Joyce Frieden

Bill Sets DXA, VFA Payment Floor

Endocrinologists, ob.gyns., and other physicians support new federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 (S. 769, H.R. 1894), would set a national minimum payment amount for DXA (CPT code 77080) and VFA (77082) that could not be less than the 2006 Medicare payment rates for these services. If enacted, the payment rates would go into effect Jan. 1, 2010. The legislation also directs the Institute of Medicine to study the impact of Medicare payment reductions for DXA and VFA on beneficiary access to bone mass measurement and quality of care. The legislation would counteract deep Medicare payment cuts that began in 2007 under the Deficit Reduction Act. The new bill is supported by the DXA Task Force, which includes the American Association of Clinical Endocrinologists, the American College of Obstetricians and Gynecologists, the American College of Rheumatology, and other physician groups.

Americans Fear Chronic Disease

More than half of Americans say that developing a chronic illness would be worse than amassing considerable financial debt, getting divorced or living alone, or losing one's job, according to an online survey of more than 2,500 people conducted by Harris Interactive. About half of respondents had not spoken with their physicians about common chronic illnesses such as heart disease, cancer, diabetes, HIV/AIDS, or Alzheimer's, the survey found. Although 83% of respondents knew that being overweight or obese was a risk factor for diabetes, 67% said they had a poor diet and 62% said they maintained an unhealthy weight. “These people are gambling daily by ignoring risk factors for a life-altering disease like diabetes and doing nothing about it,” said Dr. Richard M. Bergenstal, president-elect for medicine and science at the American Diabetes Association, which jointly funded the study with the WellPoint Foundation.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. Nearly 40% of the applications were for new EHR products, according to the federally recognized commission. The biggest category of applications was for EMR products concerning health records for children.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads that are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for diabetes treatment Avandia (rosiglitazone), multiple sclerosis drug Tysabri (natalizumab), and the cardiovascular drug Plavix (clopidogrel). The sponsored links generally contain about a dozen words—not enough to convey detailed treatment or risk information, the FDA said. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

New Ethics Rules at Johns Hopkins

Johns Hopkins University has joined the growing ranks of medical schools that are restricting interactions with pharmaceutical companies. The new Johns Hopkins Medicine Policy on Interaction With Industry, which takes effect July 1, prohibits acceptance of gifts or entertainment, regardless of value, from pharmaceutical and medical device companies. Consulting contracts that include no actual duties also will be prohibited. Starting in 2010, Johns Hopkins will no longer accept free pharmaceutical samples, but in some limited cases, deidentified samples may be used for patient education. “This policy will help us promote a culture in which Hopkins faculty and other personnel can exercise independent, unbiased judgment in all their activities while interacting with industry in appropriate ways that support our missions of delivering excellent care to patients, and integrity in teaching and research,” said Edward D. Miller, dean of the medical faculty and CEO of Johns Hopkins Medicine.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration, and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will lead the White House office. Rural health expert Mary Wakefield, Ph.D., R.N., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. Three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.

Bill Sets DXA, VFA Payment Floor

Endocrinologists, ob.gyns., and other physicians support new federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 (S. 769, H.R. 1894), would set a national minimum payment amount for DXA (CPT code 77080) and VFA (77082) that could not be less than the 2006 Medicare payment rates for these services. If enacted, the payment rates would go into effect Jan. 1, 2010. The legislation also directs the Institute of Medicine to study the impact of Medicare payment reductions for DXA and VFA on beneficiary access to bone mass measurement and quality of care. The legislation would counteract deep Medicare payment cuts that began in 2007 under the Deficit Reduction Act. The new bill is supported by the DXA Task Force, which includes the American Association of Clinical Endocrinologists, the American College of Obstetricians and Gynecologists, the American College of Rheumatology, and other physician groups.

Americans Fear Chronic Disease

More than half of Americans say that developing a chronic illness would be worse than amassing considerable financial debt, getting divorced or living alone, or losing one's job, according to an online survey of more than 2,500 people conducted by Harris Interactive. About half of respondents had not spoken with their physicians about common chronic illnesses such as heart disease, cancer, diabetes, HIV/AIDS, or Alzheimer's, the survey found. Although 83% of respondents knew that being overweight or obese was a risk factor for diabetes, 67% said they had a poor diet and 62% said they maintained an unhealthy weight. “These people are gambling daily by ignoring risk factors for a life-altering disease like diabetes and doing nothing about it,” said Dr. Richard M. Bergenstal, president-elect for medicine and science at the American Diabetes Association, which jointly funded the study with the WellPoint Foundation.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. Nearly 40% of the applications were for new EHR products, according to the federally recognized commission. The biggest category of applications was for EMR products concerning health records for children.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads that are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for diabetes treatment Avandia (rosiglitazone), multiple sclerosis drug Tysabri (natalizumab), and the cardiovascular drug Plavix (clopidogrel). The sponsored links generally contain about a dozen words—not enough to convey detailed treatment or risk information, the FDA said. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

New Ethics Rules at Johns Hopkins

Johns Hopkins University has joined the growing ranks of medical schools that are restricting interactions with pharmaceutical companies. The new Johns Hopkins Medicine Policy on Interaction With Industry, which takes effect July 1, prohibits acceptance of gifts or entertainment, regardless of value, from pharmaceutical and medical device companies. Consulting contracts that include no actual duties also will be prohibited. Starting in 2010, Johns Hopkins will no longer accept free pharmaceutical samples, but in some limited cases, deidentified samples may be used for patient education. “This policy will help us promote a culture in which Hopkins faculty and other personnel can exercise independent, unbiased judgment in all their activities while interacting with industry in appropriate ways that support our missions of delivering excellent care to patients, and integrity in teaching and research,” said Edward D. Miller, dean of the medical faculty and CEO of Johns Hopkins Medicine.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration, and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will lead the White House office. Rural health expert Mary Wakefield, Ph.D., R.N., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. Three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.

