payments, they experience fewer outpatient visits but also more hospitalizations and longer inpatient stays, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

The study, “Increased Ambulatory Care Copayments and Hospitalizations Among the Elderly,” concluded that increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory co-payments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I. “Therefore, increasing such co-payments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased co-payments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean co-payment increases were from about $7 to $14 for outpatient primary and about $12 to $22 outpatient specialty care, while the control plans kept co-payments at about $8 for a primary care visit and $11 for specialty care.

In the year after a plan would increase co-payments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional inpatient hospital admissions per 100 enrollees, adding about 13 additional inpatient days—compared with plans not increasing co-payments.

The study noted that the effect of increased co-payments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of co-payment increases also was magnified among Medicare managed care enrollees diagnosed with hypertension or diabetes and those who had histories of acute myocardial infarction, the study said.

The authors reported no conflicts of interest.

Large group health plans must treat mental health and substance abuse services the same way they treat medical and surgical services under new government regulations that will take effect July 1.

The rules implementing the Mental Health Parity and Addiction Equity Act of 2008 will ensure that plans not impose a different, more stringent set of restrictions on mental health and substance abuse treatment.

About 150 million Americans receive health insurance coverage through large group health plans, defined in the regulations as those sponsored by employers with 50 or more workers. About 90% of these plans include mental health coverage and therefore will be affected.

The rules, published Feb. 2 in the Federal Register, will prohibit large group health plans from restricting access to mental health and substance abuse care by limiting benefits and requiring higher patient cost-sharing when compared to general medical or surgical benefits.

The regulations do not require the plans to cover mental health services.

Administration officials speaking on background at a press briefing Jan. 29 said that the rules will bar plans from imposing different financial requirements, such as copayments, deductibles, and treatment limits, on mental health and substance abuse benefits.

To fulfill the new rules, financial requirements for mental health and substance abuse services must not be more restrictive than those imposed on “substantially all” medical/surgical benefits.

For example, an administration official said, if a plan expects to pay $1 million for outpatient, in-network medical services and $750,000 of that total would be subject to a copayment, that copayment is considered to apply to “substantially all” medical and surgical benefits. The copayment for mental health and substance abuse services could not be any higher, the administration official said.

Plans also will not be allowed to implement separate deductible and out-of-pocket limits for mental health/substance abuse and medical/surgical services; instead, the categories must be combined into a single total deductible or out-of-pocket limit.

The rules also apply to medical management by group health plans. In that case, medical management rules limiting mental health/substance abuse treatment cannot be applied more stringently than are rules limiting medical/surgical treatment unless there are clinically appropriate standards of care that would support the more stringent rules.

Plans must have the same standards for providers to participate in networks for both mental health/substance abuse and medicine/surgery, and must use the same standards for paying usual, customary, and reasonable fees for out-of-network providers, the administration officials said. A plan cannot have in-network providers for medicine/surgery but have only out-of-network providers for mental health/substance abuse. Networks do not have to be comparably sized, the administration officials said.

The regulations were crafted jointly by the departments of Health and Human Services, Labor, and Treasury, administration officials said. Enforcement will occur mainly through state insurance agencies, with backup from the Centers for Medicare and Medicaid Services.

The new rules were published as interim final regulations, allowing for public comment before they take effect.

The Mental Health Parity and Addiction Equity Act of 2008 greatly expanded on an earlier law, the Mental Health Parity Act of 1996. That measure required parity between mental health benefits and medical/surgical benefits only in total lifetime and annual dollar limits.

Most states already have implemented mental health parity laws, although many are far more limited than the new federal law, according to the National Alliance on Mental Illness. Administration officials said there was no evidence that companies and organizations tended to drop their mental health coverage after the implementation of such state laws.

Comments will be accepted through May 3 at www.regulations.gov

Large group health plans must treat mental health and substance abuse services the same way they treat medical and surgical services under new government regulations that will take effect July 1.

The rules implementing the Mental Health Parity and Addiction Equity Act of 2008 will ensure that plans not impose a different, more stringent set of restrictions on mental health and substance abuse treatment.

