Jane Anderson

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, which is subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, said Mr. Pew, which is especially good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine Widespread

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%-28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

About 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, which is subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, said Mr. Pew, which is especially good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine Widespread

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%-28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

About 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, which is subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, said Mr. Pew, which is especially good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine Widespread

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%-28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

About 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, he said, which is good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine: $1.4 Billion

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%–28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

Approximately 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, he said, which is good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine: $1.4 Billion

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%–28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

Approximately 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

Medical Emissions Curbed

The Environmental Protection Agency has proposed tougher air pollution standards for medical waste incinerators, which environmental groups said have been among the country's worst emitters of mercury and dioxins. The new rule, subject to public comment until late January, resulted from an 11-year legal challenge to existing standards by environmental groups Earthjustice, the Sierra Club, and the Natural Resources Defense Council. Earthjustice attorney Jim Pew said in a statement that, in recent years, incineration of medical waste has shifted from individual hospitals to commercial incinerators. Pollution reductions at these larger facilities will be significant under the new rules, he said, which is good for nearby communities.

Clinic Discloses Industry Ties

The Cleveland Clinic has begun public disclosure of the business relationships its staff physicians and scientists have with drug and medical device makers. The organization said its Web site will list the names of companies with which each staff professional has collaborations. It also will identify whether a physician or scientist owns equity or has the right to royalties, a fiduciary position, or a consulting relationship that pays $5,000 or more per year. Cleveland Clinic physicians and researchers are subject to the organization's conflict of interest rules, and must submit for approval all industry relationships. “We want our patients to have abundant information about our physicians and let them decide what's relevant to their situations,” said Dr. Joseph Hahn, Cleveland Clinic chief of staff. Dr. Hahn added that to the best of his knowledge, Cleveland Clinic is the first academic medical center in the United States to disclose these ties.

HHS Issues Final PSO Rules

The Department of Health and Human Services has issued the final requirements for Patient Safety Organizations, new entities through which health care providers can collect and analyze data to identify and reduce patient care risks. PSOs allow this activity in an environment that is legally secure for practitioners and confidential for patients, according to the HHS. The Agency for Healthcare Research and Quality, which administers the PSO program, already has listed 15 PSOs. “The Patient Safety Organization final rule describes the clear, legally protected framework for how hospitals, clinicians, and health care organizations can work together to improve patient safety and the quality of care nationwide,” said AHRQ director Dr. Carolyn Clancy in a statement.

Lawmaker Asks for Heparin Review

U.S. Rep. Joe Barton (R-Tex.), ranking minority member of the House Energy and Commerce Committee, has asked the Government Accountability Office for a thorough review of the Food and Drug Administration's handling of the recent problems with tainted heparin coming from China. In February 2008, Baxter Healthcare Corp. recalled several heparin products and the FDA identified a previously unknown contaminant in the heparin. According to the FDA, 246 people died after heparin administration between Jan. 1, 2007, and May 31, 2008, and 149 of those deaths involved allergic symptoms or the appearance of hypotension, the group of symptoms that prompted the drug recalls. Rep. Barton's letter to the FDA challenges the agency's attribution of several deaths to heparin and questions whether the FDA used “all of the tools available” to investigate the deaths. “My hope is that the GAO's review will determine the strengths and weaknesses in the FDA's response to the heparin drug safety problem, and will make recommendations on what the FDA could do better in dealing real-time with an emerging drug safety problem in the future,” Rep. Barton wrote.

Defensive Medicine: $1.4 Billion

Defensive medicine—physicians ordering tests, procedures, referrals, hospitalizations, or prescriptions because of fear of being sued—is widespread and adds a minimum of $1.4 billion per year to the cost of health care in Massachusetts, according to a physician survey conducted by the Massachusetts Medical Society. The physicians' group said that defensive practices also reduce access to care and may be unsafe for patients. The survey queried nearly 900 physicians in eight specialties between November 2007 and April 2008 about their use of seven tests and procedures. Of the respondents, 83% said they practice defensive medicine. The survey also found that 13% of hospitalizations and 18%–28% of various tests, procedures, referrals, and consultations were ordered for defensive reasons. The society said that patients are unnecessarily exposed to radiation and possible severe allergic reactions when subjected to tests ordered for defensive purposes.

