Jane Anderson

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, fewer 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, fewer 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, fewer 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.

Studies over the past several decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide.

Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. “[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident first during medical school, where professional and institutional barriers already exist, the goal of that program is to encourage medical students to seek help for depression.

Good treatments exist, Dr. Clayton said. “The treatment clearly is antidepressants and psychotherapy that focuses on your problems. There's very good short-term psychotherapy for depression—even for bipolar disorder.”

Studies over the past several decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide.

Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. “[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident first during medical school, where professional and institutional barriers already exist, the goal of that program is to encourage medical students to seek help for depression.

Good treatments exist, Dr. Clayton said. “The treatment clearly is antidepressants and psychotherapy that focuses on your problems. There's very good short-term psychotherapy for depression—even for bipolar disorder.”

Studies over the past several decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide.

Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. “[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident first during medical school, where professional and institutional barriers already exist, the goal of that program is to encourage medical students to seek help for depression.

Good treatments exist, Dr. Clayton said. “The treatment clearly is antidepressants and psychotherapy that focuses on your problems. There's very good short-term psychotherapy for depression—even for bipolar disorder.”

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Desired

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the BlueCross and BlueShield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent BlueCross and BlueShield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study from the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Desired

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the BlueCross and BlueShield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent BlueCross and BlueShield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study from the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Desired

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the BlueCross and BlueShield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent BlueCross and BlueShield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study from the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Gain Fans

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the Blue Cross and Blue Shield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent Blue Cross and Blue Shield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

But PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study in the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Gain Fans

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the Blue Cross and Blue Shield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent Blue Cross and Blue Shield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

But PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study in the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

CPAP Coverage Expanded

Medicare now will pay for continuous positive airway pressure therapy for obstructive sleep apnea diagnosed by home sleep testing, according to the Centers for Medicare and Medicaid Services. Previously, the agency covered CPAP only if obstructive sleep apnea was confirmed by polysomnography in a sleep laboratory. Under the new rules, initial coverage of CPAP is limited to a 12-week period for beneficiaries whose obstructive sleep apnea is diagnosed using clinical evaluation and testing with an unattended home sleep monitoring device. If the beneficiary's condition improves as a result of CPAP during this 12-week period, then coverage will continue, the CMS said.

Consumer-Directed Plans Gain Fans

The number of people enrolling in consumer-directed health plans has increased 25% from last year, according to a survey of nearly 2,800 private insurance enrollees by the Blue Cross and Blue Shield Association. The survey also found that consumers in CDHPs are more cost conscious than are non-CDHP consumers; they are 30% more likely to track their health expenses than are those in more traditional health insurance plans and 27% more likely to ask their doctors about the cost of treatment. “[CDHP] consumers are demonstrating more active engagement in their own health care than are non-CDHP consumers, as evidenced by an increased use of health and wellness programs and better tracking, estimating, and budgeting for health care costs,” said Maureen Sullivan, senior vice president for strategic services at BCBSA. The 39 independent Blue Cross and Blue Shield companies serve a total of 4.4 million CDHP enrollees—an increase of 50% from last year.

But PCPs Lack Knowledge on CDHPs

Many primary care physicians said they knew little about how CDHPs work, and also reported limited readiness to advise patients on issues of cost and medical budgeting, a study in the American Journal of Managed Care reported. In the survey of 528 primary care doctors, 40% said they had CDHP enrollees in their practices. Of the physicians surveyed, 43% said they had low knowledge of CDHP cost sharing, and about one-third reported low knowledge of how medical savings accounts function. Overall, physicians with CDHP enrollees in their practices knew more than did physicians without those patients, but one in four of these providers said they knew little about CDHP cost sharing. More than two-thirds said they were ready to advise patients on the costs of office visits, medications, and laboratory tests. But half or fewer said they were ready to discuss the costs of radiologic studies, specialist visits, and hospitalizations.

