Jane Anderson

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues involved with parental depression, the report said.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” according to Dr. England.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues involved with parental depression, the report said.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” according to Dr. England.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues involved with parental depression, the report said.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” according to Dr. England.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts, including meals and travel, to physicians and other health care providers. The toughest of its kind in the nation, the legislation also requires disclosure of any allowed gifts or payments, regardless of their value. In 2002, a Vermont law required disclosure of gifts or payments of $25 or more. Under the stronger law, manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations, as long as the association selects the scholarship recipient.

More Flu Preparation Needed

Federal and state governments need to do more to prepare for possible pandemic flu, the Government Accountability Office (GAO) said after reviewing the H1N1 flu outbreak. The office acknowledged pandemic planning throughout government but said that more efforts are needed to improve disease surveillance and detection, address issues of coordination between various governmental entities, and improve capacity for patient care in the event of a pandemic. The GAO warned that the H1N1 virus could return next fall or winter in a more virulent form. Meanwhile, a Robert Wood Johnson Foundation report on the recent H1N1 outbreak concluded that health officials reacted effectively but noted that public health departments often did not have enough resources to carry out plans. The report also urged improvements in the ability of providers to manage a massive influx of patients.

Minorities Face Miscommunication

Black, Hispanic, and Asian patients are more likely than white patients to report problems communicating with their physicians, the Agency for Healthcare Research and Quality said. The AHRQ found that 13% of black and Asian patients, and 12% of Hispanic patients, said they had trouble communicating with their doctors in 2005, compared with 9% of whites. Roughly twice as many poor people as high-income people, regardless of their race or ethnicity, reported communication problems.

Bankruptcies, Illness Linked

Medical problems contributed to nearly two-thirds of all bankruptcies in the United States in 2007, according to a study in the American Journal of Medicine. Based on court-record reviews and interviews of more than 2,300 bankruptcy filers in 2007, the study found that 62% of filers cited medical debts and income lost to illness as reasons for seeking bankruptcy. Of these “medically bankrupt families,” 9 out of 10 said they had medical debts over $5,000, and the rest met criteria for medical bankruptcy because they had lost significant income because of illness or mortgaged a home to pay medical bills. Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families, including the three-quarters of families that had insurance at the outset of their problems. Most medical debtors were well educated, owned homes, and had middle-class occupations, the study found.

Medical Homes, Clinics Urged

A series of innovations, including patient-centered medical homes and retail clinics staffed by nurse practitioners and physician assistants, would help transform the primary care system into one that is higher in quality and more effective, according to a report from the Massachusetts-based New England Healthcare Institute. The report noted that “the promise of a high-quality primary care system has remained largely unfulfilled” but said the current crisis in primary care offers an opportunity for change. In addition to urging adoption of the medical home model and retail clinics, the institute recommended such changes as shared medical appointments, open-access scheduling, more work site wellness programs, and primary care home visits. The report said that improvements in health information technology could free physicians to spend more time with patients.

ED Overcrowding Continues

The emergency department wait time to see a physician for emergent patients—those who should be seen in 1-14 minutes—averaged 37 minutes in 2006. Half of such patients waited longer than recommended, the GAO said in a report. In addition, patients who should have been seen immediately waited an average of 28 minutes, and about three-fourths had to wait to be seen. Hospitals performed better with urgent cases: Those patients, who should be seen in 15-60 minutes, waited an average of 50 minutes, and only about 20% waited longer than recommended, the report said. Lack of inpatient beds continues to be the main driver of ED overcrowding. ED boarding of patients who are waiting for an inpatient bed continues to be a problem, the GAO noted. The American College of Emergency Physicians warned that overcrowding and wait times will only get worse as the population ages. “People age 65 and older represent the fastest growing segment of the population and the group whose visits to the emergency department are increasing the fastest,” Dr. Nicholas Jouriles, ACEP president, said in a statement.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts, including meals and travel, to physicians and other health care providers. The toughest of its kind in the nation, the legislation also requires disclosure of any allowed gifts or payments, regardless of their value. In 2002, a Vermont law required disclosure of gifts or payments of $25 or more. Under the stronger law, manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations, as long as the association selects the scholarship recipient.

More Flu Preparation Needed

Federal and state governments need to do more to prepare for possible pandemic flu, the Government Accountability Office (GAO) said after reviewing the H1N1 flu outbreak. The office acknowledged pandemic planning throughout government but said that more efforts are needed to improve disease surveillance and detection, address issues of coordination between various governmental entities, and improve capacity for patient care in the event of a pandemic. The GAO warned that the H1N1 virus could return next fall or winter in a more virulent form. Meanwhile, a Robert Wood Johnson Foundation report on the recent H1N1 outbreak concluded that health officials reacted effectively but noted that public health departments often did not have enough resources to carry out plans. The report also urged improvements in the ability of providers to manage a massive influx of patients.

Minorities Face Miscommunication

Black, Hispanic, and Asian patients are more likely than white patients to report problems communicating with their physicians, the Agency for Healthcare Research and Quality said. The AHRQ found that 13% of black and Asian patients, and 12% of Hispanic patients, said they had trouble communicating with their doctors in 2005, compared with 9% of whites. Roughly twice as many poor people as high-income people, regardless of their race or ethnicity, reported communication problems.

Bankruptcies, Illness Linked

Medical problems contributed to nearly two-thirds of all bankruptcies in the United States in 2007, according to a study in the American Journal of Medicine. Based on court-record reviews and interviews of more than 2,300 bankruptcy filers in 2007, the study found that 62% of filers cited medical debts and income lost to illness as reasons for seeking bankruptcy. Of these “medically bankrupt families,” 9 out of 10 said they had medical debts over $5,000, and the rest met criteria for medical bankruptcy because they had lost significant income because of illness or mortgaged a home to pay medical bills. Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families, including the three-quarters of families that had insurance at the outset of their problems. Most medical debtors were well educated, owned homes, and had middle-class occupations, the study found.

Medical Homes, Clinics Urged

A series of innovations, including patient-centered medical homes and retail clinics staffed by nurse practitioners and physician assistants, would help transform the primary care system into one that is higher in quality and more effective, according to a report from the Massachusetts-based New England Healthcare Institute. The report noted that “the promise of a high-quality primary care system has remained largely unfulfilled” but said the current crisis in primary care offers an opportunity for change. In addition to urging adoption of the medical home model and retail clinics, the institute recommended such changes as shared medical appointments, open-access scheduling, more work site wellness programs, and primary care home visits. The report said that improvements in health information technology could free physicians to spend more time with patients.