Workers Have Uninsured Children

Approximately 8.6 million children in the United States are uninsured, and most of these are in working families, according to a report from the advocacy group Families USA. In fact, almost 90% of uninsured children are in families where one parent works, and more than two-thirds live in households where at least one family member works full-time, year-round. The report, based on new Census Bureau data from 2005 through 2007, does not reflect the worsening economic situation in 2008, Families USA Executive Director Ron Pollack said at a press briefing. Mr. Pollack said the report points out the need for Congress to move quickly to pass legislation to reauthorize and expand the State Children's Health Insurance Program, now scheduled to expire on March 31.

About half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.”

About half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.”

About half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.”

Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisers as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” said HHS Secretary Mike Leavitt in a statement. The inventory is available at

www.qualitymeasures.ahrq.gov

Army and NIMH to Study Suicides

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to a statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so post deployment, and 29 had never been deployed.

FDA Opens China Offices

The Food and Drug Administration has opened offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” said the FDA Commissioner Andrew von Eschenbach in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” said Rep. Henry Waxman (D-Calif.), in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisers as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” said HHS Secretary Mike Leavitt in a statement. The inventory is available at

www.qualitymeasures.ahrq.gov

Army and NIMH to Study Suicides

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to a statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so post deployment, and 29 had never been deployed.

FDA Opens China Offices

The Food and Drug Administration has opened offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” said the FDA Commissioner Andrew von Eschenbach in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” said Rep. Henry Waxman (D-Calif.), in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisers as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” said HHS Secretary Mike Leavitt in a statement. The inventory is available at

www.qualitymeasures.ahrq.gov

Army and NIMH to Study Suicides

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to a statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so post deployment, and 29 had never been deployed.

FDA Opens China Offices

The Food and Drug Administration has opened offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” said the FDA Commissioner Andrew von Eschenbach in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” said Rep. Henry Waxman (D-Calif.), in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care, and 36% said Medicare reimbursement does not cover their costs.

Only 17% of the physicians rated the financial position of their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

The Physicians' Foundation was founded in 2003 through settlement of a class action lawsuit brought by physicians and medical associations against third-party payers. Its mission is to advance the work of practicing physicians and improve health care quality.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care, and 36% said Medicare reimbursement does not cover their costs.

Only 17% of the physicians rated the financial position of their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

The Physicians' Foundation was founded in 2003 through settlement of a class action lawsuit brought by physicians and medical associations against third-party payers. Its mission is to advance the work of practicing physicians and improve health care quality.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork in the last 3 years has increased, and 63% said that the same paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I have wanted to be a doctor since I was 4 years old,” wrote one physician in response to the survey. “If anything, I spend too much time with patients. I also spend far too much time on demeaning tasks that do not require a medical degree. I am burned out. My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are today.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of issues physicians identified as impediments to the delivery of patient care in their practices, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care, and 36% said Medicare reimbursement does not cover their costs.

Only 17% of the physicians rated the financial position of their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

The Physicians' Foundation was founded in 2003 through settlement of a class action lawsuit brought by physicians and medical associations against third-party payers. Its mission is to advance the work of practicing physicians and improve health care quality.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork has increased, and 63% said that paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I am burned out,” one physician wrote in response to the survey. “My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of problematic issues, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Only 17% rated their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork has increased, and 63% said that paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I am burned out,” one physician wrote in response to the survey. “My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of problematic issues, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Only 17% rated their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

Almost half of primary care physicians responding to a survey by The Physicians' Foundation said they plan to reduce the number of patients they see or stop practicing entirely over the next 3 years.

In addition, 94% said the time they devote to nonclinical paperwork has increased, and 63% said that paperwork has caused them to spend less time per patient. Moreover, 78% said they believe there is a shortage of primary care doctors in the United States today, while the same percentage said medicine is either “no longer rewarding” or “less rewarding.”