More Trouble With Health Expenses

About one-third of Americans now say their family has had problems paying medical bills in the past year, up from about a quarter of respondents 2 years ago, according to a survey of more than 1,200 adults by the Kaiser Family Foundation. And nearly one in five Americans (18%) report household problems with medical bills amounting to more than $1,000 in the past year. In addition, almost half of respondents report that someone in their family has recently skipped pills or postponed or reduced medical care. In particular, just over one-third say they or a family member put off or postponed needed care, and 30% admitted to skipping a recommended test or treatment—in both cases, an increase of 7 percentage points from last April. “Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments, and credit card debt,” said Drew Altman, the foundation's president and CEO.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Benefits Seen for National Health ID

A national patient identifier system would improve health care quality and efficiency, according to a study from the RAND Corporation. Because no current national identifier exists, most health systems use a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, or Social Security number. Past studies have found that such systems return incomplete medical records about 8% of the time and expose patients to privacy risks because of the large amount of personal information that is out in the open during a search. The RAND researchers estimated the costs of creating a unique patient identification system at $11 billion, but noted that it would return more than that amount in benefits such as the elimination of medical record errors and the reduction of repetitive and unnecessary care. “Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care,” said Richard Hillestad, the study's lead author.

Infant Mortality Rates Stagnate

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

New President-Elect for AAP

Dr. Judith S. Palfrey, the new president-elect of the American Academy of Pediatrics, said she intends to press hard for all children to have health coverage and a medical home with a physician who can coordinate their care. SCHIP reauthorization is necessary, but is not the complete answer to the problem of uninsured children, Dr. Palfrey told PEDIATRIC NEWS. “I mean full access, not incremental. My hope is that we can work toward full access to insurance for kids so we can have a medical home for every child.” Dr. Palfrey also expressed a desire to work for appropriate physician payment and for strong partnerships between AAP and other groups that are concerned with children's issues. Dr. Palfrey will serve as AAP president during 2009–2010.

Dental Disease Still Medicaid Issue

Dental disease remains a significant problem for children on Medicaid. National surveys taken between 1999 and 2004 show that about one in three had untreated tooth decay, with one in nine having untreated decay in three or more teeth, a Government Accountability Office study showed. The study estimated that in 2005, 6.5 million children aged 2–18 years had untreated tooth decay, and noted that children with Medicaid coverage were almost twice as likely to have untreated tooth decay as were children with private insurance. Meanwhile, the Agency for Healthcare Research and Quality noted in a separate report that enrollment in government-sponsored dental insurance programs has risen sharply in the past decade. About 30% of U.S. children had government-sponsored dental insurance in 2006, compared with 18% in 1996, the AHRQ said.

Behavioral Programs Help the Obese

Obese school-aged children and teenagers can lose weight or prevent further weight gain if they participate in medium- to high-intensity behavioral management programs, the AHRQ said in a report. Effective programs taught techniques to improve dietary and physical activity habits, with some using strategies like goal setting, problem solving, and relapse prevention. These programs met for a total of more than 25 hours, usually once or twice a week, for 6–12 months. Researchers found that, after completion of weight management programs, obese children would weigh 3–23 pounds less, on average, than those who were not involved in the programs. The weight difference was greatest among heavier children as well as those enrolled in more intensive programs, and weight improvements were maintained for up to 1 year after the program ended, the AHRQ study found.

New Jersey Mandates Flu Shots

New Jersey has become the first state to mandate that children aged 6 months to 5 years who attend day care or preschool receive both the influenza and the pneumococcal conjugate vaccine. Beginning this year, the federal Centers for Disease Control and Prevention has recommended that all children aged 5–18 years receive a flu shot each year, adding to its previous recommendation that children aged 6 months to 5 years receive the vaccine. But the New Jersey Public Health Council's decision late last year to require the vaccine for preschoolers and children in day care has drawn fire from some parents, who want to be able to choose whether their children receive vaccinations. Assemblywoman Charlotte Vandervalk (R-Bergen), a critic of mandatory vaccination, said that although New Jersey allows exceptions to mandatory vaccination for medical and religious grounds, few of these exceptions are actually granted. She is sponsoring legislation to allow for conscientious objections to mandatory vaccination.

EPA Tightens Lead Standard

The Environmental Protection Agency has dramatically strengthened the nation's air quality standards for lead, reducing the allowable lead level from 1.5 mcg of lead per cubic meter of air to 0.15 mcg. The decision is the first changed in 30 years, the EPA said. The agency said it strengthened the standards after a thorough review of the science on lead as well as advice from its Clean Air Scientific Advisory Committee. By October 2011, the EPA will designate areas that must take additional steps to reduce lead air emissions, and states then will have 5 years to meet these new standards. AAP President David Tayloe applauded the move. “We were reminded again of the dangers of lead in toys and children's products over the past year, but children are exposed to lead through many sources, including the air we breathe,” Dr. Tayloe said. “We must move aggressively to reduce children's exposure to lead from all possible sources, and the EPA's action is a significant step in this battle.”