ED Overcrowding Continues

The emergency department wait time to see a physician for emergent patients—those who should be seen in 1-14 minutes—averaged 37 minutes in 2006. Half of such patients waited longer than recommended, the GAO said in a report. In addition, patients who should have been seen immediately waited an average of 28 minutes, and about three-fourths had to wait to be seen. Hospitals performed better with urgent cases: Those patients, who should be seen in 15-60 minutes, waited an average of 50 minutes, and only about 20% waited longer than recommended, the report said. Lack of inpatient beds continues to be the main driver of ED overcrowding. ED boarding of patients who are waiting for an inpatient bed continues to be a problem, the GAO noted. The American College of Emergency Physicians warned that overcrowding and wait times will only get worse as the population ages. “People age 65 and older represent the fastest growing segment of the population and the group whose visits to the emergency department are increasing the fastest,” Dr. Nicholas Jouriles, ACEP president, said in a statement.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts, including meals and travel, to physicians and other health care providers. The toughest of its kind in the nation, the legislation also requires disclosure of any allowed gifts or payments, regardless of their value. In 2002, a Vermont law required disclosure of gifts or payments of $25 or more. Under the stronger law, manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations, as long as the association selects the scholarship recipient.

More Flu Preparation Needed

Federal and state governments need to do more to prepare for possible pandemic flu, the Government Accountability Office (GAO) said after reviewing the H1N1 flu outbreak. The office acknowledged pandemic planning throughout government but said that more efforts are needed to improve disease surveillance and detection, address issues of coordination between various governmental entities, and improve capacity for patient care in the event of a pandemic. The GAO warned that the H1N1 virus could return next fall or winter in a more virulent form. Meanwhile, a Robert Wood Johnson Foundation report on the recent H1N1 outbreak concluded that health officials reacted effectively but noted that public health departments often did not have enough resources to carry out plans. The report also urged improvements in the ability of providers to manage a massive influx of patients.

Minorities Face Miscommunication

Black, Hispanic, and Asian patients are more likely than white patients to report problems communicating with their physicians, the Agency for Healthcare Research and Quality said. The AHRQ found that 13% of black and Asian patients, and 12% of Hispanic patients, said they had trouble communicating with their doctors in 2005, compared with 9% of whites. Roughly twice as many poor people as high-income people, regardless of their race or ethnicity, reported communication problems.

Bankruptcies, Illness Linked

Medical problems contributed to nearly two-thirds of all bankruptcies in the United States in 2007, according to a study in the American Journal of Medicine. Based on court-record reviews and interviews of more than 2,300 bankruptcy filers in 2007, the study found that 62% of filers cited medical debts and income lost to illness as reasons for seeking bankruptcy. Of these “medically bankrupt families,” 9 out of 10 said they had medical debts over $5,000, and the rest met criteria for medical bankruptcy because they had lost significant income because of illness or mortgaged a home to pay medical bills. Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families, including the three-quarters of families that had insurance at the outset of their problems. Most medical debtors were well educated, owned homes, and had middle-class occupations, the study found.

Medical Homes, Clinics Urged

A series of innovations, including patient-centered medical homes and retail clinics staffed by nurse practitioners and physician assistants, would help transform the primary care system into one that is higher in quality and more effective, according to a report from the Massachusetts-based New England Healthcare Institute. The report noted that “the promise of a high-quality primary care system has remained largely unfulfilled” but said the current crisis in primary care offers an opportunity for change. In addition to urging adoption of the medical home model and retail clinics, the institute recommended such changes as shared medical appointments, open-access scheduling, more work site wellness programs, and primary care home visits. The report said that improvements in health information technology could free physicians to spend more time with patients.

ED Overcrowding Continues

The emergency department wait time to see a physician for emergent patients—those who should be seen in 1-14 minutes—averaged 37 minutes in 2006. Half of such patients waited longer than recommended, the GAO said in a report. In addition, patients who should have been seen immediately waited an average of 28 minutes, and about three-fourths had to wait to be seen. Hospitals performed better with urgent cases: Those patients, who should be seen in 15-60 minutes, waited an average of 50 minutes, and only about 20% waited longer than recommended, the report said. Lack of inpatient beds continues to be the main driver of ED overcrowding. ED boarding of patients who are waiting for an inpatient bed continues to be a problem, the GAO noted. The American College of Emergency Physicians warned that overcrowding and wait times will only get worse as the population ages. “People age 65 and older represent the fastest growing segment of the population and the group whose visits to the emergency department are increasing the fastest,” Dr. Nicholas Jouriles, ACEP president, said in a statement.

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues that are related to parental depression, according to the report.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” Dr. England said.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues that are related to parental depression, according to the report.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” Dr. England said.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Physicians and other health professionals who care for adults with depression should identify and seek to prevent potential “spillover” effects on their patients' children, according to a report released by the Institute of Medicine and the National Research Council.

To achieve this “family-focused” model of depression care, government agencies, nonprofit associations, and the private sector will need to experiment with nontraditional ways of organizing, delivering, and paying for mental health care, according to the committee that wrote the report.

“Parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent,” the report said. “There is also a lack of support for public and professional education, training, infrastructure development, and implementation efforts to improve the quality of services for affected families and vulnerable children.”

Depression affects roughly 7.5 million parents in the United States annually—about 20% of parents overall, according to the report. More than 15 million children live with an adult who has had major depression in the last year, and parental depression can increase the chances for health, emotional, and behavioral problems in children, the report said.

Dr. Mary Jane England, a psychiatrist and chairman of the report committee, said in a statement that the report describes “a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort.”

The report recommended that the U.S. Surgeon General identify depression in parents and its effect on child development as part of its public health priorities. Further, the Heath and Human Services department should launch a national effort to document the scope of the problem, and should develop public education and awareness activities.

Congress, meanwhile, should authorize a new HHS demonstration project to look at strategies to identify, treat, and prevent depression in parents and its adverse effects on children, the report said. These strategies should use a combination of components, including screening and education.

The report also recommended that state governors each develop a task force focused on depression in parents. At the same time, HHS agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) should develop a national training program for primary, mental health, and substance abuse treatment providers to improve diagnosis and treatment of depression in adults and mitigate its effect on children.

Federal agencies should support collaborative research to increase understanding of the issues that are related to parental depression, according to the report.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” Dr. England said.

The Institute of Medicine and the National Research Council are both parts of the National Academies, the private, nonprofit institution that provides science, technology, and health policy advice to Congress. The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, The California Endowment, SAMHSA, and HRSA.

Architects of a 3-year-old regional health information network in Memphis are finding the system has major public health implications.

So far, the network has allowed them to quickly identify and isolate a tuberculosis patient and pinpoint possible domestic violence cases.