The survey, which painted a grim picture of primary care physicians' satisfaction with their profession, was mailed to 270,000 primary care physicians and more than 50,000 specialists, and returned by 11,950 physicians.

“I am burned out,” one physician wrote in response to the survey. “My income is so low (because I spend so much time with patients and therefore see fewer) that I am in debt. It is disgraceful and disgusting that doctors who save lives (and who bear that responsibility) are treated the way we are.”

Of the 49% of physicians who told surveyors they would stop practice altogether or reduce their patient loads over the next 3 years, 11% said they plan to retire in the next 3 years, 13% said they plan to seek a job in a nonclinical health care setting, 20% said they would cut back on patients seen, and 10% said they would work part-time.

“Declining reimbursement” rated highest on the list of problematic issues, followed by “demands on physician time.” Nearly two-thirds said Medicaid reimbursement is less than their cost of providing care.

Only 17% rated their practices as “healthy and profitable,” and 45% of physicians said they would retire today if they had the financial means.

Special Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” HHS Secretary Mike Leavitt said in a statement. The quality measures inventory is available online at

www.qualitymeasures.ahrq.gov

FDA Opens China Offices

The Food and Drug Administration has opened field offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” FDA Commissioner Andrew von Eschenbach said in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. The MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, the MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” Rep. Henry Waxman (D-Calif.) said in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

NIMH to Study Suicides in Army

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to an agency statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so following deployment, and 29 had never been deployed.

Special Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” HHS Secretary Mike Leavitt said in a statement. The quality measures inventory is available online at

www.qualitymeasures.ahrq.gov

FDA Opens China Offices

The Food and Drug Administration has opened field offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” FDA Commissioner Andrew von Eschenbach said in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. The MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, the MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” Rep. Henry Waxman (D-Calif.) said in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

NIMH to Study Suicides in Army

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to an agency statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so following deployment, and 29 had never been deployed.

Special Medicare Advantage Criteria

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling or life threatening, and as having a high risk of hospitalization or adverse outcome. Included are certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list of conditions is part of new guidelines for the special needs plans that will go into effect in 2010. Medicare officials noted the list is an effort to ensure that the plans stay focused on a specific population and do not expand to the larger Medicare Advantage population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory is available from the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, and is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. “This effort is pivotal to achieving the goal of transparency in quality measurement as a cornerstone of value-driven health care,” HHS Secretary Mike Leavitt said in a statement. The quality measures inventory is available online at

www.qualitymeasures.ahrq.gov

FDA Opens China Offices

The Food and Drug Administration has opened field offices in Beijing, Guangzhou, and Shanghai, China, as part of an effort to improve the safety of food and other consumer products. “A permanent FDA presence in China will help us address the challenges presented by globalization,” FDA Commissioner Andrew von Eschenbach said in a statement. “We look forward to working with the Chinese government and manufacturers to ensure that FDA standards for safety and manufacturing quality are met before products ship to the United States.” Establishing a permanent presence by the FDA in China will greatly enhance efforts to protect consumers in both countries and also will enable the FDA officials to help the Chinese government in its ongoing efforts to improve its regulatory systems for exports to help ensure product safety, agency officials said. The FDA also intends to open offices in other parts of the world and ultimately will have a presence in five geographic regions, including China, India, Europe, Latin America, and the Middle East, the agency said.

MedPAC Calls for Disclosure

Congress should pass legislation to require drug, device, and medical supply makers and distributors, along with hospitals, to disclose their financial ties to physicians and physician groups, the Medicare Payment Advisory Commission has decided. The companies also should be required to disclose financial relationships with pharmacies, pharmacists, health plans, pharmacy benefit managers, hospitals, medical schools, continuing medical education organizations, patient organizations, and professional organizations. The MedPAC said it will urge Congress to require drug manufacturers to post on a Web site all details about free drug samples given to providers. In addition, the MedPAC said that lawmakers should require the HHS to submit a report describing financial arrangements between hospitals and physicians. MedPAC advises Congress on Medicare issues, but lawmakers are not required to implement the commission's recommendations.