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate. S. Res. 616, introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

Infant Mortality Rates Stagnate

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

New President-Elect for AAP

Dr. Judith S. Palfrey, the new president-elect of the American Academy of Pediatrics, said she intends to press hard for all children to have health coverage and a medical home with a physician who can coordinate their care. SCHIP reauthorization is necessary, but is not the complete answer to the problem of uninsured children, Dr. Palfrey told PEDIATRIC NEWS. “I mean full access, not incremental. My hope is that we can work toward full access to insurance for kids so we can have a medical home for every child.” Dr. Palfrey also expressed a desire to work for appropriate physician payment and for strong partnerships between AAP and other groups that are concerned with children's issues. Dr. Palfrey will serve as AAP president during 2009–2010.

Dental Disease Still Medicaid Issue

Dental disease remains a significant problem for children on Medicaid. National surveys taken between 1999 and 2004 show that about one in three had untreated tooth decay, with one in nine having untreated decay in three or more teeth, a Government Accountability Office study showed. The study estimated that in 2005, 6.5 million children aged 2–18 years had untreated tooth decay, and noted that children with Medicaid coverage were almost twice as likely to have untreated tooth decay as were children with private insurance. Meanwhile, the Agency for Healthcare Research and Quality noted in a separate report that enrollment in government-sponsored dental insurance programs has risen sharply in the past decade. About 30% of U.S. children had government-sponsored dental insurance in 2006, compared with 18% in 1996, the AHRQ said.

Behavioral Programs Help the Obese

Obese school-aged children and teenagers can lose weight or prevent further weight gain if they participate in medium- to high-intensity behavioral management programs, the AHRQ said in a report. Effective programs taught techniques to improve dietary and physical activity habits, with some using strategies like goal setting, problem solving, and relapse prevention. These programs met for a total of more than 25 hours, usually once or twice a week, for 6–12 months. Researchers found that, after completion of weight management programs, obese children would weigh 3–23 pounds less, on average, than those who were not involved in the programs. The weight difference was greatest among heavier children as well as those enrolled in more intensive programs, and weight improvements were maintained for up to 1 year after the program ended, the AHRQ study found.

New Jersey Mandates Flu Shots

New Jersey has become the first state to mandate that children aged 6 months to 5 years who attend day care or preschool receive both the influenza and the pneumococcal conjugate vaccine. Beginning this year, the federal Centers for Disease Control and Prevention has recommended that all children aged 5–18 years receive a flu shot each year, adding to its previous recommendation that children aged 6 months to 5 years receive the vaccine. But the New Jersey Public Health Council's decision late last year to require the vaccine for preschoolers and children in day care has drawn fire from some parents, who want to be able to choose whether their children receive vaccinations. Assemblywoman Charlotte Vandervalk (R-Bergen), a critic of mandatory vaccination, said that although New Jersey allows exceptions to mandatory vaccination for medical and religious grounds, few of these exceptions are actually granted. She is sponsoring legislation to allow for conscientious objections to mandatory vaccination.

EPA Tightens Lead Standard

The Environmental Protection Agency has dramatically strengthened the nation's air quality standards for lead, reducing the allowable lead level from 1.5 mcg of lead per cubic meter of air to 0.15 mcg. The decision is the first changed in 30 years, the EPA said. The agency said it strengthened the standards after a thorough review of the science on lead as well as advice from its Clean Air Scientific Advisory Committee. By October 2011, the EPA will designate areas that must take additional steps to reduce lead air emissions, and states then will have 5 years to meet these new standards. AAP President David Tayloe applauded the move. “We were reminded again of the dangers of lead in toys and children's products over the past year, but children are exposed to lead through many sources, including the air we breathe,” Dr. Tayloe said. “We must move aggressively to reduce children's exposure to lead from all possible sources, and the EPA's action is a significant step in this battle.”

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate. S. Res. 616, introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

Infant Mortality Rates Stagnate

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

New President-Elect for AAP

Dr. Judith S. Palfrey, the new president-elect of the American Academy of Pediatrics, said she intends to press hard for all children to have health coverage and a medical home with a physician who can coordinate their care. SCHIP reauthorization is necessary, but is not the complete answer to the problem of uninsured children, Dr. Palfrey told PEDIATRIC NEWS. “I mean full access, not incremental. My hope is that we can work toward full access to insurance for kids so we can have a medical home for every child.” Dr. Palfrey also expressed a desire to work for appropriate physician payment and for strong partnerships between AAP and other groups that are concerned with children's issues. Dr. Palfrey will serve as AAP president during 2009–2010.