The MidSouth eHealth Alliance database is funded with $12 million from federal and state programs to promote electronic connectivity between health databases. The database combines patient data from the region's major hospitals and safety net clinics. Because it's still in its formative stages, firm evidence on its effects aren't yet available. But anecdotal reports indicate the system is already having a positive effect.

“We've saved some lives—we know that,” said Dr. Mark Frisse, professor and director of regional informatics at Vanderbilt University, Nashville, Tenn. For example, emergency department (ED) staff was able to intervene quickly in ectopic pregnancy because of the information retrieved from the database.

In addition, the database has improved care by enabling much faster exchange of clinical data between care centers, said Dr. Jerry Shenep, chief medical information officer at St. Jude Children's Research Hospital. “It's not an electronic medical record,” said Dr. Shenep. “You don't use it to do order entry. But just to be able to look at the data for all the hospitals and clinics is an amazing step forward.”

The system came online at the first site—the Regional Medical Center at Memphis—in May 2006 and has been gradually expanding its reach into the community, according to Dr. Frisse.

Users of the system now include all 14 emergency departments in the region, 15 ambulatory clinics, and hospitalists at four of the regional hospitals. The database covers about 1 million people and costs about $3 million a year to operate. That amounts to about $3 per person per year, said Dr. Frisse, who called it a bargain.

“The goal from the outset was to create a system that would make your information available wherever you sought care, independent of everything other than your consent,” said Dr. Frisse, an internist by training. Very few people—about 2%–3% of those in the inner city, and 1% of those in the suburbs—have declined consent to participate, he said.

The system is designed to answer questions when medical histories are not enough, Dr. Frisse said. Thus, its architects do not expect 100% usage. For example, the system is used during fewer than 5% of visits to the ED, he explained, in large part because health care practitioners have less time there to consult the database. It's not clear yet whether that number optimally should be higher, he said. In at least one ED, usage has risen to 14% of all visits.

Primary care usage is increasing slightly, and now averages 5.6% of all visits. Usage generally is higher if the patient has been seen elsewhere within the past few days or weeks, he said.

The MidSouth eHealth Alliance is conducting analyses of database usage patterns and usability. Preliminary analyses indicate that the system is helping to avoid duplication of several common tests, including head CT, abdominal CT, ankle x-ray, and hemoglobin A_1c.

But the potential public health implications for the project are also very interesting, Dr. Frisse said.

For example, there have been a few instances of ED or clinic staff accessing the database and realizing that a patient may be a victim of domestic violence, he said.

In addition, the safety net clinic information in the database makes it possible to “basically track migratory patterns and usage patterns—to see where people go and where people cluster,” he said. That could enable public health officials to see patterns of care and determine how to influence them. In the coming months, MidSouth eHealth Alliance will begin some of that analysis, he added.

With approximately 100,000 lab tests per day entered into the database, including some 2,000 white blood cell counts, the database can serve as a “thermometer for the city” to track the spread of influenza and other infectious diseases, Dr. Frisse explained.

Clinicians potentially could use the database to identify spikes in ED visits related to diseases such as West Nile virus or methicillin-resistant Staphylococcus aureus (MRSA), noted Dr. Kevin Johnson, a pediatrician and lead evaluator for the project. Clinicians also can use the database to provide better case management to patients with chronic illnesses and conditions, such as mental health disorders or hypertension.

Dr. Shenep recalled one case in which a patient presented at an ED with a fever, but failed to disclose—and never was asked directly—that he previously had been diagnosed with tuberculosis. Because the staff at the ED used the database to check the patient's history, they were able to remove the patient from the ED immediately and place him into isolation, preventing potential exposure of other patients, Dr. Shenep said.

“That's worth a lot of effort and a lot of expenditure right there, to avoid that one incident of exposure,” he said. “How do you put a value on that?”

Other benefits are more mundane but just as potentially valuable, Dr. Shenep added.

For example, children with brain cancer often receive their surgery at one hospital center and their chemotherapy at another hospital center. Historically, there have been delays in having critical lab data faxed back and forth between the two hospitals, he said. Now, those culture results and the latest radiology reports are available in the database. “This has been a great benefit for those patients who get treated at both centers,” he explained.

If one of those pediatric oncology patients is in an accident, ED staff could access those records as well, Dr. Shenep said. “They might see low hemoglobin and think the patient must be having a major bleed—but the hemoglobin may be low because of chemo,” he added.

The Memphis database project has managed to combine data from hospitals that normally compete with one another, even though the data are in different formats and different standards. In addition, leaders of the project went into the community to describe what the project hoped to achieve and how privacy would be protected, Dr. Frisse explained.

To replicate Memphis' progress, a city would need “sustained leadership” that continued to press for change even through opposition, he said. “The real challenge here is culture.”

Architects of a 3-year-old regional health information network in Memphis are finding the system has major public health implications.

So far, the network has allowed them to quickly identify and isolate a tuberculosis patient and pinpoint possible domestic violence cases.

The MidSouth eHealth Alliance database is funded with $12 million from federal and state programs to promote electronic connectivity between health databases. The database combines patient data from the region's major hospitals and safety net clinics. Because it's still in its formative stages, firm evidence on its effects aren't yet available. But anecdotal reports indicate the system is already having a positive effect.

“We've saved some lives—we know that,” said Dr. Mark Frisse, professor and director of regional informatics at Vanderbilt University, Nashville, Tenn. For example, emergency department (ED) staff was able to intervene quickly in ectopic pregnancy because of the information retrieved from the database.

In addition, the database has improved care by enabling much faster exchange of clinical data between care centers, said Dr. Jerry Shenep, chief medical information officer at St. Jude Children's Research Hospital. “It's not an electronic medical record,” said Dr. Shenep. “You don't use it to do order entry. But just to be able to look at the data for all the hospitals and clinics is an amazing step forward.”

The system came online at the first site—the Regional Medical Center at Memphis—in May 2006 and has been gradually expanding its reach into the community, according to Dr. Frisse.

Users of the system now include all 14 emergency departments in the region, 15 ambulatory clinics, and hospitalists at four of the regional hospitals. The database covers about 1 million people and costs about $3 million a year to operate. That amounts to about $3 per person per year, said Dr. Frisse, who called it a bargain.

“The goal from the outset was to create a system that would make your information available wherever you sought care, independent of everything other than your consent,” said Dr. Frisse, an internist by training. Very few people—about 2%–3% of those in the inner city, and 1% of those in the suburbs—have declined consent to participate, he said.