About 150 million Americans receive health insurance coverage through large group health plans, defined in the regulations as those sponsored by employers with 50 or more workers. About 90% of these plans include mental health coverage and therefore will be affected.

The rules, published Feb. 2 in the Federal Register, will prohibit large group health plans from restricting access to mental health and substance abuse care by limiting benefits and requiring higher patient cost-sharing when compared to general medical or surgical benefits.

The regulations do not require the plans to cover mental health services.

Administration officials speaking on background at a press briefing Jan. 29 said that the rules will bar plans from imposing different financial requirements, such as copayments, deductibles, and treatment limits, on mental health and substance abuse benefits.

To fulfill the new rules, financial requirements for mental health and substance abuse services must not be more restrictive than those imposed on “substantially all” medical/surgical benefits.

For example, an administration official said, if a plan expects to pay $1 million for outpatient, in-network medical services and $750,000 of that total would be subject to a copayment, that copayment is considered to apply to “substantially all” medical and surgical benefits. The copayment for mental health and substance abuse services could not be any higher, the administration official said.

Plans also will not be allowed to implement separate deductible and out-of-pocket limits for mental health/substance abuse and medical/surgical services; instead, the categories must be combined into a single total deductible or out-of-pocket limit.

The rules also apply to medical management by group health plans. In that case, medical management rules limiting mental health/substance abuse treatment cannot be applied more stringently than are rules limiting medical/surgical treatment unless there are clinically appropriate standards of care that would support the more stringent rules.

Plans must have the same standards for providers to participate in networks for both mental health/substance abuse and medicine/surgery, and must use the same standards for paying usual, customary, and reasonable fees for out-of-network providers, the administration officials said. A plan cannot have in-network providers for medicine/surgery but have only out-of-network providers for mental health/substance abuse. Networks do not have to be comparably sized, the administration officials said.

The regulations were crafted jointly by the departments of Health and Human Services, Labor, and Treasury, administration officials said. Enforcement will occur mainly through state insurance agencies, with backup from the Centers for Medicare and Medicaid Services.

The new rules were published as interim final regulations, allowing for public comment before they take effect.

The Mental Health Parity and Addiction Equity Act of 2008 greatly expanded on an earlier law, the Mental Health Parity Act of 1996. That measure required parity between mental health benefits and medical/surgical benefits only in total lifetime and annual dollar limits.

Most states already have implemented mental health parity laws, although many are far more limited than the new federal law, according to the National Alliance on Mental Illness. Administration officials said there was no evidence that companies and organizations tended to drop their mental health coverage after the implementation of such state laws.

Comments will be accepted through May 3 at www.regulations.gov

Large group health plans must treat mental health and substance abuse services the same way they treat medical and surgical services under new government regulations that will take effect July 1.

The rules implementing the Mental Health Parity and Addiction Equity Act of 2008 will ensure that plans not impose a different, more stringent set of restrictions on mental health and substance abuse treatment.

About 150 million Americans receive health insurance coverage through large group health plans, defined in the regulations as those sponsored by employers with 50 or more workers. About 90% of these plans include mental health coverage and therefore will be affected.

The rules, published Feb. 2 in the Federal Register, will prohibit large group health plans from restricting access to mental health and substance abuse care by limiting benefits and requiring higher patient cost-sharing when compared to general medical or surgical benefits.

The regulations do not require the plans to cover mental health services.

Administration officials speaking on background at a press briefing Jan. 29 said that the rules will bar plans from imposing different financial requirements, such as copayments, deductibles, and treatment limits, on mental health and substance abuse benefits.

To fulfill the new rules, financial requirements for mental health and substance abuse services must not be more restrictive than those imposed on “substantially all” medical/surgical benefits.

For example, an administration official said, if a plan expects to pay $1 million for outpatient, in-network medical services and $750,000 of that total would be subject to a copayment, that copayment is considered to apply to “substantially all” medical and surgical benefits. The copayment for mental health and substance abuse services could not be any higher, the administration official said.

Plans also will not be allowed to implement separate deductible and out-of-pocket limits for mental health/substance abuse and medical/surgical services; instead, the categories must be combined into a single total deductible or out-of-pocket limit.