Dental Disease Still Medicaid Issue

Dental disease remains a significant problem for children on Medicaid. National surveys taken between 1999 and 2004 show that about one in three had untreated tooth decay, with one in nine having untreated decay in three or more teeth, a Government Accountability Office study showed. The study estimated that in 2005, 6.5 million children aged 2–18 years had untreated tooth decay, and noted that children with Medicaid coverage were almost twice as likely to have untreated tooth decay as were children with private insurance. Meanwhile, the Agency for Healthcare Research and Quality noted in a separate report that enrollment in government-sponsored dental insurance programs has risen sharply in the past decade. About 30% of U.S. children had government-sponsored dental insurance in 2006, compared with 18% in 1996, the AHRQ said.

Behavioral Programs Help the Obese

Obese school-aged children and teenagers can lose weight or prevent further weight gain if they participate in medium- to high-intensity behavioral management programs, the AHRQ said in a report. Effective programs taught techniques to improve dietary and physical activity habits, with some using strategies like goal setting, problem solving, and relapse prevention. These programs met for a total of more than 25 hours, usually once or twice a week, for 6–12 months. Researchers found that, after completion of weight management programs, obese children would weigh 3–23 pounds less, on average, than those who were not involved in the programs. The weight difference was greatest among heavier children as well as those enrolled in more intensive programs, and weight improvements were maintained for up to 1 year after the program ended, the AHRQ study found.

New Jersey Mandates Flu Shots

New Jersey has become the first state to mandate that children aged 6 months to 5 years who attend day care or preschool receive both the influenza and the pneumococcal conjugate vaccine. Beginning this year, the federal Centers for Disease Control and Prevention has recommended that all children aged 5–18 years receive a flu shot each year, adding to its previous recommendation that children aged 6 months to 5 years receive the vaccine. But the New Jersey Public Health Council's decision late last year to require the vaccine for preschoolers and children in day care has drawn fire from some parents, who want to be able to choose whether their children receive vaccinations. Assemblywoman Charlotte Vandervalk (R-Bergen), a critic of mandatory vaccination, said that although New Jersey allows exceptions to mandatory vaccination for medical and religious grounds, few of these exceptions are actually granted. She is sponsoring legislation to allow for conscientious objections to mandatory vaccination.

EPA Tightens Lead Standard

The Environmental Protection Agency has dramatically strengthened the nation's air quality standards for lead, reducing the allowable lead level from 1.5 mcg of lead per cubic meter of air to 0.15 mcg. The decision is the first changed in 30 years, the EPA said. The agency said it strengthened the standards after a thorough review of the science on lead as well as advice from its Clean Air Scientific Advisory Committee. By October 2011, the EPA will designate areas that must take additional steps to reduce lead air emissions, and states then will have 5 years to meet these new standards. AAP President David Tayloe applauded the move. “We were reminded again of the dangers of lead in toys and children's products over the past year, but children are exposed to lead through many sources, including the air we breathe,” Dr. Tayloe said. “We must move aggressively to reduce children's exposure to lead from all possible sources, and the EPA's action is a significant step in this battle.”

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate. S. Res. 616, introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

Medical error studies that focus only on inpatient stays and do not take into account hospital readmissions and other patient care may underestimate costs by up to 30%, according to an analysis of millions of health insurance claims.

William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., researchers at the Agency for Healthcare Research and Quality, examined a database of 5.6 million insurance claims for 14 potentially preventable adverse medical errors defined by the agency's Patient Safety Indicators (PSIs).

PSIs included technical problems, infections, pulmonary and vascular problems, acute respiratory failure, metabolic problems, wound problems, and nursing-sensitive events such as postoperative hip fracture and decubitus ulcer.

“Many hospitals are struggling to survive financially,” Dr. Encinosa said in a statement. “The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought.”

A total of 2.6% of the 161,004 claims for major surgery in an adult included at least one of the 14 potentially preventable adverse medical errors; almost 6% of those claims had more than one error (Health Services Research 2008 July 25 [doi:10.1111/j.1475-6773.2008.00882.x]).