Payments Backlogged in West

Medicare payments to physicians in California, Hawaii, and Nevada have been held up because of problems stemming from the new National Provider Identifier numbers and from the transition to a new claims processor. Columbia, S.C.-based Palmetto GBA began processing fee-for-service Medicare claims for the three states in September, and the California Medical Association said that it had received calls from more than 1,000 physicians complaining of delays in payment. The transition to Palmetto has been “marred by missteps,” and “the delay in payments threatens to compromise patient care and provider solvency,” Rep. Henry Waxman (D-Calif.) said in a statement. To address the issue, Palmetto said in a statement that it has added 35 staffed phone lines and expects the backlog will be cleared or nearly cleared by Dec. 31.

NIMH to Study Suicides in Army

The National Institute of Mental Health has signed a memorandum of understanding with the U.S. Army to study suicide and suicidal behavior among active-duty soldiers, National Guard members, and Army Reservists. The 5-year, $50 million effort will be the largest study of suicide ever undertaken by the institute, according to an agency statement. The goal is to identify risk and protective factors for suicide and to help the Army develop effective intervention programs. In 2007, 115 Army members committed suicide; of those, 36 committed suicide while deployed, 50 did so following deployment, and 29 had never been deployed.

Diabetes Prescriptions Double

Children and teenagers aged 5–19 years doubled their use of type 2 diabetes medications between 2002 and 2005, according to a study published in the journal Pediatrics. The rise in diabetes prescriptions was driven by huge increases in use of those medications by preteen and teen girls; the number of prescriptions filled for girls aged 10–14 years grew by 166%, while the number filled for girls aged 15–19 years rose by 135%, according to the researchers. They also found increases in prescriptions for high blood pressure, high cholesterol, attention-deficit disorder, attention-deficit/hyperactivity disorder, asthma, and depression.

Hawaii Ends Child Health Care Plan

Hawaii has stopped funding the only state universal child health care program in the country. The Keiki Care Plan (Keiki is the Hawaiian word for child) pilot project was intended to provide free health care coverage for children whose parents could not afford private insurance. But just 7 months after its launch, the results showed that an estimated 85% of the 2,000 children enrolled in the program had switched from a private health plan to the state-funded program, Linda Smith, senior adviser for Gov. Linda Lingle (R), said in a statement. Because the free state program was drawing many more insured than uninsured children, Gov. Lingle decided to cut off funding for it, Ms. Smith said.

WVU Creates Pediatric Institute

West Virginia University has launched the multimillion-dollar WVU Pediatric Research Institute, using a bequest from a well-known state physician and unclaimed settlement money from a class action lawsuit. Through a bequest from the late Dr. James H. Walker, WVU professor emeritus, nearly $6.4 million will go toward the institute and the creation of the James H. Walker Chair in Pediatric Cardiology. Dr. William Neal is the inaugural recipient of the Walker chair. In addition, the institute will receive nearly $5.7 million from a unique settlement in a state class action lawsuit against the makers of diabetes drug troglitazone (Rezulin). Because a number of patients who were eligible to receive damages in the case did not claim their money, the lawyers and judge who were involved agreed in September to award the money to WVU and to Marshall University in Huntington, W. Va. WVU officials said the university will use the money primarily to research links between obesity, diabetes, and asthma in the new research institute, while Marshall officials said they will use their share of the funds, $2.2 million, to improve diabetes care.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 shows that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

TV Sex Tied to Teen Pregnancy

Teen pregnancy may be somehow linked to the amount of sex teens see on television, according to a provocative new study in the November issue of Pediatrics. The more exposure teens had to sexual content on television, the more likely they were to get pregnant or get someone else pregnant, according to a multivariate regression model used in the study. Other significant predictors of teen pregnancy were being African American, having a problem behavior, and not living in a two-parent family. The researchers noted that while the results do not establish a causal relationship between exposure to sexual content on television and teen pregnancy, the magnitude of the association merits consideration in designing prevention programs. The findings are based on data from a national longitudinal survey of adolescents aged 12–17 years at baseline. The teens were reinterviewed 1 and 3 years later.