Bill Sets DXA, VFA Payment Floor

Endocrinologists, ob.gyns., and other physicians support new federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 (S. 769, H.R. 1894), would set a national minimum payment amount for DXA (CPT code 77080) and VFA (77082) that could not be less than the 2006 Medicare payment rates for these services. If enacted, the payment rates would go into effect Jan. 1, 2010. The legislation also directs the Institute of Medicine to study the impact of Medicare payment reductions for DXA and VFA on beneficiary access to bone mass measurement and quality of care. The legislation would counteract deep Medicare payment cuts that began in 2007 under the Deficit Reduction Act. The new bill is supported by the DXA Task Force, which includes the American Association of Clinical Endocrinologists, the American College of Obstetricians and Gynecologists, the American College of Rheumatology, and other physician groups.

Americans Fear Chronic Disease

More than half of Americans say that developing a chronic illness would be worse than amassing considerable financial debt, getting divorced or living alone, or losing one's job, according to an online survey of more than 2,500 people conducted by Harris Interactive. About half of respondents had not spoken with their physicians about common chronic illnesses such as heart disease, cancer, diabetes, HIV/AIDS, or Alzheimer's, the survey found. Although 83% of respondents knew that being overweight or obese was a risk factor for diabetes, 67% said they had a poor diet and 62% said they maintained an unhealthy weight. “These people are gambling daily by ignoring risk factors for a life-altering disease like diabetes and doing nothing about it,” said Dr. Richard M. Bergenstal, president-elect for medicine and science at the American Diabetes Association, which jointly funded the study with the WellPoint Foundation.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. Nearly 40% of the applications were for new EHR products, according to the federally recognized commission. The biggest category of applications was for EMR products concerning health records for children.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads that are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for diabetes treatment Avandia (rosiglitazone), multiple sclerosis drug Tysabri (natalizumab), and the cardiovascular drug Plavix (clopidogrel). The sponsored links generally contain about a dozen words—not enough to convey detailed treatment or risk information, the FDA said. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

New Ethics Rules at Johns Hopkins

Johns Hopkins University has joined the growing ranks of medical schools that are restricting interactions with pharmaceutical companies. The new Johns Hopkins Medicine Policy on Interaction With Industry, which takes effect July 1, prohibits acceptance of gifts or entertainment, regardless of value, from pharmaceutical and medical device companies. Consulting contracts that include no actual duties also will be prohibited. Starting in 2010, Johns Hopkins will no longer accept free pharmaceutical samples, but in some limited cases, deidentified samples may be used for patient education. “This policy will help us promote a culture in which Hopkins faculty and other personnel can exercise independent, unbiased judgment in all their activities while interacting with industry in appropriate ways that support our missions of delivering excellent care to patients, and integrity in teaching and research,” said Edward D. Miller, dean of the medical faculty and CEO of Johns Hopkins Medicine.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration, and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will lead the White House office. Rural health expert Mary Wakefield, Ph.D., R.N., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. Three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to several speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to get advice from stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

Dr. Nielsen noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

The IOM committee's report on CER priorities is expected to be finished by July.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to several speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to get advice from stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

Dr. Nielsen noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

The IOM committee's report on CER priorities is expected to be finished by July.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to several speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to get advice from stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

Dr. Nielsen noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

The IOM committee's report on CER priorities is expected to be finished by July.

WASHINGTON — Pediatric diabetes remains a thorny problem, with many environmental and behavioral challenges impeding progress in preventing the disease, according to Dr. Francine Kaufman.

“One in three children born in the year 2000 will develop diabetes,” Dr. Kaufman said at a diabetes meeting sponsored by Avalere Health. And when it comes to type 2 diabetes in U.S. children, minorities are the hardest hit.

However, it's not just the existing diabetes cases that concern Dr. Kaufman, a pediatric endocrinologist and Distinguished Professor of Pediatrics at the University of Southern California, in Los Angeles. It's also the prediabetes. “As many as 40% of minority teens have impaired fasting glucose,” a high risk factor for type 2 diabetes, she noted.

Dr. Kaufman is chairing a study to see if interventions to improve physical activity levels and nutrition quality will improve diabetes risk factors among teens. The study, which is known as HEALTHY, follows more than 6,000 middle school students at seven sites nationwide from sixth through eighth grades. The middle schools chosen for the study have a student body that is at least 50% minority (defined as African American, Hispanic/Latino, or Native American) and/or have greater than 50% of the students eligible for free or reduced lunch.