The rules also apply to medical management by group health plans. In that case, medical management rules limiting mental health/substance abuse treatment cannot be applied more stringently than are rules limiting medical/surgical treatment unless there are clinically appropriate standards of care that would support the more stringent rules.

Plans must have the same standards for providers to participate in networks for both mental health/substance abuse and medicine/surgery, and must use the same standards for paying usual, customary, and reasonable fees for out-of-network providers, the administration officials said. A plan cannot have in-network providers for medicine/surgery but have only out-of-network providers for mental health/substance abuse. Networks do not have to be comparably sized, the administration officials said.

The regulations were crafted jointly by the departments of Health and Human Services, Labor, and Treasury, administration officials said. Enforcement will occur mainly through state insurance agencies, with backup from the Centers for Medicare and Medicaid Services.

The new rules were published as interim final regulations, allowing for public comment before they take effect.

The Mental Health Parity and Addiction Equity Act of 2008 greatly expanded on an earlier law, the Mental Health Parity Act of 1996. That measure required parity between mental health benefits and medical/surgical benefits only in total lifetime and annual dollar limits.

Most states already have implemented mental health parity laws, although many are far more limited than the new federal law, according to the National Alliance on Mental Illness. Administration officials said there was no evidence that companies and organizations tended to drop their mental health coverage after the implementation of such state laws.

Comments will be accepted through May 3 at www.regulations.gov

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income patients. In a survey of the 27 New Orleans clinics, the nonprofit group found that patients at these facilities were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, compared with one-third of the general U.S. adult population.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.– based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, and general practitioners qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get a timely appointment when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals aged 50-64 years. Of note, both groups reported that finding a new primary care physician was more difficult than finding a new specialist. In related news, MedPAC voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” report author Devon Herrick said in a statement.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009, the study said. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. However, it's not clear how many MA plans engage in inappropriate marketing or how many beneficiaries have been affected, the report said. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing, which can include providing inaccurate benefits information and conducting prohibited marketing practices.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June.

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income patients. In a survey of the 27 New Orleans clinics, the nonprofit group found that patients at these facilities were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, compared with one-third of the general U.S. adult population.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.– based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, and general practitioners qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get a timely appointment when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals aged 50-64 years. Of note, both groups reported that finding a new primary care physician was more difficult than finding a new specialist. In related news, MedPAC voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” report author Devon Herrick said in a statement.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009, the study said. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. However, it's not clear how many MA plans engage in inappropriate marketing or how many beneficiaries have been affected, the report said. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing, which can include providing inaccurate benefits information and conducting prohibited marketing practices.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June.

Clinic Patients Have Less Debt

Patients at “safety-net” clinics in New Orleans have fewer problems affording care and fewer instances of insufficient care than most U.S. adults, even though the clinic patients are disproportionately low-income and uninsured, the Commonwealth Fund reported. According to the group's researchers, this success indicates that the post-Katrina primary care program, which relies on a network of government-funded clinics, could serve as a national model for providing primary care to low-income patients. In a survey of the 27 New Orleans clinics, the nonprofit group found that patients at these facilities were much less concerned about affordability of care than were other U.S. adults and reported less medical debt and fewer unpaid medical bills. They also said they received more efficient care: Only 4% of clinic patients reported getting duplicate medical tests or being told results were delayed or missing, compared with one-third of the general U.S. adult population.

IBM Drops Copays for Primary Care

IBM said it will no longer require copayments or deductibles from U.S.– based employees getting fee-for-service primary care, making it one of the first U.S. companies to cover 100% of primary care costs through health insurance. Visits to in-network internists, family physicians, pediatricians, and general practitioners qualify for full coverage, the company said. The new benefit applies to about 80% of IBM's approximately 110,000 U.S. employees. The remaining IBM employees in this country participate in HMOs that already provide free or low-cost primary care.