The system is designed to answer questions when medical histories are not enough, Dr. Frisse said. Thus, its architects do not expect 100% usage. For example, the system is used during fewer than 5% of visits to the ED, he explained, in large part because health care practitioners have less time there to consult the database. It's not clear yet whether that number optimally should be higher, he said. In at least one ED, usage has risen to 14% of all visits.

Primary care usage is increasing slightly, and now averages 5.6% of all visits. Usage generally is higher if the patient has been seen elsewhere within the past few days or weeks, he said.

The MidSouth eHealth Alliance is conducting analyses of database usage patterns and usability. Preliminary analyses indicate that the system is helping to avoid duplication of several common tests, including head CT, abdominal CT, ankle x-ray, and hemoglobin A_1c.

But the potential public health implications for the project are also very interesting, Dr. Frisse said.

For example, there have been a few instances of ED or clinic staff accessing the database and realizing that a patient may be a victim of domestic violence, he said.

In addition, the safety net clinic information in the database makes it possible to “basically track migratory patterns and usage patterns—to see where people go and where people cluster,” he said. That could enable public health officials to see patterns of care and determine how to influence them. In the coming months, MidSouth eHealth Alliance will begin some of that analysis, he added.

With approximately 100,000 lab tests per day entered into the database, including some 2,000 white blood cell counts, the database can serve as a “thermometer for the city” to track the spread of influenza and other infectious diseases, Dr. Frisse explained.

Clinicians potentially could use the database to identify spikes in ED visits related to diseases such as West Nile virus or methicillin-resistant Staphylococcus aureus (MRSA), noted Dr. Kevin Johnson, a pediatrician and lead evaluator for the project. Clinicians also can use the database to provide better case management to patients with chronic illnesses and conditions, such as mental health disorders or hypertension.

Dr. Shenep recalled one case in which a patient presented at an ED with a fever, but failed to disclose—and never was asked directly—that he previously had been diagnosed with tuberculosis. Because the staff at the ED used the database to check the patient's history, they were able to remove the patient from the ED immediately and place him into isolation, preventing potential exposure of other patients, Dr. Shenep said.

“That's worth a lot of effort and a lot of expenditure right there, to avoid that one incident of exposure,” he said. “How do you put a value on that?”

Other benefits are more mundane but just as potentially valuable, Dr. Shenep added.

For example, children with brain cancer often receive their surgery at one hospital center and their chemotherapy at another hospital center. Historically, there have been delays in having critical lab data faxed back and forth between the two hospitals, he said. Now, those culture results and the latest radiology reports are available in the database. “This has been a great benefit for those patients who get treated at both centers,” he explained.

If one of those pediatric oncology patients is in an accident, ED staff could access those records as well, Dr. Shenep said. “They might see low hemoglobin and think the patient must be having a major bleed—but the hemoglobin may be low because of chemo,” he added.

The Memphis database project has managed to combine data from hospitals that normally compete with one another, even though the data are in different formats and different standards. In addition, leaders of the project went into the community to describe what the project hoped to achieve and how privacy would be protected, Dr. Frisse explained.

To replicate Memphis' progress, a city would need “sustained leadership” that continued to press for change even through opposition, he said. “The real challenge here is culture.”

Architects of a 3-year-old regional health information network in Memphis are finding the system has major public health implications.

So far, the network has allowed them to quickly identify and isolate a tuberculosis patient and pinpoint possible domestic violence cases.

The MidSouth eHealth Alliance database is funded with $12 million from federal and state programs to promote electronic connectivity between health databases. The database combines patient data from the region's major hospitals and safety net clinics. Because it's still in its formative stages, firm evidence on its effects aren't yet available. But anecdotal reports indicate the system is already having a positive effect.

“We've saved some lives—we know that,” said Dr. Mark Frisse, professor and director of regional informatics at Vanderbilt University, Nashville, Tenn. For example, emergency department (ED) staff was able to intervene quickly in ectopic pregnancy because of the information retrieved from the database.

In addition, the database has improved care by enabling much faster exchange of clinical data between care centers, said Dr. Jerry Shenep, chief medical information officer at St. Jude Children's Research Hospital. “It's not an electronic medical record,” said Dr. Shenep. “You don't use it to do order entry. But just to be able to look at the data for all the hospitals and clinics is an amazing step forward.”

The system came online at the first site—the Regional Medical Center at Memphis—in May 2006 and has been gradually expanding its reach into the community, according to Dr. Frisse.

Users of the system now include all 14 emergency departments in the region, 15 ambulatory clinics, and hospitalists at four of the regional hospitals. The database covers about 1 million people and costs about $3 million a year to operate. That amounts to about $3 per person per year, said Dr. Frisse, who called it a bargain.

“The goal from the outset was to create a system that would make your information available wherever you sought care, independent of everything other than your consent,” said Dr. Frisse, an internist by training. Very few people—about 2%–3% of those in the inner city, and 1% of those in the suburbs—have declined consent to participate, he said.

The system is designed to answer questions when medical histories are not enough, Dr. Frisse said. Thus, its architects do not expect 100% usage. For example, the system is used during fewer than 5% of visits to the ED, he explained, in large part because health care practitioners have less time there to consult the database. It's not clear yet whether that number optimally should be higher, he said. In at least one ED, usage has risen to 14% of all visits.

Primary care usage is increasing slightly, and now averages 5.6% of all visits. Usage generally is higher if the patient has been seen elsewhere within the past few days or weeks, he said.

The MidSouth eHealth Alliance is conducting analyses of database usage patterns and usability. Preliminary analyses indicate that the system is helping to avoid duplication of several common tests, including head CT, abdominal CT, ankle x-ray, and hemoglobin A_1c.

But the potential public health implications for the project are also very interesting, Dr. Frisse said.

For example, there have been a few instances of ED or clinic staff accessing the database and realizing that a patient may be a victim of domestic violence, he said.

In addition, the safety net clinic information in the database makes it possible to “basically track migratory patterns and usage patterns—to see where people go and where people cluster,” he said. That could enable public health officials to see patterns of care and determine how to influence them. In the coming months, MidSouth eHealth Alliance will begin some of that analysis, he added.

With approximately 100,000 lab tests per day entered into the database, including some 2,000 white blood cell counts, the database can serve as a “thermometer for the city” to track the spread of influenza and other infectious diseases, Dr. Frisse explained.

Clinicians potentially could use the database to identify spikes in ED visits related to diseases such as West Nile virus or methicillin-resistant Staphylococcus aureus (MRSA), noted Dr. Kevin Johnson, a pediatrician and lead evaluator for the project. Clinicians also can use the database to provide better case management to patients with chronic illnesses and conditions, such as mental health disorders or hypertension.

