Joyce Frieden

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call.

He emphasized that the proposed regulations are open for public comment until March 15. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American College of Physicians is “very supportive of the goals articulated by the proposed rules,” said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement.

In a written statement, Dr. Barr told

The ACP will address three questions:

▸ Will the process for certifying EHR technology help ACP members identify the appropriate solution for their practice needs as well as help practices maximize the benefit of the EHR incentive program for patient care?

▸ Are the measures selected for reporting clinically relevant, evidence-based, and truly associated with meaningful use of health information technology?

▸ Do the processes required for collecting data to document and report on meaningful use minimize administrative and financial burdens for practices?

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology. The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

The HHS issued a rule that outlines proposed provisions governing the incentive programs, as well as an interim final regulation that sets initial standards, implementation specifications, and certification criteria for EHR technology.

“We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that,” Dr. Blumenthal said.

The meaningful use criteria start with minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, the requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

Other requirements deal with reporting quality data, filing claims electronically, encouraging patients to be active in their care, improving care coordination, and protecting the privacy of health records.

In 2012, the rules tighten for submitting quality data. Although providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“For clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” CMS said. That goal can be achieved “by using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, maintained that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” In a statement, the group cited among its objections “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission, “potentially difficult meaningful use attestation after the first year,” and a requirement that physician offices provide patients and others with electronic copies of medical records.

“We were pleased to see that the CMS and ONC rules include some flexibility, especially in the areas of escalating stages of meaningful use requirements, straightforward first-year attestation, and reasonable 90-day reporting windows,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve widespread adoption by professionals in all types of clinical settings.”

For more information on the proposed regulations, go to www.cms.hhs.gov/Recovery/11_HealthIT.asp

Federal health officials have “tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal said.

Source: Courtesy HHS.gov

My Take

HITECH Rules Pose a Challenge

The passage of the HITECH legislation created a monumental task for Dr. Blumenthal and the Office of the National Coordinator, who have done an excellent job in responding to the challenge of defining “meaningful use” of electronic health information systems.

The rules spell out a phased set of requirements that build upon the work of the preceding advisory process. And the financial incentives that Congress put in place are especially notable for all internists who care for patients in a fee-for-service setting.

However—and this is a big however—lawmakers and many within the bureaucracy still may not fully realize what an enormous hurdle practitioners must overcome in trying to go from paper to electronic records. Also, the voices of those concerned with privacy issues have yet to be fully heard. Even the multiyear approach laid out in the rules may be unreasonably ambitious.

ALAN R. NELSON, M.D., is a member of the

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call.

He emphasized that the proposed regulations are open for public comment until March 15. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American College of Physicians is “very supportive of the goals articulated by the proposed rules,” said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement.

In a written statement, Dr. Barr told

The ACP will address three questions:

▸ Will the process for certifying EHR technology help ACP members identify the appropriate solution for their practice needs as well as help practices maximize the benefit of the EHR incentive program for patient care?

▸ Are the measures selected for reporting clinically relevant, evidence-based, and truly associated with meaningful use of health information technology?

▸ Do the processes required for collecting data to document and report on meaningful use minimize administrative and financial burdens for practices?

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology. The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

The HHS issued a rule that outlines proposed provisions governing the incentive programs, as well as an interim final regulation that sets initial standards, implementation specifications, and certification criteria for EHR technology.

“We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that,” Dr. Blumenthal said.

The meaningful use criteria start with minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, the requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

Other requirements deal with reporting quality data, filing claims electronically, encouraging patients to be active in their care, improving care coordination, and protecting the privacy of health records.

In 2012, the rules tighten for submitting quality data. Although providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“For clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” CMS said. That goal can be achieved “by using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, maintained that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” In a statement, the group cited among its objections “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission, “potentially difficult meaningful use attestation after the first year,” and a requirement that physician offices provide patients and others with electronic copies of medical records.

“We were pleased to see that the CMS and ONC rules include some flexibility, especially in the areas of escalating stages of meaningful use requirements, straightforward first-year attestation, and reasonable 90-day reporting windows,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve widespread adoption by professionals in all types of clinical settings.”

For more information on the proposed regulations, go to www.cms.hhs.gov/Recovery/11_HealthIT.asp

Federal health officials have “tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal said.