Students are randomized to either their usual activities or to nutrition, physical education, and behavior intervention. Primary outcomes include body mass index, fasting glucose, and fasting insulin. Although the study will not be completed until June, preliminary results showed that at baseline, 16% of sixth graders and 39% of eighth graders had fasting blood glucose levels of 100-125 mg/dL, a range considered by many to fall into the “prediabetes” category (Diabetes Care 2006;29:212-7).

Dr. Kaufman said the environmental barriers that are preventing minority students and their families from exercising and eating right include limited access to safe parks and supermarkets.

Legislative efforts to solve the problem have met with varying degrees of success. Obesity task forces, for instance, have not achieved much. “California has had a lot of obesity task forces; I've led most of them,” said Dr. Kaufman. “We do a lot of great talking to each other … and not much else happens.”

Attempts to modify school nutrition, on the other hand, have been more successful. “In 2003, we banned sodas in the Los Angeles Unified School District, the second largest school district in the country,” an action she called “the ban heard 'round the world.” There are now bans on soda in schools throughout California, as well as bans on junk food, Dr. Kaufman added.

Efforts also are being made to bring more fruits and vegetables into impoverished communities via farmers' markets, and to give convenience stores a rebate if they purchase a refrigerator for the purpose of vending fresh fruits and vegetables. Giving participants in the Women, Infants, and Children Program vouchers redeemable at farmers' markets and supermarkets for fresh produce increased their fruit and vegetable intake (Am. J. Public Health 2008;98:98-105)

Given all these challenges, “you tell me how I get [my newly diagnosed patients] on a journey that will last their lifetime, in which they now have to balance something every minute of the day when for the most part they live in an environment in which all that I ask them to do is the hardest choice that they have to make,” said Dr. Kaufman, who noted in May she would leave USC to become chief medical officer and vice president of global medical affairs for Medtronic Diabetes, in Northridge, Calif.

When it comes to type 2 diabetes in American children, minorities are the hardest hit. DR. KAUFMAN

WASHINGTON — Pediatric diabetes remains a thorny problem, with many environmental and behavioral challenges impeding progress in preventing the disease, according to Dr. Francine Kaufman.

“One in three children born in the year 2000 will develop diabetes,” Dr. Kaufman said at a diabetes meeting sponsored by Avalere Health. And when it comes to type 2 diabetes in U.S. children, minorities are the hardest hit.

However, it's not just the existing diabetes cases that concern Dr. Kaufman, a pediatric endocrinologist and Distinguished Professor of Pediatrics at the University of Southern California, in Los Angeles. It's also the prediabetes. “As many as 40% of minority teens have impaired fasting glucose,” a high risk factor for type 2 diabetes, she noted.

Dr. Kaufman is chairing a study to see if interventions to improve physical activity levels and nutrition quality will improve diabetes risk factors among teens. The study, which is known as HEALTHY, follows more than 6,000 middle school students at seven sites nationwide from sixth through eighth grades. The middle schools chosen for the study have a student body that is at least 50% minority (defined as African American, Hispanic/Latino, or Native American) and/or have greater than 50% of the students eligible for free or reduced lunch.

Students are randomized to either their usual activities or to nutrition, physical education, and behavior intervention. Primary outcomes include body mass index, fasting glucose, and fasting insulin. Although the study will not be completed until June, preliminary results showed that at baseline, 16% of sixth graders and 39% of eighth graders had fasting blood glucose levels of 100-125 mg/dL, a range considered by many to fall into the “prediabetes” category (Diabetes Care 2006;29:212-7).

Dr. Kaufman said the environmental barriers that are preventing minority students and their families from exercising and eating right include limited access to safe parks and supermarkets.

Legislative efforts to solve the problem have met with varying degrees of success. Obesity task forces, for instance, have not achieved much. “California has had a lot of obesity task forces; I've led most of them,” said Dr. Kaufman. “We do a lot of great talking to each other … and not much else happens.”

Attempts to modify school nutrition, on the other hand, have been more successful. “In 2003, we banned sodas in the Los Angeles Unified School District, the second largest school district in the country,” an action she called “the ban heard 'round the world.” There are now bans on soda in schools throughout California, as well as bans on junk food, Dr. Kaufman added.

Efforts also are being made to bring more fruits and vegetables into impoverished communities via farmers' markets, and to give convenience stores a rebate if they purchase a refrigerator for the purpose of vending fresh fruits and vegetables. Giving participants in the Women, Infants, and Children Program vouchers redeemable at farmers' markets and supermarkets for fresh produce increased their fruit and vegetable intake (Am. J. Public Health 2008;98:98-105)

Given all these challenges, “you tell me how I get [my newly diagnosed patients] on a journey that will last their lifetime, in which they now have to balance something every minute of the day when for the most part they live in an environment in which all that I ask them to do is the hardest choice that they have to make,” said Dr. Kaufman, who noted in May she would leave USC to become chief medical officer and vice president of global medical affairs for Medtronic Diabetes, in Northridge, Calif.

When it comes to type 2 diabetes in American children, minorities are the hardest hit. DR. KAUFMAN

WASHINGTON — Pediatric diabetes remains a thorny problem, with many environmental and behavioral challenges impeding progress in preventing the disease, according to Dr. Francine Kaufman.

“One in three children born in the year 2000 will develop diabetes,” Dr. Kaufman said at a diabetes meeting sponsored by Avalere Health. And when it comes to type 2 diabetes in U.S. children, minorities are the hardest hit.