MedPAC Pushes for Pay Increases

Most Medicare beneficiaries are able to get a timely appointment when they need one, according to an annual survey conducted by the Medicare Payment Advisory Commission. In fact, Medicare beneficiaries report better physician access than the privately insured population, according to the findings, which were based on a poll of 4,000 Medicare beneficiaries and 4,000 privately insured individuals aged 50-64 years. Of note, both groups reported that finding a new primary care physician was more difficult than finding a new specialist. In related news, MedPAC voted last month to request that Congress approve a 1% increase in the Medicare physician payment rate for 2011.

Concierge Medicine Is Growing

The number of concierge practices has grown to more than 5,000 nationwide, according to a report from the National Center for Policy Analysis. The private primary care delivery model also has expanded from a high-end option for wealthy people to include uninsured patients who pay a flat fee to access primary care services they might otherwise lack, the report said. In addition, physicians have opened concierge practices that supplement Medicare and other insurance coverage. The concierge model allows physicians to experiment with different ways of charging patients, such as billing for telephone and e-mail consultations, the analysis noted. “Innovative practices now offer many different kinds of bundled prices and solutions—for those with or without insurance, for the middle income or the wealthy patient,” report author Devon Herrick said in a statement.

Advantage-Plan Gaffs Are Unclear

The Centers for Medicare and Medicaid Services has little information about the number of beneficiaries who have experienced inappropriate marketing of Medicare Advantage (MA) plans, despite a high number of complaints and questions from lawmakers about the problem, a Government Accountability Office study found. The CMS took compliance and enforcement actions for inappropriate marketing against at least 73 organizations that sponsored MA plans from January 2006 through February 2009, the study said. The government actions ranged from warning letters to fines and suspensions of marketing and enrollment. However, it's not clear how many MA plans engage in inappropriate marketing or how many beneficiaries have been affected, the report said. The GAO recommended that the CMS gather more information on the extent of inappropriate marketing, which can include providing inaccurate benefits information and conducting prohibited marketing practices.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as a drug-device combination. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with the FDA's justification for its action. However, he did not address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June.

When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.

“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.

In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.

The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.

The authors reported having no conflicts of interest.

When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.

“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.

In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.

The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.

The authors reported having no conflicts of interest.

When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.

Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).

“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.

“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.

Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.

The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.

In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.

The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.

The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.

The authors reported having no conflicts of interest.

Subspecialist Shortages Cause Waits

A survey from the National Association of Children's Hospitals and Related Institutions found that shortages in pediatric subspecialists are leading to significant wait times for many patients and families to get needed care. Shortages in pediatric neurologists, gastroenterologists, general surgeons, and pulmonologists and developmental-behavioral pediatricians have the most effect, according to the survey. Some pediatric subspecialty openings—including those for neurology, endocrinology, pulmonology, gastroenterology, and developmental-behavioral pediatrics—remain vacant for 12 months or longer, the hospitals reported. Half the children's hospitals said that wait times for seeing pediatricians in the subspecialties experiencing the most severe shortages exceed 2 weeks. The average wait time for seeing a developmental pediatrician is more than 13 weeks, according to the report.

Head Start Improvements Planned

Head Start and Early Head Start will raise their performance standards and increase accountability by supporting only local programs that continuously improve, the Department of Health and Human Services said. HHS also promised better training for classroom teachers, staff, and program directors as well as improved technical assistance to grantees seeking to improve their work. The initiative stems from new evidence on what works in early learning and incorporates mandates from the 2007 Head Start Act reauthorization, HHS said. The agency also released a study of children enrolled in Head Start during 2002-2003. The researchers found that by the end of that program year, access to Head Start had increased the children's school readiness.

Agency Weighs Crib Refunds

The Consumer Product Safety Commission is considering whether to require crib manufacturers to provide customers with refunds or store credits when cribs are recalled, CPSC Chairwoman Inez Tenenbaum told a House panel. Many parents have failed to respond to crib recalls, which typically have involved free repair kits and not refunds, Tenenbaum told a House Energy and Commerce subcommittee. Refunds or store credits could motivate many parents to get rid of defective cribs, she said. The new rules would be part of the CPSC's initiative to create the safest possible sleep environment for babies and toddlers, set to be unveiled later this year, Ms. Tenenbaum said. She testified 2 days after the CPSC announced the recall of 635,000 cribs distributed by the company Dorel Asia. The agency said that the hardware holding up the side of the crib can fail, risking the child's becoming entrapped and suffocating as a result.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia has ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained numerous shipments of e-cigarettes, all imported by one company, Smoking Everywhere, saying that the products were unapproved drug-delivery devices. Judge Richard Leon disagreed with FDA's justification for its action. However, Judge Leon didn't address whether the federal agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June—after the FDA had already halted the shipments of e-cigarette in this case.