Source: Courtesy HHS.gov

My Take

HITECH Rules Pose a Challenge

The passage of the HITECH legislation created a monumental task for Dr. Blumenthal and the Office of the National Coordinator, who have done an excellent job in responding to the challenge of defining “meaningful use” of electronic health information systems.

The rules spell out a phased set of requirements that build upon the work of the preceding advisory process. And the financial incentives that Congress put in place are especially notable for all internists who care for patients in a fee-for-service setting.

However—and this is a big however—lawmakers and many within the bureaucracy still may not fully realize what an enormous hurdle practitioners must overcome in trying to go from paper to electronic records. Also, the voices of those concerned with privacy issues have yet to be fully heard. Even the multiyear approach laid out in the rules may be unreasonably ambitious.

ALAN R. NELSON, M.D., is a member of the

Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.

The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.

“We've tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call.

He emphasized that the proposed regulations are open for public comment until March 15. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American College of Physicians is “very supportive of the goals articulated by the proposed rules,” said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement.

In a written statement, Dr. Barr told

The ACP will address three questions:

▸ Will the process for certifying EHR technology help ACP members identify the appropriate solution for their practice needs as well as help practices maximize the benefit of the EHR incentive program for patient care?

▸ Are the measures selected for reporting clinically relevant, evidence-based, and truly associated with meaningful use of health information technology?

▸ Do the processes required for collecting data to document and report on meaningful use minimize administrative and financial burdens for practices?

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology. The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

The HHS issued a rule that outlines proposed provisions governing the incentive programs, as well as an interim final regulation that sets initial standards, implementation specifications, and certification criteria for EHR technology.

“We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that,” Dr. Blumenthal said.

The meaningful use criteria start with minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, the requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

Other requirements deal with reporting quality data, filing claims electronically, encouraging patients to be active in their care, improving care coordination, and protecting the privacy of health records.

In 2012, the rules tighten for submitting quality data. Although providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“For clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” CMS said. That goal can be achieved “by using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Medical Group Management Association (MGMA), however, maintained that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” In a statement, the group cited among its objections “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission, “potentially difficult meaningful use attestation after the first year,” and a requirement that physician offices provide patients and others with electronic copies of medical records.

“We were pleased to see that the CMS and ONC rules include some flexibility, especially in the areas of escalating stages of meaningful use requirements, straightforward first-year attestation, and reasonable 90-day reporting windows,” said MGMA president and CEO Dr. William Jessee. “However, we firmly believe that the government should make additional changes to achieve widespread adoption by professionals in all types of clinical settings.”

For more information on the proposed regulations, go to www.cms.hhs.gov/Recovery/11_HealthIT.asp

Federal health officials have “tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal said.

Source: Courtesy HHS.gov

My Take

HITECH Rules Pose a Challenge

The passage of the HITECH legislation created a monumental task for Dr. Blumenthal and the Office of the National Coordinator, who have done an excellent job in responding to the challenge of defining “meaningful use” of electronic health information systems.

The rules spell out a phased set of requirements that build upon the work of the preceding advisory process. And the financial incentives that Congress put in place are especially notable for all internists who care for patients in a fee-for-service setting.

However—and this is a big however—lawmakers and many within the bureaucracy still may not fully realize what an enormous hurdle practitioners must overcome in trying to go from paper to electronic records. Also, the voices of those concerned with privacy issues have yet to be fully heard. Even the multiyear approach laid out in the rules may be unreasonably ambitious.

ALAN R. NELSON, M.D., is a member of the

NIH Targets Obesity Prevention

The National Institutes of Health is committing $37 million to fund research on better ways to reduce obesity. The program, titled, “Translating Basic Behavioral and Social Science Discoveries Into Interventions to Reduce Obesity,” will fund interdisciplinary teams at seven sites. The program is led by the National Heart, Lung, and Blood Institute but includes several institutes. Dr. Francis S. Collins, director of the National Institutes of Health, said that the interventions being developed include new ways to promote awareness of eating behaviors, decrease the desire for high-calorie foods, reduce stress-related eating, increase motivation to adhere to weight-loss strategies, engage patients' social networks and communities to encourage physical activity, and improve sleep patterns.