However, it's not just the existing diabetes cases that concern Dr. Kaufman, a pediatric endocrinologist and Distinguished Professor of Pediatrics at the University of Southern California, in Los Angeles. It's also the prediabetes. “As many as 40% of minority teens have impaired fasting glucose,” a high risk factor for type 2 diabetes, she noted.

Dr. Kaufman is chairing a study to see if interventions to improve physical activity levels and nutrition quality will improve diabetes risk factors among teens. The study, which is known as HEALTHY, follows more than 6,000 middle school students at seven sites nationwide from sixth through eighth grades. The middle schools chosen for the study have a student body that is at least 50% minority (defined as African American, Hispanic/Latino, or Native American) and/or have greater than 50% of the students eligible for free or reduced lunch.

Students are randomized to either their usual activities or to nutrition, physical education, and behavior intervention. Primary outcomes include body mass index, fasting glucose, and fasting insulin. Although the study will not be completed until June, preliminary results showed that at baseline, 16% of sixth graders and 39% of eighth graders had fasting blood glucose levels of 100-125 mg/dL, a range considered by many to fall into the “prediabetes” category (Diabetes Care 2006;29:212-7).

Dr. Kaufman said the environmental barriers that are preventing minority students and their families from exercising and eating right include limited access to safe parks and supermarkets.

Legislative efforts to solve the problem have met with varying degrees of success. Obesity task forces, for instance, have not achieved much. “California has had a lot of obesity task forces; I've led most of them,” said Dr. Kaufman. “We do a lot of great talking to each other … and not much else happens.”

Attempts to modify school nutrition, on the other hand, have been more successful. “In 2003, we banned sodas in the Los Angeles Unified School District, the second largest school district in the country,” an action she called “the ban heard 'round the world.” There are now bans on soda in schools throughout California, as well as bans on junk food, Dr. Kaufman added.

Efforts also are being made to bring more fruits and vegetables into impoverished communities via farmers' markets, and to give convenience stores a rebate if they purchase a refrigerator for the purpose of vending fresh fruits and vegetables. Giving participants in the Women, Infants, and Children Program vouchers redeemable at farmers' markets and supermarkets for fresh produce increased their fruit and vegetable intake (Am. J. Public Health 2008;98:98-105)

Given all these challenges, “you tell me how I get [my newly diagnosed patients] on a journey that will last their lifetime, in which they now have to balance something every minute of the day when for the most part they live in an environment in which all that I ask them to do is the hardest choice that they have to make,” said Dr. Kaufman, who noted in May she would leave USC to become chief medical officer and vice president of global medical affairs for Medtronic Diabetes, in Northridge, Calif.

When it comes to type 2 diabetes in American children, minorities are the hardest hit. DR. KAUFMAN

Athough Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said in a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold of 20%. The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year, gradually decreasing over the next 4 years.) Physicians in health professional shortage areas can receive a 10% additional payment, Dr. Jessee noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” he said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, said Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to… make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive, he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

There has been speculation about whether the government was going to come out with a free EHR for providers, but “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy advisor at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation.”

The Recovery Act also contains additional health care privacy provisions, Dr. Jessee said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said. MGMA, MedFusion, Athena health, and MicroMD sponsored the teleconference.

Athough Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said in a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold of 20%. The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year, gradually decreasing over the next 4 years.) Physicians in health professional shortage areas can receive a 10% additional payment, Dr. Jessee noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” he said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, said Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to… make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive, he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

There has been speculation about whether the government was going to come out with a free EHR for providers, but “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy advisor at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation.”

The Recovery Act also contains additional health care privacy provisions, Dr. Jessee said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said. MGMA, MedFusion, Athena health, and MicroMD sponsored the teleconference.

Athough Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said in a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold of 20%. The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year, gradually decreasing over the next 4 years.) Physicians in health professional shortage areas can receive a 10% additional payment, Dr. Jessee noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” he said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, said Dr. Jessee.

Also still to be determined is what constitutes a certified EHR. “You need to… make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive, he said.

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

There has been speculation about whether the government was going to come out with a free EHR for providers, but “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy advisor at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation.”

The Recovery Act also contains additional health care privacy provisions, Dr. Jessee said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said. MGMA, MedFusion, Athena health, and MicroMD sponsored the teleconference.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Dr. Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the DHHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.”

In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but said that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Teresa Lee, vice president for payment and policy at AdvaMed, the lobbying group for medical device makers, suggested that “chronic disease management and health care-associated infections represent significant research opportunities. Examples of [chronic diseases] include diabetes, asthma, and major depression.”

Children's health care also came under discussion. Christopher Fox of the American Association for Dental Research made the case for including dental caries among the CER priorities. Dental caries are preventable. “We're spending $76 billion and yet enormous health disparities exist,” he said.

“We're not getting the right preventive services and treatments to the right people at the right time.”

Mary Jean Schumann of the American Nurses Association said that CER should “address the full spectrum of interventions, including prevention, alternative therapies, and watchful waiting,” whereas Kitty Ernst of the Frontier School of Midwifery and Family Nursing asked that expanded use of midwifery services be considered as a research priority.

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding.