Diabetes Prescriptions Double

Children and teenagers aged 5–19 years doubled their use of type 2 diabetes medications between 2002 and 2005, according to a study published in the journal Pediatrics. The rise in diabetes prescriptions was driven by huge increases in use of those medications by preteen and teen girls; the number of prescriptions filled for girls aged 10–14 years grew by 166%, while the number filled for girls aged 15–19 years rose by 135%, according to the researchers. They also found increases in prescriptions for high blood pressure, high cholesterol, attention-deficit disorder, attention-deficit/hyperactivity disorder, asthma, and depression.

Hawaii Ends Child Health Care Plan

Hawaii has stopped funding the only state universal child health care program in the country. The Keiki Care Plan (Keiki is the Hawaiian word for child) pilot project was intended to provide free health care coverage for children whose parents could not afford private insurance. But just 7 months after its launch, the results showed that an estimated 85% of the 2,000 children enrolled in the program had switched from a private health plan to the state-funded program, Linda Smith, senior adviser for Gov. Linda Lingle (R), said in a statement. Because the free state program was drawing many more insured than uninsured children, Gov. Lingle decided to cut off funding for it, Ms. Smith said.

WVU Creates Pediatric Institute

West Virginia University has launched the multimillion-dollar WVU Pediatric Research Institute, using a bequest from a well-known state physician and unclaimed settlement money from a class action lawsuit. Through a bequest from the late Dr. James H. Walker, WVU professor emeritus, nearly $6.4 million will go toward the institute and the creation of the James H. Walker Chair in Pediatric Cardiology. Dr. William Neal is the inaugural recipient of the Walker chair. In addition, the institute will receive nearly $5.7 million from a unique settlement in a state class action lawsuit against the makers of diabetes drug troglitazone (Rezulin). Because a number of patients who were eligible to receive damages in the case did not claim their money, the lawyers and judge who were involved agreed in September to award the money to WVU and to Marshall University in Huntington, W. Va. WVU officials said the university will use the money primarily to research links between obesity, diabetes, and asthma in the new research institute, while Marshall officials said they will use their share of the funds, $2.2 million, to improve diabetes care.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 shows that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

TV Sex Tied to Teen Pregnancy

Teen pregnancy may be somehow linked to the amount of sex teens see on television, according to a provocative new study in the November issue of Pediatrics. The more exposure teens had to sexual content on television, the more likely they were to get pregnant or get someone else pregnant, according to a multivariate regression model used in the study. Other significant predictors of teen pregnancy were being African American, having a problem behavior, and not living in a two-parent family. The researchers noted that while the results do not establish a causal relationship between exposure to sexual content on television and teen pregnancy, the magnitude of the association merits consideration in designing prevention programs. The findings are based on data from a national longitudinal survey of adolescents aged 12–17 years at baseline. The teens were reinterviewed 1 and 3 years later.

Diabetes Prescriptions Double

Children and teenagers aged 5–19 years doubled their use of type 2 diabetes medications between 2002 and 2005, according to a study published in the journal Pediatrics. The rise in diabetes prescriptions was driven by huge increases in use of those medications by preteen and teen girls; the number of prescriptions filled for girls aged 10–14 years grew by 166%, while the number filled for girls aged 15–19 years rose by 135%, according to the researchers. They also found increases in prescriptions for high blood pressure, high cholesterol, attention-deficit disorder, attention-deficit/hyperactivity disorder, asthma, and depression.

Hawaii Ends Child Health Care Plan

Hawaii has stopped funding the only state universal child health care program in the country. The Keiki Care Plan (Keiki is the Hawaiian word for child) pilot project was intended to provide free health care coverage for children whose parents could not afford private insurance. But just 7 months after its launch, the results showed that an estimated 85% of the 2,000 children enrolled in the program had switched from a private health plan to the state-funded program, Linda Smith, senior adviser for Gov. Linda Lingle (R), said in a statement. Because the free state program was drawing many more insured than uninsured children, Gov. Lingle decided to cut off funding for it, Ms. Smith said.