Total 90-day cost for surgery claims with one or more errors was $66,879 on average, compared with $18,284 for surgery claims without an error. In addition, surgeries with one or more errors averaged 21.5 inpatient days, with 5.3 of those days occurring on readmission, the researchers found.

In contrast, surgeries without an error averaged 5.1 inpatient days, with just 1 day of readmission.

Errors associated with the postoperative acute respiratory failure PSI were the most expensive of the seven patient-safety event classes, costing an average of $106,370 over the 90-day period, along with the highest 90-day death rate (12%), according to the researchers.

Readmission costs for the postoperative acute respiratory failure PSI averaged $12,274.

Medical error studies that focus only on inpatient stays and do not take into account hospital readmissions and other patient care may underestimate costs by up to 30%, according to an analysis of millions of health insurance claims.

William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., researchers at the Agency for Healthcare Research and Quality, examined a database of 5.6 million insurance claims for 14 potentially preventable adverse medical errors defined by the agency's Patient Safety Indicators (PSIs).

PSIs included technical problems, infections, pulmonary and vascular problems, acute respiratory failure, metabolic problems, wound problems, and nursing-sensitive events such as postoperative hip fracture and decubitus ulcer.

“Many hospitals are struggling to survive financially,” Dr. Encinosa said in a statement. “The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought.”

A total of 2.6% of the 161,004 claims for major surgery in an adult included at least one of the 14 potentially preventable adverse medical errors; almost 6% of those claims had more than one error (Health Services Research 2008 July 25 [doi:10.1111/j.1475-6773.2008.00882.x]).

Total 90-day cost for surgery claims with one or more errors was $66,879 on average, compared with $18,284 for surgery claims without an error. In addition, surgeries with one or more errors averaged 21.5 inpatient days, with 5.3 of those days occurring on readmission, the researchers found.

In contrast, surgeries without an error averaged 5.1 inpatient days, with just 1 day of readmission.

Errors associated with the postoperative acute respiratory failure PSI were the most expensive of the seven patient-safety event classes, costing an average of $106,370 over the 90-day period, along with the highest 90-day death rate (12%), according to the researchers.

Readmission costs for the postoperative acute respiratory failure PSI averaged $12,274.

Medical error studies that focus only on inpatient stays and do not take into account hospital readmissions and other patient care may underestimate costs by up to 30%, according to an analysis of millions of health insurance claims.

William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., researchers at the Agency for Healthcare Research and Quality, examined a database of 5.6 million insurance claims for 14 potentially preventable adverse medical errors defined by the agency's Patient Safety Indicators (PSIs).

PSIs included technical problems, infections, pulmonary and vascular problems, acute respiratory failure, metabolic problems, wound problems, and nursing-sensitive events such as postoperative hip fracture and decubitus ulcer.

“Many hospitals are struggling to survive financially,” Dr. Encinosa said in a statement. “The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought.”

A total of 2.6% of the 161,004 claims for major surgery in an adult included at least one of the 14 potentially preventable adverse medical errors; almost 6% of those claims had more than one error (Health Services Research 2008 July 25 [doi:10.1111/j.1475-6773.2008.00882.x]).

Total 90-day cost for surgery claims with one or more errors was $66,879 on average, compared with $18,284 for surgery claims without an error. In addition, surgeries with one or more errors averaged 21.5 inpatient days, with 5.3 of those days occurring on readmission, the researchers found.

In contrast, surgeries without an error averaged 5.1 inpatient days, with just 1 day of readmission.

Errors associated with the postoperative acute respiratory failure PSI were the most expensive of the seven patient-safety event classes, costing an average of $106,370 over the 90-day period, along with the highest 90-day death rate (12%), according to the researchers.

Readmission costs for the postoperative acute respiratory failure PSI averaged $12,274.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Heath and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, because of the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Heath and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, because of the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Heath and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, because of the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured, and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Health and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in Arizona, California, Florida, Massachusetts, New York, and South Carolina collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, due to the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to Mr. McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured, and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Health and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in Arizona, California, Florida, Massachusetts, New York, and South Carolina collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, due to the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to Mr. McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Mass. Medicaid Waiver Extended

The Centers for Medicare and Medicaid Services has granted Massachusetts a 3-year, $21.2 billion Medicaid waiver that will allow the state to continue to expand access to care through its health reform law. The agreement represents a $4.3 billion increase over the current waiver and fully preserves existing eligibility and benefit levels as well as federal matching funds for all government health insurance programs, Massachusetts Gov. Deval Patrick (D) said in a statement. The waiver allows the state to continue to subsidize health coverage for residents with incomes up to 300% of the poverty level. “In less than 2 years, health care reform in Massachusetts has made a difference,” he said. “Nearly 440,000 adults and children are newly insured, and total system costs have begun to level off.”