In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive. … We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “We should look at clinical effectiveness, not cost-effectiveness,” said Ms. Lee of AdvaMed. “Cost-effectiveness is an important priority, but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

The makeup of the IOM committee was the subject of some controversy. After a group of 20 public interest, patient advocacy, and consumer groups complained in a letter that the panel had only one consumer representative, two more were added.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Dr. Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the DHHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.”

In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but said that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Teresa Lee, vice president for payment and policy at AdvaMed, the lobbying group for medical device makers, suggested that “chronic disease management and health care-associated infections represent significant research opportunities. Examples of [chronic diseases] include diabetes, asthma, and major depression.”

Children's health care also came under discussion. Christopher Fox of the American Association for Dental Research made the case for including dental caries among the CER priorities. Dental caries are preventable. “We're spending $76 billion and yet enormous health disparities exist,” he said.

“We're not getting the right preventive services and treatments to the right people at the right time.”

Mary Jean Schumann of the American Nurses Association said that CER should “address the full spectrum of interventions, including prevention, alternative therapies, and watchful waiting,” whereas Kitty Ernst of the Frontier School of Midwifery and Family Nursing asked that expanded use of midwifery services be considered as a research priority.

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding.

In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive. … We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “We should look at clinical effectiveness, not cost-effectiveness,” said Ms. Lee of AdvaMed. “Cost-effectiveness is an important priority, but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

The makeup of the IOM committee was the subject of some controversy. After a group of 20 public interest, patient advocacy, and consumer groups complained in a letter that the panel had only one consumer representative, two more were added.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Dr. Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the DHHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.”

In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but said that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Teresa Lee, vice president for payment and policy at AdvaMed, the lobbying group for medical device makers, suggested that “chronic disease management and health care-associated infections represent significant research opportunities. Examples of [chronic diseases] include diabetes, asthma, and major depression.”

Children's health care also came under discussion. Christopher Fox of the American Association for Dental Research made the case for including dental caries among the CER priorities. Dental caries are preventable. “We're spending $76 billion and yet enormous health disparities exist,” he said.

“We're not getting the right preventive services and treatments to the right people at the right time.”

Mary Jean Schumann of the American Nurses Association said that CER should “address the full spectrum of interventions, including prevention, alternative therapies, and watchful waiting,” whereas Kitty Ernst of the Frontier School of Midwifery and Family Nursing asked that expanded use of midwifery services be considered as a research priority.

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding.

In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive. … We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “We should look at clinical effectiveness, not cost-effectiveness,” said Ms. Lee of AdvaMed. “Cost-effectiveness is an important priority, but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

The makeup of the IOM committee was the subject of some controversy. After a group of 20 public interest, patient advocacy, and consumer groups complained in a letter that the panel had only one consumer representative, two more were added.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said. The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said. The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said. The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” he said. “Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

She noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

Coronary heart disease was first on the list of Naomi Aronson, Ph.D., executive director of the Technology Evaluation Center at the BlueCross BlueShield Association. Dr. Aronson suggested looking at the management of chronic stable angina—“optimal medical management versus percutaneous coronary interventions, versus coronary artery bypass grafting. … Our concern is to understand what's optimal for specific populations.”

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but explained that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding. In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive…. We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “Cost-effectiveness is an important priority but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

She noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

Coronary heart disease was first on the list of Naomi Aronson, Ph.D., executive director of the Technology Evaluation Center at the BlueCross BlueShield Association. Dr. Aronson suggested looking at the management of chronic stable angina—“optimal medical management versus percutaneous coronary interventions, versus coronary artery bypass grafting. … Our concern is to understand what's optimal for specific populations.”

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but explained that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding. In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive…. We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “Cost-effectiveness is an important priority but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

WASHINGTON — As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting.

But more of what? That was the thorny question addressed at the meeting, convened in March by the institute's 23-member Committee on Comparative Effectiveness Research Priorities. The meeting was held to seek advice from various stakeholders on how the federal government should spend the $1.1 billion in stimulus money allocated for comparative effectiveness research (CER).

Committee chair Harold C. Sox emphasized that the committee's work was just beginning. “This is an information-gathering process,” he told the audience. “It's a time for the committee to listen and take what we hear under advisement as we formulate our recommendations. We're early in our process.”

He added that “it would be a mistake for anybody to infer any conclusions or drift in the direction of the committee's thinking by any questions the committee members may ask the speakers. We will be asking probing questions—just don't try to read something into it.”

Once the committee finalizes its recommendations, it will write a report that will be scrutinized by a group of experts. The committee will be held accountable for responding to the criticisms of the reviewers, said Dr. Sox, editor of Annals of Internal Medicine and a past president of the American College of Physicians.

The committee's report on CER priorities is expected to be finished by July.

In a related effort, the Department of Health and Human Services recently named a 15-member Federal Coordinating Council for Comparative Effectiveness, which the department says will help the HHS, the Department of Veterans Affairs, the Department of Defense, and other federal agencies use the stimulus money “to coordinate comparative effectiveness and related health services research.” In addition to various agency representatives, the council includes Dr. Ezekiel Emanuel, who is serving as a special adviser for health policy at the White House Office of Management and Budget.

At the IOM meeting, the committee heard from dozens of speakers, each delivering a 3-minute talk advocating CER priorities. Ideas varied widely, from urologic diseases to the best way to use electronic health records. But one concept kept coming up over and over again: Focus on conditions that are widespread and cost a lot of money.