WVU Creates Pediatric Institute

West Virginia University has launched the multimillion-dollar WVU Pediatric Research Institute, using a bequest from a well-known state physician and unclaimed settlement money from a class action lawsuit. Through a bequest from the late Dr. James H. Walker, WVU professor emeritus, nearly $6.4 million will go toward the institute and the creation of the James H. Walker Chair in Pediatric Cardiology. Dr. William Neal is the inaugural recipient of the Walker chair. In addition, the institute will receive nearly $5.7 million from a unique settlement in a state class action lawsuit against the makers of diabetes drug troglitazone (Rezulin). Because a number of patients who were eligible to receive damages in the case did not claim their money, the lawyers and judge who were involved agreed in September to award the money to WVU and to Marshall University in Huntington, W. Va. WVU officials said the university will use the money primarily to research links between obesity, diabetes, and asthma in the new research institute, while Marshall officials said they will use their share of the funds, $2.2 million, to improve diabetes care.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 shows that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

TV Sex Tied to Teen Pregnancy

Teen pregnancy may be somehow linked to the amount of sex teens see on television, according to a provocative new study in the November issue of Pediatrics. The more exposure teens had to sexual content on television, the more likely they were to get pregnant or get someone else pregnant, according to a multivariate regression model used in the study. Other significant predictors of teen pregnancy were being African American, having a problem behavior, and not living in a two-parent family. The researchers noted that while the results do not establish a causal relationship between exposure to sexual content on television and teen pregnancy, the magnitude of the association merits consideration in designing prevention programs. The findings are based on data from a national longitudinal survey of adolescents aged 12–17 years at baseline. The teens were reinterviewed 1 and 3 years later.

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.

Many Have Drug 'Gap' Coverage

A total of 13% of Medicare beneficiaries enrolled in Part D prescription drug plans and 63% of those in Medicare Advantage plans with prescription benefits had some form of coverage in the “doughnut hole,” or coverage gap, according to a Centers for Medicare and Medicaid Services study on Part D drug claims. The study, which included data on Medicare drug claims for the 25 million Part D beneficiaries, also indicated that the vast majority of enrollees used the drug benefit: In the program's first year, 90% of enrollees filled at least one prescription. In addition, the use of generic drugs has been high in Part D, rising from 60% in 2006 to nearly 68% in the first quarter of this year.

Resuscitation Practices Ineffective

An overwhelming majority of emergency physicians believe that resuscitation practices in the United States are not very effective, according to a survey released by the American College of Emergency Physicians. In addition, more than half of emergency physicians surveyed believe that poor survival rates from sudden cardiac arrest are related to the aging population, while one-quarter of respondents said that obesity has contributed most to poor survival rates. Increased bystander CPR, faster patient-to-doctor time, improved data collection and sharing, and greater use of technology all are critical to improving resuscitation, the survey concluded. “It is necessary for communities to encourage more CPR trainings, offer more access to a broader range of critical life-saving technologies, and report sudden cardiac arrest cases more consistently,” said ACEP President Nick Jouriles.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require e-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Program Cuts Illicit Drug Use

A government-supported program used to screen patients seeking health care for signs of substance abuse can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings, a study found. The Screening, Brief Intervention, and Referral to Treatment program uses a variety of techniques to screen patients for signs of substance abuse. If a patient screens positive, immediate steps are taken to help the patient effectively deal with the problem. The study, published in Drug and Alcohol Dependence, found that rates of illicit drug use dropped by nearly 68% 6 months after patients using illicit drugs had received help through the screening program. Illicit drug users receiving brief treatment or referral to specialty treatment also reported other quality of life improvements. The Substance Abuse and Mental Health Services Administration has been awarding grants to expand the screening program since 2003.

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.