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism. The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at NIH are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. NIH will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Many Girls Involved in Violence

Over one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006-2008, the researchers found that 19% of adolescent girls reported getting into a serious fight at school, 14% participated in group-against-group fights, and 6% attacked others with the intent to hurt them seriously. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.”

Subspecialist Shortages Cause Waits

A survey from the National Association of Children's Hospitals and Related Institutions found that shortages in pediatric subspecialists are leading to significant wait times for many patients and families to get needed care. Shortages in pediatric neurologists, gastroenterologists, general surgeons, and pulmonologists and developmental-behavioral pediatricians have the most effect, according to the survey. Some pediatric subspecialty openings—including those for neurology, endocrinology, pulmonology, gastroenterology, and developmental-behavioral pediatrics—remain vacant for 12 months or longer, the hospitals reported. Half the children's hospitals said that wait times for seeing pediatricians in the subspecialties experiencing the most severe shortages exceed 2 weeks. The average wait time for seeing a developmental pediatrician is more than 13 weeks, according to the report.

Head Start Improvements Planned

Head Start and Early Head Start will raise their performance standards and increase accountability by supporting only local programs that continuously improve, the Department of Health and Human Services said. HHS also promised better training for classroom teachers, staff, and program directors as well as improved technical assistance to grantees seeking to improve their work. The initiative stems from new evidence on what works in early learning and incorporates mandates from the 2007 Head Start Act reauthorization, HHS said. The agency also released a study of children enrolled in Head Start during 2002-2003. The researchers found that by the end of that program year, access to Head Start had increased the children's school readiness.

Agency Weighs Crib Refunds

The Consumer Product Safety Commission is considering whether to require crib manufacturers to provide customers with refunds or store credits when cribs are recalled, CPSC Chairwoman Inez Tenenbaum told a House panel. Many parents have failed to respond to crib recalls, which typically have involved free repair kits and not refunds, Tenenbaum told a House Energy and Commerce subcommittee. Refunds or store credits could motivate many parents to get rid of defective cribs, she said. The new rules would be part of the CPSC's initiative to create the safest possible sleep environment for babies and toddlers, set to be unveiled later this year, Ms. Tenenbaum said. She testified 2 days after the CPSC announced the recall of 635,000 cribs distributed by the company Dorel Asia. The agency said that the hardware holding up the side of the crib can fail, risking the child's becoming entrapped and suffocating as a result.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia has ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained numerous shipments of e-cigarettes, all imported by one company, Smoking Everywhere, saying that the products were unapproved drug-delivery devices. Judge Richard Leon disagreed with FDA's justification for its action. However, Judge Leon didn't address whether the federal agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June—after the FDA had already halted the shipments of e-cigarette in this case.

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism. The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at NIH are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. NIH will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Many Girls Involved in Violence

Over one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006-2008, the researchers found that 19% of adolescent girls reported getting into a serious fight at school, 14% participated in group-against-group fights, and 6% attacked others with the intent to hurt them seriously. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.”

Subspecialist Shortages Cause Waits

A survey from the National Association of Children's Hospitals and Related Institutions found that shortages in pediatric subspecialists are leading to significant wait times for many patients and families to get needed care. Shortages in pediatric neurologists, gastroenterologists, general surgeons, and pulmonologists and developmental-behavioral pediatricians have the most effect, according to the survey. Some pediatric subspecialty openings—including those for neurology, endocrinology, pulmonology, gastroenterology, and developmental-behavioral pediatrics—remain vacant for 12 months or longer, the hospitals reported. Half the children's hospitals said that wait times for seeing pediatricians in the subspecialties experiencing the most severe shortages exceed 2 weeks. The average wait time for seeing a developmental pediatrician is more than 13 weeks, according to the report.