Dr. Shenep recalled one case in which a patient presented at an ED with a fever, but failed to disclose—and never was asked directly—that he previously had been diagnosed with tuberculosis. Because the staff at the ED used the database to check the patient's history, they were able to remove the patient from the ED immediately and place him into isolation, preventing potential exposure of other patients, Dr. Shenep said.

“That's worth a lot of effort and a lot of expenditure right there, to avoid that one incident of exposure,” he said. “How do you put a value on that?”

Other benefits are more mundane but just as potentially valuable, Dr. Shenep added.

For example, children with brain cancer often receive their surgery at one hospital center and their chemotherapy at another hospital center. Historically, there have been delays in having critical lab data faxed back and forth between the two hospitals, he said. Now, those culture results and the latest radiology reports are available in the database. “This has been a great benefit for those patients who get treated at both centers,” he explained.

If one of those pediatric oncology patients is in an accident, ED staff could access those records as well, Dr. Shenep said. “They might see low hemoglobin and think the patient must be having a major bleed—but the hemoglobin may be low because of chemo,” he added.

The Memphis database project has managed to combine data from hospitals that normally compete with one another, even though the data are in different formats and different standards. In addition, leaders of the project went into the community to describe what the project hoped to achieve and how privacy would be protected, Dr. Frisse explained.

To replicate Memphis' progress, a city would need “sustained leadership” that continued to press for change even through opposition, he said. “The real challenge here is culture.”

Obama Gets Health Team in Place

President Obama now has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well-known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multi-drug resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman, Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman index.

Medicaid Plans Save States Money

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%–15% lower than for fee-for-service programs.

Obama Gets Health Team in Place

President Obama now has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well-known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multi-drug resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman, Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman index.

Medicaid Plans Save States Money

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%–15% lower than for fee-for-service programs.

Obama Gets Health Team in Place

President Obama now has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well-known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multi-drug resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman, Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman index.

Medicaid Plans Save States Money

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%–15% lower than for fee-for-service programs.

Obama Gets Health Team in Place

President Obama has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies have increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman Index.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said coauthor Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School, Boston.

Medicaid Plans Cut State Costs

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%-15% lower than for fee-for-service programs.

Obama Gets Health Team in Place

President Obama has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies have increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman Index.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said coauthor Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School, Boston.

Medicaid Plans Cut State Costs

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%-15% lower than for fee-for-service programs.

Obama Gets Health Team in Place

President Obama has filled several of the major positions on his health care team. They include former Kansas governor Kathleen Sebelius as Health and Human Services secretary, former New York City health commissioner Dr. Thomas Frieden as Centers for Disease Control and Prevention director, and another former New York City health commissioner, Dr. Margaret Hamburg, as Food and Drug Administration commissioner. Ms. Sebelius, a former insurance commissioner, was chosen in part for her health insurance expertise, while Dr. Frieden is well known as a crusader for various public health causes, such as decreasing the number of people who smoke and removing trans fats from restaurant food. Dr. Hamburg is respected for her work on a multidrug-resistant tuberculosis outbreak in New York. Acting FDA commissioner Dr. Joshua Sharfstein has been nominated as deputy chief of the agency.

Feds Launch Disease Program

The National Institutes of Health has launched a $24 million drug development program to produce new treatments for rare and neglected diseases. The Therapeutics for Rare and Neglected Diseases program, funded by Congress this spring, creates a drug development pipeline within NIH and is intended to stimulate research collaborations with academic scientists researching these diseases, NIH said. The NIH Office of Rare Diseases Research will oversee the program. NIH estimates that more than 6,800 rare diseases affect more than 25 million Americans, but effective pharmacologic treatments exist for only about 200 of these illnesses. In addition, many neglected diseases—uncommon in the United States but more common in parts of the world where people cannot afford expensive therapies—also lack treatments, NIH said.

AHRQ: Quality Improving Slowly

U.S. health care quality continued to improve at a slow pace in 2008, but many Americans still do not receive recommended care, the annual quality report from the Agency for Healthcare Research and Quality found. Quality varies widely throughout the system, AHRQ found. For example, patients hospitalized with a heart attack receive 95% of recommended services, but only 15% of patients on dialysis are registered on a kidney transplant waiting list, the report found. A median of 59% of patients received needed care across the core measures tracked, AHRQ said. In addition, reporting of hospital quality measures is propelling improvement in those measures, but patient safety lags, the report said, adding that one in seven adult hospitalized Medicare patients experiences one or more adverse events. AHRQ urged more work in the area of patients' experiences, saying that “patients see problems from a personal perspective and may observe deficiencies that busy providers do not notice.”

Family Medical Spending Rises

A typical U.S. family of four will account for about $16,711 in medical spending this year, up $1,162 from last year, according to a report from actuarial firm Milliman Inc. Of the total, employers paid 59% and families 41%, according to the annual Milliman Medical Index report, which looks at the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization. Employer subsidies have increased about $500 since last year, and employees picked up about $650 more of the health care tab, including about $500 for employee contributions toward coverage and $150 for employee out-of-pocket expenses, according to the Milliman Index.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said coauthor Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School, Boston.

Medicaid Plans Cut State Costs

Medicaid health plans appear to be saving money for most states, increasing access to and quality of care, according to a study performed by the Lewin Group for insurer group America's Health Insurance Plans. Lewin analyzed 24 existing studies and found states achieved savings ranging from less than 1% to 20% after implementing private Medicaid health plans. A large part of the cost savings reported came from reducing unnecessary utilization. For example, California found that preventable hospitalizations were as much as 38% lower in health plans than in fee-for-service Medicaid, according to the report. Beneficiary drug costs in Medicaid health plans were 10%-15% lower than for fee-for-service programs.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

CMS Proposal: Rescind Medicaid Rules

The Centers for Medicare and Medicaid Services has proposed rescinding three Medicaid rules that were finalized in the last days of the Bush administration. Late last year, CMS finalized rules eliminating federal Medicaid reimbursement for school administrative activities and for transportation between home and school, and rules limiting treatments that could be billed and paid as Medicaid outpatient procedures. The agency also published a final rule posing new limits on case management services. However, Congress halted implementation of these rules, so none have been fully implemented. CMS said rescinding the rules will allow further study “in light of concerns raised about the adverse effects that could result from these regulations, in particular the potential restrictions on services available to beneficiaries… and the lack of clear evidence demonstrating that the approaches taken in the regulations are warranted.”

Programs Improve School Performance

Comprehensive services for children and youth with serious mental challenges dramatically improve performance in academics, behavior, and emotion when the services are received from coordinated community-based networks, according to a report from the Substance Abuse and Mental Health Services Administration. Such coordinated networks of care are associated with higher graduation rates among high school students with emotional challenges, and with significant decreases in reported levels of depression and anxiety, the report said. Improvements occurred among many young people within 12 months of their enrollment in these programs, SAMHSA said.