Many Have Drug 'Gap' Coverage

A total of 13% of Medicare beneficiaries enrolled in Part D prescription drug plans and 63% of those in Medicare Advantage plans with prescription benefits had some form of coverage in the “doughnut hole,” or coverage gap, according to a Centers for Medicare and Medicaid Services study on Part D drug claims. The study, which included data on Medicare drug claims for the 25 million Part D beneficiaries, also indicated that the vast majority of enrollees used the drug benefit: In the program's first year, 90% of enrollees filled at least one prescription. In addition, the use of generic drugs has been high in Part D, rising from 60% in 2006 to nearly 68% in the first quarter of this year.

Resuscitation Practices Ineffective

An overwhelming majority of emergency physicians believe that resuscitation practices in the United States are not very effective, according to a survey released by the American College of Emergency Physicians. In addition, more than half of emergency physicians surveyed believe that poor survival rates from sudden cardiac arrest are related to the aging population, while one-quarter of respondents said that obesity has contributed most to poor survival rates. Increased bystander CPR, faster patient-to-doctor time, improved data collection and sharing, and greater use of technology all are critical to improving resuscitation, the survey concluded. “It is necessary for communities to encourage more CPR trainings, offer more access to a broader range of critical life-saving technologies, and report sudden cardiac arrest cases more consistently,” said ACEP President Nick Jouriles.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require e-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Program Cuts Illicit Drug Use

A government-supported program used to screen patients seeking health care for signs of substance abuse can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings, a study found. The Screening, Brief Intervention, and Referral to Treatment program uses a variety of techniques to screen patients for signs of substance abuse. If a patient screens positive, immediate steps are taken to help the patient effectively deal with the problem. The study, published in Drug and Alcohol Dependence, found that rates of illicit drug use dropped by nearly 68% 6 months after patients using illicit drugs had received help through the screening program. Illicit drug users receiving brief treatment or referral to specialty treatment also reported other quality of life improvements. The Substance Abuse and Mental Health Services Administration has been awarding grants to expand the screening program since 2003.

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.

Many Have Drug 'Gap' Coverage

A total of 13% of Medicare beneficiaries enrolled in Part D prescription drug plans and 63% of those in Medicare Advantage plans with prescription benefits had some form of coverage in the “doughnut hole,” or coverage gap, according to a Centers for Medicare and Medicaid Services study on Part D drug claims. The study, which included data on Medicare drug claims for the 25 million Part D beneficiaries, also indicated that the vast majority of enrollees used the drug benefit: In the program's first year, 90% of enrollees filled at least one prescription. In addition, the use of generic drugs has been high in Part D, rising from 60% in 2006 to nearly 68% in the first quarter of this year.

Resuscitation Practices Ineffective

An overwhelming majority of emergency physicians believe that resuscitation practices in the United States are not very effective, according to a survey released by the American College of Emergency Physicians. In addition, more than half of emergency physicians surveyed believe that poor survival rates from sudden cardiac arrest are related to the aging population, while one-quarter of respondents said that obesity has contributed most to poor survival rates. Increased bystander CPR, faster patient-to-doctor time, improved data collection and sharing, and greater use of technology all are critical to improving resuscitation, the survey concluded. “It is necessary for communities to encourage more CPR trainings, offer more access to a broader range of critical life-saving technologies, and report sudden cardiac arrest cases more consistently,” said ACEP President Nick Jouriles.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require e-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Program Cuts Illicit Drug Use

A government-supported program used to screen patients seeking health care for signs of substance abuse can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings, a study found. The Screening, Brief Intervention, and Referral to Treatment program uses a variety of techniques to screen patients for signs of substance abuse. If a patient screens positive, immediate steps are taken to help the patient effectively deal with the problem. The study, published in Drug and Alcohol Dependence, found that rates of illicit drug use dropped by nearly 68% 6 months after patients using illicit drugs had received help through the screening program. Illicit drug users receiving brief treatment or referral to specialty treatment also reported other quality of life improvements. The Substance Abuse and Mental Health Services Administration has been awarding grants to expand the screening program since 2003.