Head Start Improvements Planned

Head Start and Early Head Start will raise their performance standards and increase accountability by supporting only local programs that continuously improve, the Department of Health and Human Services said. HHS also promised better training for classroom teachers, staff, and program directors as well as improved technical assistance to grantees seeking to improve their work. The initiative stems from new evidence on what works in early learning and incorporates mandates from the 2007 Head Start Act reauthorization, HHS said. The agency also released a study of children enrolled in Head Start during 2002-2003. The researchers found that by the end of that program year, access to Head Start had increased the children's school readiness.

Agency Weighs Crib Refunds

The Consumer Product Safety Commission is considering whether to require crib manufacturers to provide customers with refunds or store credits when cribs are recalled, CPSC Chairwoman Inez Tenenbaum told a House panel. Many parents have failed to respond to crib recalls, which typically have involved free repair kits and not refunds, Tenenbaum told a House Energy and Commerce subcommittee. Refunds or store credits could motivate many parents to get rid of defective cribs, she said. The new rules would be part of the CPSC's initiative to create the safest possible sleep environment for babies and toddlers, set to be unveiled later this year, Ms. Tenenbaum said. She testified 2 days after the CPSC announced the recall of 635,000 cribs distributed by the company Dorel Asia. The agency said that the hardware holding up the side of the crib can fail, risking the child's becoming entrapped and suffocating as a result.

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia has ruled that the Food and Drug Administration does not have the authority to regulate so-called e-cigarettes—electronic cigarettes—as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained numerous shipments of e-cigarettes, all imported by one company, Smoking Everywhere, saying that the products were unapproved drug-delivery devices. Judge Richard Leon disagreed with FDA's justification for its action. However, Judge Leon didn't address whether the federal agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June—after the FDA had already halted the shipments of e-cigarette in this case.

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism. The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at NIH are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. NIH will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Many Girls Involved in Violence

Over one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006-2008, the researchers found that 19% of adolescent girls reported getting into a serious fight at school, 14% participated in group-against-group fights, and 6% attacked others with the intent to hurt them seriously. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.”

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use in the U.S. by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

New York Limits Its Salt

The New York City Health Department said it will ask restaurants and producers of packaged food to voluntarily reduce sodium in their meals and products by 25% over 5 years in an effort to curb high blood pressure and heart disease. The department acted as leader of the National Salt Reduction Initiative, a partnership of cities, states, and health organizations. The New York agency said that only 11% of the sodium in Americans' diets comes from salt added at home, while nearly 80% is added to foods before they are sold. After a year of consultation with food industry leaders, the coalition has developed targets for salt reductions in various foods. In a statement following the New York announcement, Centers for Disease Control and Prevention director Thomas Frieden endorsed such efforts and said, “The majority of Americans are consuming about twice the recommended limit of sodium each day, and not by choice. Achieving substantial reductions in sodium levels by incremental decreases in sodium content across the food supply can save many lives while maintaining good taste.”

Adverse Event Reports Are Limited

Little information is made public about adverse events in hospitals, even though public disclosure can help practitioners improve patient safety, according to a government report. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, the report said.

Few Drug-Safety Data Are Online

Safety and efficacy information collected as part of the federal drug approval process is not available online for 9 of the top 25 prescribed brand-name drugs in the United States, according to the Sunlight Foundation, a group that advocates for transparency in government. The foundation's report found that the FDA makes background documents available online only for drugs approved since 1997. Information for drugs approved earlier is online only if someone made a formal request for it. Safety and efficacy information for Lipitor (atorvastatin), Plavix (clopidogrel), and Synthroid (levothroxine) is not available online, according to the foundation. In addition, the information that is online is in a format that's difficult for researchers and the public to use, the report claimed.

FDA Okayed 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington–based investment adviser. Among the new biologics were Medicis's injectable wrinkle fighter Dysport. In the report, Washington Analysis's Ira Loss said that he expected more approvals last year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews. In 2008, the FDA approved 21 new chemical entities and 4 new biologics, according to the report.