Cephalon Pays $425 Million

Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off-label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year agreement with the Health and Human Services Office of Inspector General that requires the company to notify physicians of the settlement terms and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.

Consumers Like Flat Rx Pricing

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers 44 years and older, the study said. Satisfaction among “bricks-and-mortar” pharmacy customers who participate in flat-rate prescription pricing programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Nationwide RAC Launched

CMS has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingency fee basis, soon will begin to contact providers about the program, CMS said. The 3-year RAC demonstration program in Arizona, California, Florida, Massachusetts, New York, and South Carolina collected more than $900 million in overpayments, according to CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. In addition to implementing the RACs, CMS said it will begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Many Drug Studies Unpublished

Studies on new prescription drugs are less likely to be published if they conclude that the medication is ineffective, researchers reported in the journal PLoS Medicine. The researchers found that only 43% of all clinical trials submitted to the Food and Drug Administration to support drug approvals between 1998 and 2000 had been published 5 years after the drug in question was approved. Among all the trials, those with statistically significant results were nearly twice as likely to have been published as those without statistically significant results, and pivotal trials were three times more likely to have been published as nonpivotal trials. But the study revealed “selective reporting” of results, the authors said. “A pivotal trial in which the new drug does no better than an old drug is less likely to be published than one where the new drug is more effective, a publication bias that could establish an inappropriately favorable record for the new drug in the medical literature,” the authors wrote.

Florida Files Vioxx Suit

Florida Attorney General Bill McCollum has sued Merck & Co. on behalf of state agencies he said were damaged by “the company's allegedly deceptive marketing and promotion” of Vioxx. The lawsuit follows a 3-year investigation of Merck's promotional practices of Vioxx (rofecoxib) and alleges that, due to the company's marketing practices, numerous Florida agencies approved the inclusion of Vioxx as a covered or approved drug. Vioxx purchases by the Florida Medicaid program exceeded $80 million between 1999 and 2004, according to Mr. McCollum, who argued that, if the facts about Vioxx had been known earlier, physicians and their Medicaid patients would have chosen other, less expensive prescriptions. Eight other states have filed similar lawsuits, according to Merck spokesman Ronald Rogers, who said in an interview that Merck acted responsibly on Vioxx and will defend against the suits.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to the CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, the CMS actuary, said during a briefing.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same ten clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can seek to recoup the payment only after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments.

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck, the company was not aware of the immigration policy and did not lobby for that provision.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to the CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, the CMS actuary, said during a briefing.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same ten clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can seek to recoup the payment only after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments.

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck, the company was not aware of the immigration policy and did not lobby for that provision.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to the CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, the CMS actuary, said during a briefing.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same ten clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can seek to recoup the payment only after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments.

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck, the company was not aware of the immigration policy and did not lobby for that provision.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, CMS actuary, said during a briefing. For Medicare Part A, the deductible—which covers the first 60 days of Medicare beneficiary's hospital stay, will rise to $1,068 next year, an increase of $44.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the new regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said, adding that CMS is encouraging beneficiaries to examine their options and review their plans before making a decision for next year.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same 10 clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, Hospice Caps calculations, provider-initiated adjustments, Home Health Agency Requests for Anticipated Payment, Accelerated/Advance Payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to CMS.

NIH Director Zerhouni Steps Down

Dr. Elias Zerhouni, director of the National Institutes of Health since May 2002, announced that he will step down at the end of October to pursue writing projects and explore other professional opportunities. During his tenure, he worked to lower barriers between disciplines of science and to encourage trans-NIH collaborations, such as the NIH Roadmap for Medical Research, which brought together all 27 NIH institutes and centers to fund research initiatives that single institutes couldn't tackle alone.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, CMS actuary, said during a briefing. For Medicare Part A, the deductible—which covers the first 60 days of Medicare beneficiary's hospital stay, will rise to $1,068 next year, an increase of $44.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the new regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said, adding that CMS is encouraging beneficiaries to examine their options and review their plans before making a decision for next year.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same 10 clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, Hospice Caps calculations, provider-initiated adjustments, Home Health Agency Requests for Anticipated Payment, Accelerated/Advance Payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to CMS.