“The priority areas of CER should include high-volume, high-cost diagnostic and treatment modalities, and other kinds of health services for which there is significant variation in practice,” said Dr. Nancy Nielsen, president of the American Medical Association. “Areas in need of further research include cardiovascular disease; disorders of endocrine and metabolic systems, including diabetes; and nutrition, including obesity.”

She noted that CER findings are scarce in the area of nutrition and obesity. “It's an area of great national concern, and a wide range of interventions exist with little clarity about what is most effective.”

Coronary heart disease was first on the list of Naomi Aronson, Ph.D., executive director of the Technology Evaluation Center at the BlueCross BlueShield Association. Dr. Aronson suggested looking at the management of chronic stable angina—“optimal medical management versus percutaneous coronary interventions, versus coronary artery bypass grafting. … Our concern is to understand what's optimal for specific populations.”

Dorothy Jeffress, executive director of the Center for Advancing Health, did not name specific conditions but explained that “priorities for CER should be on high-volume and/or high-cost conditions for which there exist significant variation in practice and multiple treatment or diagnostic options.”

Dr. Mohammad Akhter, executive director of the National Medical Association, asked the panel to consider many of the same issues other speakers mentioned, but also noted that his group has “trust issues” with government research funding. In an interview, Dr. Akhter said he wondered whether the ulterior motive behind CER was cost savings. Government efforts often purport to be about improving patient care, but then turn out to be something else entirely, he said. For example, peer review organizations started out being concerned about professionalism “and then they became punitive…. We should know what the aim of all this is. Is it just about saving money?”

That sentiment was repeated by other speakers. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “Cost-effectiveness is an important priority but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: “Our industry believes comparative information on cost is equally important,” said Carmella Bucchino of America's Health Insurance Plans. “If one intervention is marginally better, we still want to know how much more we're paying for that benefit.”

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a 20% threshold.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, Dr. Jessee said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said.

“Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a 20% threshold.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, Dr. Jessee said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said.

“Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a 20% threshold.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a “meaningful” user—haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, Dr. Jessee said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said.

“Remember when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014, to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act–formally known as the American Recovery and Reinvestment Act of 2009–includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold–just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions–such as who is a “meaningful” user–haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee. Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive.

“We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember, when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act–formally known as the American Recovery and Reinvestment Act of 2009–includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold–just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions–such as who is a “meaningful” user–haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee. Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive.

“We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember, when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, “Medicaid is a little better than Medicare because there's more upfront money,” Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the stimulus bill.

The Recovery Act–formally known as the American Recovery and Reinvestment Act of 2009–includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be “meaningful electronic health records users” and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold–just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next 4 years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions–such as who is a “meaningful” user–haven't yet been made clear. “What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?” Dr. Jessee said.

The incentive also comes with a “stick” attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, according to Dr. Jessee. Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, “you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive.

“We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive.”

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels, he said. “It's an HIT extension service modeled on the agricultural extension service, with the idea that people will need assistance implementing HIT. No one knows who's going to be performing that function, or whether it will be national, state, or local, but a substantial sum of money has been devoted to supporting that extension service.”

Although there has been speculation about whether the government was going to come out with a free EHR for providers, “my guess is, don't hold your breath,” Dr. Jessee said. “Remember, when HHS said it was going to create a 'freeware' version of [the EHR used by the Veterans Affairs department]? They found that it wasn't exactly free, and it didn't lend itself to being transferred from a large mainframe environment to a disseminated environment.”

Physicians looking to hospitals for funding of their EHR systems aren't getting any guidance yet on whether the new EHR rules will help or hurt their cause, according to Rob Tennant, senior policy adviser at MGMA. “There's nothing we've seen that prohibits that, but it's a gray area where we'll have to see what the government does in terms of regulation,” he said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. “If you liked HIPAA, you'll love the privacy provisions” in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. “The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade” for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

Hospitalized elderly patients are receiving care from hospitalists more and more often, a study of Medicare beneficiaries has found.

“The odds that a hospitalized Medicare patient would receive care from a hospitalist increased by 29.2% per year from 1997 to 2006,” Yong-Fang Kuo, Ph.D., of the University of Texas at Galveston, and colleagues wrote (N. Engl. J. Med. 2009;360:1102–12). “Although the growth of care by hospitalists has been greater in large hospitals, teaching hospitals, and in certain geographic areas, substantial growth occurred in every area and type of hospital.”

The researchers looked at Medicare claims data from a 5% nationwide sample of beneficiaries for 1995, 1997, 1999, and 2001–2006. They defined hospitalists as general internal medicine physicians who had at least five evaluation and management billings in a given year and generated at least 90% of their total evaluation and management billings in that year from services to hospital inpatients.

The number of hospitalists increased greatly during this period; hospitalists identifying themselves as general internists, for example, grew from 2,770 in 1995 to 13,466 in 2006. Hospitalists' career stability has also increased over time; while 33% of those identified as hospitalists in 1995 met that definition 2 years later, that percentage rose to 66% for those identified as hospitalists in 2004.