Bonuses Help Medicaid Enrollment

Performance bonuses paid to the states to reward them for enrolling eligible children in Medicaid hold the potential to get many more children—especially the poorest children—covered, according to a report from advocacy group Families USA. As part of the recent reauthorization of the Children's Health Insurance Program, federal lawmakers devised a bonus system to give states an incentive to find the lowest-income uninsured children and enroll them in Medicaid, even though states receive less federal money for enrolling children in Medicaid than they do for enrolling children in CHIP. The bonuses are designed to offset those additional costs. The report noted that states understand the steps they need to take to get children enrolled. However, “performance bonuses sweeten the deal for states that already are doing the right thing to cover low-income children, and they give states that have not been as aggressive a clear incentive to change their ways,” the report said.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

CMS Proposal: Rescind Medicaid Rules

The Centers for Medicare and Medicaid Services has proposed rescinding three Medicaid rules that were finalized in the last days of the Bush administration. Late last year, CMS finalized rules eliminating federal Medicaid reimbursement for school administrative activities and for transportation between home and school, and rules limiting treatments that could be billed and paid as Medicaid outpatient procedures. The agency also published a final rule posing new limits on case management services. However, Congress halted implementation of these rules, so none have been fully implemented. CMS said rescinding the rules will allow further study “in light of concerns raised about the adverse effects that could result from these regulations, in particular the potential restrictions on services available to beneficiaries… and the lack of clear evidence demonstrating that the approaches taken in the regulations are warranted.”

Programs Improve School Performance

Comprehensive services for children and youth with serious mental challenges dramatically improve performance in academics, behavior, and emotion when the services are received from coordinated community-based networks, according to a report from the Substance Abuse and Mental Health Services Administration. Such coordinated networks of care are associated with higher graduation rates among high school students with emotional challenges, and with significant decreases in reported levels of depression and anxiety, the report said. Improvements occurred among many young people within 12 months of their enrollment in these programs, SAMHSA said.

Bonuses Help Medicaid Enrollment

Performance bonuses paid to the states to reward them for enrolling eligible children in Medicaid hold the potential to get many more children—especially the poorest children—covered, according to a report from advocacy group Families USA. As part of the recent reauthorization of the Children's Health Insurance Program, federal lawmakers devised a bonus system to give states an incentive to find the lowest-income uninsured children and enroll them in Medicaid, even though states receive less federal money for enrolling children in Medicaid than they do for enrolling children in CHIP. The bonuses are designed to offset those additional costs. The report noted that states understand the steps they need to take to get children enrolled. However, “performance bonuses sweeten the deal for states that already are doing the right thing to cover low-income children, and they give states that have not been as aggressive a clear incentive to change their ways,” the report said.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Patients Want Internet Advice

Patients expect to rely on computers and other electronic technology in the future for many routine medical issues, and seem to be less concerned about privacy issues than providers are, a study in the Journal of General Internal Medicine found. The investigators convened focus groups of frequent Internet users, and then analyzed the transcripts. They found that the participants want customized health information from the Internet, and also want complete access to their own health record. In addition, they expect that in the future, home monitors and other technologies will communicate with clinicians, increasing efficiency and quality of life for patients and providers. “Patients know how busy their doctors are and they want to reserve us for what they really need us for—treating serious illness and conditions,” said co-author Dr. Tom Delbanco, professor of general medicine and primary care at Harvard Medical School.

CMS Proposal: Rescind Medicaid Rules

The Centers for Medicare and Medicaid Services has proposed rescinding three Medicaid rules that were finalized in the last days of the Bush administration. Late last year, CMS finalized rules eliminating federal Medicaid reimbursement for school administrative activities and for transportation between home and school, and rules limiting treatments that could be billed and paid as Medicaid outpatient procedures. The agency also published a final rule posing new limits on case management services. However, Congress halted implementation of these rules, so none have been fully implemented. CMS said rescinding the rules will allow further study “in light of concerns raised about the adverse effects that could result from these regulations, in particular the potential restrictions on services available to beneficiaries… and the lack of clear evidence demonstrating that the approaches taken in the regulations are warranted.”

Programs Improve School Performance

Comprehensive services for children and youth with serious mental challenges dramatically improve performance in academics, behavior, and emotion when the services are received from coordinated community-based networks, according to a report from the Substance Abuse and Mental Health Services Administration. Such coordinated networks of care are associated with higher graduation rates among high school students with emotional challenges, and with significant decreases in reported levels of depression and anxiety, the report said. Improvements occurred among many young people within 12 months of their enrollment in these programs, SAMHSA said.

Bonuses Help Medicaid Enrollment

Performance bonuses paid to the states to reward them for enrolling eligible children in Medicaid hold the potential to get many more children—especially the poorest children—covered, according to a report from advocacy group Families USA. As part of the recent reauthorization of the Children's Health Insurance Program, federal lawmakers devised a bonus system to give states an incentive to find the lowest-income uninsured children and enroll them in Medicaid, even though states receive less federal money for enrolling children in Medicaid than they do for enrolling children in CHIP. The bonuses are designed to offset those additional costs. The report noted that states understand the steps they need to take to get children enrolled. However, “performance bonuses sweeten the deal for states that already are doing the right thing to cover low-income children, and they give states that have not been as aggressive a clear incentive to change their ways,” the report said.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home requires “epic whole-practice reimagination and redesign,” according to researchers reporting on one of the first demonstrations of the model. The results of the 2-year pilot project, launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology needed to run a patient-centered medical home (PCMH) was especially difficult to implement. In addition, transitioning to a PCMH required physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, manage chronic care differently, incorporate populationwide health management, use evidence at the point of care, and partner with patients, the researchers said in the May/June Annals of Family Medicine.

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure. “The data suggest that adopting these more restrictive policies will reverse long-standing adverse trends on physicians' prescribing habits,” Dr. Philip Greenland of Northwestern University wrote in an accompanying editorial. “It is time to act.”

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home requires “epic whole-practice reimagination and redesign,” according to researchers reporting on one of the first demonstrations of the model. The results of the 2-year pilot project, launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology needed to run a patient-centered medical home (PCMH) was especially difficult to implement. In addition, transitioning to a PCMH required physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, manage chronic care differently, incorporate populationwide health management, use evidence at the point of care, and partner with patients, the researchers said in the May/June Annals of Family Medicine.