NIH Director Zerhouni Steps Down

Dr. Elias Zerhouni, director of the National Institutes of Health since May 2002, announced that he will step down at the end of October to pursue writing projects and explore other professional opportunities. During his tenure, he worked to lower barriers between disciplines of science and to encourage trans-NIH collaborations, such as the NIH Roadmap for Medical Research, which brought together all 27 NIH institutes and centers to fund research initiatives that single institutes couldn't tackle alone.

Part B Premiums Same for 2009

Medicare beneficiaries won't have to reach any deeper into their wallets to pay their Part B premiums and deductibles next year. Officials at the Centers for Medicare and Medicaid Services announced that the 2009 standard Part B monthly premiums will be the same as in 2008—$96.40. This is the first time since 2000 that the standard premium has not increased over the previous year, according to CMS. The Part B deductible also remains the same at $135. Part B expenditures, which cover physician services and outpatient hospital services, continue to rise, but government officials were able to keep premiums from increasing because of a surplus in the Part B account of the Supplementary Medical Insurance trust fund. However, premiums are likely to go up in 2010, Richard Foster, CMS actuary, said during a briefing. For Medicare Part A, the deductible—which covers the first 60 days of Medicare beneficiary's hospital stay, will rise to $1,068 next year, an increase of $44.

Part D Marketing Rules Finalized

CMS officials have finalized new Medicare Advantage and Part D prescription drug plan marketing regulations that prohibit plans from telemarketing to seniors and making other unsolicited sales contacts. Under the new regulations, plans cannot provide meals to beneficiaries as part of marketing activities, and cannot conduct sales presentations or distribute or accept applications in places where health care is delivered. The rules also ban financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or “churning,” beneficiaries from one plan to another. CMS is requiring plans to be in compliance with the provisions as they begin their marketing for the 2009 plan year. CMS also said it will increase marketplace surveillance, which includes “secret shopper” activities in which a Medicare official poses as a prospective enrollee.

Part D Premiums Up $3 a Month

Medicare Part D prescription drug plan premiums will average $28 per month next year, up $3 from $25 per month this year, CMS Acting Administrator Kerry Weems said. In addition, some beneficiaries may see coverage changes, such as reduced coverage in the Part D “doughnut hole,” Mr. Weems said during a press briefing. Some plans had been providing full coverage of generic medications through the doughnut hole, but that coverage is “decreasing somewhat,” Mr. Weems said. Still, approximately 97% of beneficiaries currently enrolled in a stand-alone drug plan will have access to Part D and Medicare Advantage plans next year with premiums at the same cost or lower than their coverage this year, though they might have to switch plans to do so, Mr. Weems said, adding that CMS is encouraging beneficiaries to examine their options and review their plans before making a decision for next year.

Retail Clinics Reach Underserved

Retail clinics reach patients who don't have a regular primary care physician, but there is no evidence that the clinics reduce overall health care costs, according to two studies published in the journal Health Affairs. Ten clinical problems, including sinusitis and immunizations, encompass 90% of all retail clinic visits, the first study found. These same 10 clinical problems make up 13% of adult primary care physician visits, 30% of pediatric primary care visits, and 12% of emergency department visits. Although 81% of adults and children nationwide report having a primary care physician, fewer than 40% of the patients surveyed as part of the study reported having one. The second study compared costs over 4 years at the Minnesota locations of MinuteClinics, retail clinics owned by CVS Pharmacy, to those at a physician's office. It found that getting treated at a MinuteClinic costs an average of $104, $55 less than treatment at a physician's office. However, the study said, retail clinic visits accounted for only 6% of all provider visits, and costs rose substantially at all locations over the course of the study.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, Hospice Caps calculations, provider-initiated adjustments, Home Health Agency Requests for Anticipated Payment, Accelerated/Advance Payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to CMS.

NIH Director Zerhouni Steps Down

Dr. Elias Zerhouni, director of the National Institutes of Health since May 2002, announced that he will step down at the end of October to pursue writing projects and explore other professional opportunities. During his tenure, he worked to lower barriers between disciplines of science and to encourage trans-NIH collaborations, such as the NIH Roadmap for Medical Research, which brought together all 27 NIH institutes and centers to fund research initiatives that single institutes couldn't tackle alone.