The percentage of hospitals with at least three hospitalists increased as well, from 12% in 1995 to 47% in 2006. In major teaching and nonteaching hospitals, the median numbers of hospitalists were 11 and 3, respectively, in 2006. Use of hospitalists varied greatly by region, with Medicare patients in New England nearly four times more likely to receive care from a hospitalist as patients in the mid-Atlantic region in 2006.

Dr. Win Whitcomb, cofounder of the Society for Hospital Medicine, said the study provided a good qualitative snapshot of the increase in hospitalists overall.

“Their analysis is very detailed and as rigorous as any I've seen,” he said in an interview. “I think the numbers are going to continue to increase for an indefinite period of time.”

He said he was not surprised by the regional variation the authors found in hospitalist care. Nationally speaking, “Health care's hallmark is wide degrees in variation, so I'm not surprised by this.”

Not everyone is thrilled with the increase in hospitalist care. “Although hospitalists provide important benefits, their involvement disrupts the continuity of care provided by the patients' primary care physicians, resulting in potential adverse effects for both patients and doctors,” Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, and his colleagues wrote in an editorial. “With the increasing burden of chronic illness and complexity of medical care, coordinating care across settings and providers has become especially important. When primary care physicians are not at the bedside of their acutely ill patients, valuable opportunities to deepen the patient-doctor relationship are missed” (N. Engl. J. Med. 2009;360:1141–3).

Furthermore, “there is little to suggest that the hospitalist movement has increased the attractiveness of primary care as a career,” Dr. Epstein and colleagues continued. Hospitalists “may have reduced [primary care physicians'] own value in the eyes of their patients and, in some instances, decreased their job satisfaction.” Although the authors note that hospitalists have played an important role in the area of transitioning patients to outpatient or home care, they urged greater use, where possible, of a model in which members of a primary care group practice rotate as the practice's inpatient attending physician.

But Dr. Whitcomb said that he has seen “rotator” models of hospitalist practice come and go over the years. “In that model, as a primary care physician you're in the hospital 1 week out of every 8. You can't become involved in the hospital system or become a leader in hospital improvement” if you're there so infrequently. In addition, “if you have a busy practice and go away every 6–8 weeks for 1 week, you come back and are overwhelmed with office work and administrative responsibilities.”

And rather than detract from the attractiveness of primary care, “no primary care practice can effectively recruit without hospitalists,” said Dr. Whitcomb, vice president for quality improvement at Mercy Medical Center in Springfield, Mass. Although the hospitalist movement was driven by primary care in its early days, today primary care physicians coming out of training are going into practices that are covered by hospitalists, he said.

One coauthor of the study, Dr. Gulshan Sharma, reported receiving lecture fees from Pfizer Inc.; the other study authors and editorial authors reported no conflicts of interest.

Hospitalized elderly patients are receiving care from hospitalists more and more often, a study of Medicare beneficiaries has found.

“The odds that a hospitalized Medicare patient would receive care from a hospitalist increased by 29.2% per year from 1997 to 2006,” Yong-Fang Kuo, Ph.D., of the University of Texas at Galveston, and colleagues wrote (N. Engl. J. Med. 2009;360:1102–12). “Although the growth of care by hospitalists has been greater in large hospitals, teaching hospitals, and in certain geographic areas, substantial growth occurred in every area and type of hospital.”

The researchers looked at Medicare claims data from a 5% nationwide sample of beneficiaries for 1995, 1997, 1999, and 2001–2006. They defined hospitalists as general internal medicine physicians who had at least five evaluation and management billings in a given year and generated at least 90% of their total evaluation and management billings in that year from services to hospital inpatients.

The number of hospitalists increased greatly during this period; hospitalists identifying themselves as general internists, for example, grew from 2,770 in 1995 to 13,466 in 2006. Hospitalists' career stability has also increased over time; while 33% of those identified as hospitalists in 1995 met that definition 2 years later, that percentage rose to 66% for those identified as hospitalists in 2004.

The percentage of hospitals with at least three hospitalists increased as well, from 12% in 1995 to 47% in 2006. In major teaching and nonteaching hospitals, the median numbers of hospitalists were 11 and 3, respectively, in 2006. Use of hospitalists varied greatly by region, with Medicare patients in New England nearly four times more likely to receive care from a hospitalist as patients in the mid-Atlantic region in 2006.

Dr. Win Whitcomb, cofounder of the Society for Hospital Medicine, said the study provided a good qualitative snapshot of the increase in hospitalists overall.

“Their analysis is very detailed and as rigorous as any I've seen,” he said in an interview. “I think the numbers are going to continue to increase for an indefinite period of time.”

He said he was not surprised by the regional variation the authors found in hospitalist care. Nationally speaking, “Health care's hallmark is wide degrees in variation, so I'm not surprised by this.”

Not everyone is thrilled with the increase in hospitalist care. “Although hospitalists provide important benefits, their involvement disrupts the continuity of care provided by the patients' primary care physicians, resulting in potential adverse effects for both patients and doctors,” Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, and his colleagues wrote in an editorial. “With the increasing burden of chronic illness and complexity of medical care, coordinating care across settings and providers has become especially important. When primary care physicians are not at the bedside of their acutely ill patients, valuable opportunities to deepen the patient-doctor relationship are missed” (N. Engl. J. Med. 2009;360:1141–3).