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure. “The data suggest that adopting these more restrictive policies will reverse long-standing adverse trends on physicians' prescribing habits,” Dr. Philip Greenland of Northwestern University wrote in an accompanying editorial. “It is time to act.”

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families can't afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets minus debt—rather than just income. The AHRQ concluded that while an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families with low net worth and underestimates enrollment for families with high net worth. Also, families without access to employer-based coverage were much more likely than those with access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home requires “epic whole-practice reimagination and redesign,” according to researchers reporting on one of the first demonstrations of the model. The results of the 2-year pilot project, launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology needed to run a patient-centered medical home (PCMH) was especially difficult to implement. In addition, transitioning to a PCMH required physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, manage chronic care differently, incorporate populationwide health management, use evidence at the point of care, and partner with patients, the researchers said in the May/June Annals of Family Medicine.

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure. “The data suggest that adopting these more restrictive policies will reverse long-standing adverse trends on physicians' prescribing habits,” Dr. Philip Greenland of Northwestern University wrote in an accompanying editorial. “It is time to act.”

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should stimulate action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius commented. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that insurance plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families cannot afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets, minus debt—rather than just family income. The AHRQ concluded that although an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families that have low net worth and underestimates enrollment for families that have high net worth. Also, families without access to employer-based coverage were much more likely than those with such access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home (PCMH) requires “epic whole-practice reimagination and redesign,” according to researchers who reported on one of the first demonstrations of the PCMH model. The results of the 2-year pilot project, which was launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology that is needed to run a PCMH is especially difficult to implement. In addition, a successful transition to a PCMH requires physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, change how they manage chronic care, incorporate a populationwide approach to health management, use evidence at the point of care, and partner with their patients, the researchers wrote in the May/June Annals of Family Medicine.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should stimulate action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius commented. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that insurance plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families cannot afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets, minus debt—rather than just family income. The AHRQ concluded that although an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families that have low net worth and underestimates enrollment for families that have high net worth. Also, families without access to employer-based coverage were much more likely than those with such access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home (PCMH) requires “epic whole-practice reimagination and redesign,” according to researchers who reported on one of the first demonstrations of the PCMH model. The results of the 2-year pilot project, which was launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology that is needed to run a PCMH is especially difficult to implement. In addition, a successful transition to a PCMH requires physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, change how they manage chronic care, incorporate a populationwide approach to health management, use evidence at the point of care, and partner with their patients, the researchers wrote in the May/June Annals of Family Medicine.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because the fund is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. If lawmakers don't make changes in the program, in 2017 the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. The trustees also predicted that premiums for Medicare Parts B and D will continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should stimulate action on the part of lawmakers considering overall health care reform. “This isn't just another government report,” Ms. Sebelius commented. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Mental Heath Parity Comments Due

The federal government is seeking public comments before implementing a law that demands broader insurance coverage for mental health benefits. The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans use the same rules for cost-sharing and visit limits in offering mental health and addiction treatment that they use for medical and surgical treatments. Together, HHS and the Labor Department said they want to know the financial and treatment limits that insurance plans currently impose, the plans' practices in determining medical necessity for and denying mental health benefits, and how plans handle out-of-network mental health benefits.

Families Can't Afford Insurance

The majority of uninsured American families cannot afford to buy nongroup health insurance, according to a study from the Agency for Healthcare Research and Quality. The study measured families' median net worth—their savings plus other assets, minus debt—rather than just family income. The AHRQ concluded that although an income-based model works well to estimate how many families will enroll in employer-based coverage, it overestimates nongroup health insurance enrollment for families that have low net worth and underestimates enrollment for families that have high net worth. Also, families without access to employer-based coverage were much more likely than those with such access to earn below 200% of the federal poverty level, the study showed.

Medical Homes Are Challenging

Transforming a primary care practice into a patient-centered medical home (PCMH) requires “epic whole-practice reimagination and redesign,” according to researchers who reported on one of the first demonstrations of the PCMH model. The results of the 2-year pilot project, which was launched in 2006 and supported by the American Academy of Family Physicians, showed that the technology that is needed to run a PCMH is especially difficult to implement. In addition, a successful transition to a PCMH requires physicians “to change their professional identity and the socialized ways they currently deliver primary care.” For example, physicians must learn to work in practice teams, change how they manage chronic care, incorporate a populationwide approach to health management, use evidence at the point of care, and partner with their patients, the researchers wrote in the May/June Annals of Family Medicine.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The “Voices of Physicians” campaign has collected and published comments from doctors nationwide at

www.voicesofphysicians.org

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they couldn't get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. A total of 67% of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

CMS Considers Hospice Rule

Physicians certifying patients for Medicare-covered hospice stays would be required to write a brief explanation of why a patient has 6 months or less to live, under a new rule proposed by the Centers for Medicare and Medicaid Services. Currently, physicians need only sign a certification to qualify someone for hospice services, although the CMS also requires the medical record to include documentation supporting a terminal prognosis. However, the Medicare Payment Advisory Commission has noted an increasing number of hospice patients with stays longer than 180 days, and the proposed rule is designed to provide more accountability for hospice certification, the CMS said. Comments, including whether the requirement would increase physician engagement in the certification process, are due by June 22.

Medical Discipline Declined

State medical boards seriously disciplined far fewer doctors in 2007 and 2008 than they did in 2004, the peak year for such actions against doctors, according to an analysis by the consumer-advocacy group Public Citizen. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, the same rate as in 2007 but 21% lower than in 2004. The states that disciplined the most doctors per 1,000 practitioners were Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado, and Maine. Minnesota disciplined the fewest physicians, and California, Florida, Maryland, South Carolina, and Wisconsin ranked low on the list, Public Citizen said. The annual rankings are based on data from the Federation of State Medical Boards. Serious disciplinary actions include license revocations and surrenders, suspensions, and probation with restrictions on practice.

Proposed Dialysis Policy Risky

A proposed change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, a study in the Journal of the American Society of Nephrology suggested. Under the possible policy change, CMS would make a single bundled payment to dialysis units to cover both dialysis and injectable medications, which have been reimbursed separately. The analysis of 12,000 patients starting dialysis found that African Americans had lower initial hemoglobin levels, compared with readings in whites who were beginning treatment. The study also found that the average required dose of erythropoiesis-stimulating agents over the first 2 months of dialysis was 11% higher in African American patients. Since dialysis centers no longer will be reimbursed more for the higher doses, the researchers said they are concerned that the new policy could create a financial disincentive for centers to accept African Americans. “If race is not included as a payment adjuster, African Americans could be disadvantaged by this policy change,” asserted study coauthor Dr. Areef Ishani of the University of Minnesota.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drug makers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to “greatly expand transparency in medical research” by providing summaries of results from for all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drug makers to adopt the authorship standards of the International Committee of Medical Journal Editors. The committee says, for instance, that only individuals who make substantial contributions to a manuscript should be included as authors.