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The CMS said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, the CMS said.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use in the U.S. by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

New York Limits Its Salt

The New York City Health Department said it will ask restaurants and producers of packaged food to voluntarily reduce sodium in their meals and products by 25% over 5 years in an effort to curb high blood pressure and heart disease. The department acted as leader of the National Salt Reduction Initiative, a partnership of cities, states, and health organizations. The New York agency said that only 11% of the sodium in Americans' diets comes from salt added at home, while nearly 80% is added to foods before they are sold. After a year of consultation with food industry leaders, the coalition has developed targets for salt reductions in various foods. In a statement following the New York announcement, Centers for Disease Control and Prevention director Thomas Frieden endorsed such efforts and said, “The majority of Americans are consuming about twice the recommended limit of sodium each day, and not by choice. Achieving substantial reductions in sodium levels by incremental decreases in sodium content across the food supply can save many lives while maintaining good taste.”

Adverse Event Reports Are Limited

Little information is made public about adverse events in hospitals, even though public disclosure can help practitioners improve patient safety, according to a government report. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, the report said.

Few Drug-Safety Data Are Online

Safety and efficacy information collected as part of the federal drug approval process is not available online for 9 of the top 25 prescribed brand-name drugs in the United States, according to the Sunlight Foundation, a group that advocates for transparency in government. The foundation's report found that the FDA makes background documents available online only for drugs approved since 1997. Information for drugs approved earlier is online only if someone made a formal request for it. Safety and efficacy information for Lipitor (atorvastatin), Plavix (clopidogrel), and Synthroid (levothroxine) is not available online, according to the foundation. In addition, the information that is online is in a format that's difficult for researchers and the public to use, the report claimed.

FDA Okayed 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington–based investment adviser. Among the new biologics were Medicis's injectable wrinkle fighter Dysport. In the report, Washington Analysis's Ira Loss said that he expected more approvals last year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews. In 2008, the FDA approved 21 new chemical entities and 4 new biologics, according to the report.

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The CMS said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, the CMS said.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use in the U.S. by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

New York Limits Its Salt

The New York City Health Department said it will ask restaurants and producers of packaged food to voluntarily reduce sodium in their meals and products by 25% over 5 years in an effort to curb high blood pressure and heart disease. The department acted as leader of the National Salt Reduction Initiative, a partnership of cities, states, and health organizations. The New York agency said that only 11% of the sodium in Americans' diets comes from salt added at home, while nearly 80% is added to foods before they are sold. After a year of consultation with food industry leaders, the coalition has developed targets for salt reductions in various foods. In a statement following the New York announcement, Centers for Disease Control and Prevention director Thomas Frieden endorsed such efforts and said, “The majority of Americans are consuming about twice the recommended limit of sodium each day, and not by choice. Achieving substantial reductions in sodium levels by incremental decreases in sodium content across the food supply can save many lives while maintaining good taste.”

Adverse Event Reports Are Limited

Little information is made public about adverse events in hospitals, even though public disclosure can help practitioners improve patient safety, according to a government report. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, the report said.

Few Drug-Safety Data Are Online

Safety and efficacy information collected as part of the federal drug approval process is not available online for 9 of the top 25 prescribed brand-name drugs in the United States, according to the Sunlight Foundation, a group that advocates for transparency in government. The foundation's report found that the FDA makes background documents available online only for drugs approved since 1997. Information for drugs approved earlier is online only if someone made a formal request for it. Safety and efficacy information for Lipitor (atorvastatin), Plavix (clopidogrel), and Synthroid (levothroxine) is not available online, according to the foundation. In addition, the information that is online is in a format that's difficult for researchers and the public to use, the report claimed.

FDA Okayed 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington–based investment adviser. Among the new biologics were Medicis's injectable wrinkle fighter Dysport. In the report, Washington Analysis's Ira Loss said that he expected more approvals last year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews. In 2008, the FDA approved 21 new chemical entities and 4 new biologics, according to the report.

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The CMS said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, the CMS said.