Furthermore, “there is little to suggest that the hospitalist movement has increased the attractiveness of primary care as a career,” Dr. Epstein and colleagues continued. Hospitalists “may have reduced [primary care physicians'] own value in the eyes of their patients and, in some instances, decreased their job satisfaction.” Although the authors note that hospitalists have played an important role in the area of transitioning patients to outpatient or home care, they urged greater use, where possible, of a model in which members of a primary care group practice rotate as the practice's inpatient attending physician.

But Dr. Whitcomb said that he has seen “rotator” models of hospitalist practice come and go over the years. “In that model, as a primary care physician you're in the hospital 1 week out of every 8. You can't become involved in the hospital system or become a leader in hospital improvement” if you're there so infrequently. In addition, “if you have a busy practice and go away every 6–8 weeks for 1 week, you come back and are overwhelmed with office work and administrative responsibilities.”

And rather than detract from the attractiveness of primary care, “no primary care practice can effectively recruit without hospitalists,” said Dr. Whitcomb, vice president for quality improvement at Mercy Medical Center in Springfield, Mass. Although the hospitalist movement was driven by primary care in its early days, today primary care physicians coming out of training are going into practices that are covered by hospitalists, he said.

One coauthor of the study, Dr. Gulshan Sharma, reported receiving lecture fees from Pfizer Inc.; the other study authors and editorial authors reported no conflicts of interest.

Hospitalized elderly patients are receiving care from hospitalists more and more often, a study of Medicare beneficiaries has found.

“The odds that a hospitalized Medicare patient would receive care from a hospitalist increased by 29.2% per year from 1997 to 2006,” Yong-Fang Kuo, Ph.D., of the University of Texas at Galveston, and colleagues wrote (N. Engl. J. Med. 2009;360:1102–12). “Although the growth of care by hospitalists has been greater in large hospitals, teaching hospitals, and in certain geographic areas, substantial growth occurred in every area and type of hospital.”

The researchers looked at Medicare claims data from a 5% nationwide sample of beneficiaries for 1995, 1997, 1999, and 2001–2006. They defined hospitalists as general internal medicine physicians who had at least five evaluation and management billings in a given year and generated at least 90% of their total evaluation and management billings in that year from services to hospital inpatients.

The number of hospitalists increased greatly during this period; hospitalists identifying themselves as general internists, for example, grew from 2,770 in 1995 to 13,466 in 2006. Hospitalists' career stability has also increased over time; while 33% of those identified as hospitalists in 1995 met that definition 2 years later, that percentage rose to 66% for those identified as hospitalists in 2004.

The percentage of hospitals with at least three hospitalists increased as well, from 12% in 1995 to 47% in 2006. In major teaching and nonteaching hospitals, the median numbers of hospitalists were 11 and 3, respectively, in 2006. Use of hospitalists varied greatly by region, with Medicare patients in New England nearly four times more likely to receive care from a hospitalist as patients in the mid-Atlantic region in 2006.

Dr. Win Whitcomb, cofounder of the Society for Hospital Medicine, said the study provided a good qualitative snapshot of the increase in hospitalists overall.

“Their analysis is very detailed and as rigorous as any I've seen,” he said in an interview. “I think the numbers are going to continue to increase for an indefinite period of time.”

He said he was not surprised by the regional variation the authors found in hospitalist care. Nationally speaking, “Health care's hallmark is wide degrees in variation, so I'm not surprised by this.”

Not everyone is thrilled with the increase in hospitalist care. “Although hospitalists provide important benefits, their involvement disrupts the continuity of care provided by the patients' primary care physicians, resulting in potential adverse effects for both patients and doctors,” Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, and his colleagues wrote in an editorial. “With the increasing burden of chronic illness and complexity of medical care, coordinating care across settings and providers has become especially important. When primary care physicians are not at the bedside of their acutely ill patients, valuable opportunities to deepen the patient-doctor relationship are missed” (N. Engl. J. Med. 2009;360:1141–3).

Furthermore, “there is little to suggest that the hospitalist movement has increased the attractiveness of primary care as a career,” Dr. Epstein and colleagues continued. Hospitalists “may have reduced [primary care physicians'] own value in the eyes of their patients and, in some instances, decreased their job satisfaction.” Although the authors note that hospitalists have played an important role in the area of transitioning patients to outpatient or home care, they urged greater use, where possible, of a model in which members of a primary care group practice rotate as the practice's inpatient attending physician.

But Dr. Whitcomb said that he has seen “rotator” models of hospitalist practice come and go over the years. “In that model, as a primary care physician you're in the hospital 1 week out of every 8. You can't become involved in the hospital system or become a leader in hospital improvement” if you're there so infrequently. In addition, “if you have a busy practice and go away every 6–8 weeks for 1 week, you come back and are overwhelmed with office work and administrative responsibilities.”

And rather than detract from the attractiveness of primary care, “no primary care practice can effectively recruit without hospitalists,” said Dr. Whitcomb, vice president for quality improvement at Mercy Medical Center in Springfield, Mass. Although the hospitalist movement was driven by primary care in its early days, today primary care physicians coming out of training are going into practices that are covered by hospitalists, he said.

One coauthor of the study, Dr. Gulshan Sharma, reported receiving lecture fees from Pfizer Inc.; the other study authors and editorial authors reported no conflicts of interest.