Routine HIV Testing Urged

The American College of Physicians and the Infectious Disease Society of America have jointly called for routine HIV testing for sexually active adults, pregnant women, and newborns. Federally supported health care programs should provide coverage for such testing, said the policy statement published in Clinical Infectious Diseases. Public health officials also should promote evidence-based interventions to minimize the risk of HIV transmission—comprehensive sex education, condom distribution, and syringe-exchange programs—the two groups said. They also urged that all patients living with HIV/AIDS in the United States have access to care provided by physicians trained in AIDS treatment.

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they couldn't get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. A total of 67% of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

CMS Considers Hospice Rule

Physicians certifying patients for Medicare-covered hospice stays would be required to write a brief explanation of why a patient has 6 months or less to live, under a new rule proposed by the Centers for Medicare and Medicaid Services. Currently, physicians need only sign a certification to qualify someone for hospice services, although the CMS also requires the medical record to include documentation supporting a terminal prognosis. However, the Medicare Payment Advisory Commission has noted an increasing number of hospice patients with stays longer than 180 days, and the proposed rule is designed to provide more accountability for hospice certification, the CMS said. Comments, including whether the requirement would increase physician engagement in the certification process, are due by June 22.

Medical Discipline Declined

State medical boards seriously disciplined far fewer doctors in 2007 and 2008 than they did in 2004, the peak year for such actions against doctors, according to an analysis by the consumer-advocacy group Public Citizen. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, the same rate as in 2007 but 21% lower than in 2004. The states that disciplined the most doctors per 1,000 practitioners were Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado, and Maine. Minnesota disciplined the fewest physicians, and California, Florida, Maryland, South Carolina, and Wisconsin ranked low on the list, Public Citizen said. The annual rankings are based on data from the Federation of State Medical Boards. Serious disciplinary actions include license revocations and surrenders, suspensions, and probation with restrictions on practice.

Proposed Dialysis Policy Risky

A proposed change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, a study in the Journal of the American Society of Nephrology suggested. Under the possible policy change, CMS would make a single bundled payment to dialysis units to cover both dialysis and injectable medications, which have been reimbursed separately. The analysis of 12,000 patients starting dialysis found that African Americans had lower initial hemoglobin levels, compared with readings in whites who were beginning treatment. The study also found that the average required dose of erythropoiesis-stimulating agents over the first 2 months of dialysis was 11% higher in African American patients. Since dialysis centers no longer will be reimbursed more for the higher doses, the researchers said they are concerned that the new policy could create a financial disincentive for centers to accept African Americans. “If race is not included as a payment adjuster, African Americans could be disadvantaged by this policy change,” asserted study coauthor Dr. Areef Ishani of the University of Minnesota.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drug makers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to “greatly expand transparency in medical research” by providing summaries of results from for all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drug makers to adopt the authorship standards of the International Committee of Medical Journal Editors. The committee says, for instance, that only individuals who make substantial contributions to a manuscript should be included as authors.

Routine HIV Testing Urged

The American College of Physicians and the Infectious Disease Society of America have jointly called for routine HIV testing for sexually active adults, pregnant women, and newborns. Federally supported health care programs should provide coverage for such testing, said the policy statement published in Clinical Infectious Diseases. Public health officials also should promote evidence-based interventions to minimize the risk of HIV transmission—comprehensive sex education, condom distribution, and syringe-exchange programs—the two groups said. They also urged that all patients living with HIV/AIDS in the United States have access to care provided by physicians trained in AIDS treatment.

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they couldn't get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. A total of 67% of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

CMS Considers Hospice Rule

Physicians certifying patients for Medicare-covered hospice stays would be required to write a brief explanation of why a patient has 6 months or less to live, under a new rule proposed by the Centers for Medicare and Medicaid Services. Currently, physicians need only sign a certification to qualify someone for hospice services, although the CMS also requires the medical record to include documentation supporting a terminal prognosis. However, the Medicare Payment Advisory Commission has noted an increasing number of hospice patients with stays longer than 180 days, and the proposed rule is designed to provide more accountability for hospice certification, the CMS said. Comments, including whether the requirement would increase physician engagement in the certification process, are due by June 22.

Medical Discipline Declined

State medical boards seriously disciplined far fewer doctors in 2007 and 2008 than they did in 2004, the peak year for such actions against doctors, according to an analysis by the consumer-advocacy group Public Citizen. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, the same rate as in 2007 but 21% lower than in 2004. The states that disciplined the most doctors per 1,000 practitioners were Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado, and Maine. Minnesota disciplined the fewest physicians, and California, Florida, Maryland, South Carolina, and Wisconsin ranked low on the list, Public Citizen said. The annual rankings are based on data from the Federation of State Medical Boards. Serious disciplinary actions include license revocations and surrenders, suspensions, and probation with restrictions on practice.

Proposed Dialysis Policy Risky

A proposed change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, a study in the Journal of the American Society of Nephrology suggested. Under the possible policy change, CMS would make a single bundled payment to dialysis units to cover both dialysis and injectable medications, which have been reimbursed separately. The analysis of 12,000 patients starting dialysis found that African Americans had lower initial hemoglobin levels, compared with readings in whites who were beginning treatment. The study also found that the average required dose of erythropoiesis-stimulating agents over the first 2 months of dialysis was 11% higher in African American patients. Since dialysis centers no longer will be reimbursed more for the higher doses, the researchers said they are concerned that the new policy could create a financial disincentive for centers to accept African Americans. “If race is not included as a payment adjuster, African Americans could be disadvantaged by this policy change,” asserted study coauthor Dr. Areef Ishani of the University of Minnesota.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drug makers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to “greatly expand transparency in medical research” by providing summaries of results from for all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drug makers to adopt the authorship standards of the International Committee of Medical Journal Editors. The committee says, for instance, that only individuals who make substantial contributions to a manuscript should be included as authors.

Routine HIV Testing Urged

The American College of Physicians and the Infectious Disease Society of America have jointly called for routine HIV testing for sexually active adults, pregnant women, and newborns. Federally supported health care programs should provide coverage for such testing, said the policy statement published in Clinical Infectious Diseases. Public health officials also should promote evidence-based interventions to minimize the risk of HIV transmission—comprehensive sex education, condom distribution, and syringe-exchange programs—the two groups said. They also urged that all patients living with HIV/AIDS in the United States have access to care provided by physicians trained in AIDS treatment.