Firm Discloses Payments to Doctors

The drug giant GlaxoSmithKline paid $14.6 million to U.S. physicians between April 1 and June 30, 2009, according to a list of payments published by the company. The list includes the names of about 3,700 U.S. physicians and other health care professionals who received speaking or consulting fees. The average payment was $3,909, according to the company. The disclosure is part of a growing industry effort to increase transparency. GlaxoSmithKline also said it will begin publishing payments made to researchers in 2011. The company also is posting results from more of its studies, including those of terminated compounds. The list of fees paid to health care providers is available online at

http://gsk-us.com/html/responsibility/index.html

Diabetes Expected to Double

The number of Americans living with diabetes will nearly double by 2034, and diabetes spending will nearly triple, according to a study published in the November issue of Diabetes Care. The predictions should hold true even if the prevalence of obesity in this country remains stable, wrote lead researcher Elbert S. Huang of the University of Chicago and his colleagues. Using a model of diabetes costs that accounts for trends in risk factors (such as obesity), the natural history of the disease, and the effects of treatments, the researchers concluded that the number of Americans who have diagnosed and undiagnosed diabetes will increase to 44.1 million during the 25-year period. Annual spending related to diabetes will rise to $336 billion (in 2007 dollars), the researchers indicated. They also predicted that among Medicare beneficiaries, prevalence should rise from 8.2 million Americans to 14.6 million, and associated spending would be expected to jump from $45 billion to $171 billion. “Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system,” Dr. Huang and his colleagues concluded.

Information Tech Gets Funding

The American Recovery and Reinvestment Act will fund $235 million in grants to strengthen the existing health information technology (HIT) infrastructure and increase information-exchange capabilities, according to the Department of Health and Human Services. The Beacon Community Program will fund 15 initiatives run by nonprofit organizations or government entities that already have HIT systems in place with wide adoption of electronic medical records. The goal of the program is to show how cutting-edge HIT programs can improve quality, safety, efficiency, and population health while maintaining strong privacy and security measures, according to the HHS. The results from the grant program will provide guidance for the use of electronic medical records throughout the United States, the primary goal of the federal government's HIT initiative, the agency said.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug manufacturers spent $20 billion (or about 11% of total U.S. sales) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal ads. The remainder of the spending was on direct-to-consumer ads. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending. Looking at classes of drugs, the CBO found that most consumer-directed spending promoted—in order—erectile dysfunction drugs, bone resorption inhibitors, nonbarbiturate sleep aids, autoimmune treatments, statins, serotonin norepinephrine reuptake inhibitor antidepressants, antiplatelet agents, drugs for seizure disorders, atypical antipsychotics, and central nervous system stimulants.

Medicare Strike Force Expands

Medicare's “strike force” against fraud has expanded its operations to include Brooklyn, N.Y.; Tampa, Fla.; and Baton Rouge, La., the Department of Justice announced. The multiagency team of federal, state, and local investigators focuses on data analysis and community policing. Strike force teams already were operating in Miami, Los Angeles, Detroit, and Houston. Since its inception in March 2007, the strike force has obtained indictments of more than 460 people and organizations for falsely billing Medicare for more than $1 billion collectively. In December, strike force officials charged 30 people in Miami, Detroit, and Brooklyn with scheming to submit more than $61 million in false Medicare claims. “Medicare fraud schemes are driven by greed—pure and simple,” said Assistant Attorney General Lanny A. Breuer. Mr. Breuer credited the strike force's “proven data analysis” with success to date and he predicted aggressive action in the group's new turf.

NIH Targets Obesity Prevention

The National Institutes of Health is committing $37 million to fund research on better ways to reduce obesity. The program, titled, “Translating Basic Behavioral and Social Science Discoveries Into Interventions to Reduce Obesity,” will fund interdisciplinary teams at seven sites. The program is led by the National Heart, Lung, and Blood Institute but includes several institutes. Dr. Francis S. Collins, director of the National Institutes of Health, said that the interventions being developed include new ways to promote awareness of eating behaviors, decrease the desire for high-calorie foods, reduce stress-related eating, increase motivation to adhere to weight-loss strategies, engage patients' social networks and communities to encourage physical activity, and improve sleep patterns.

Firm Discloses Payments to Doctors

The drug giant GlaxoSmithKline paid $14.6 million to U.S. physicians between April 1 and June 30, 2009, according to a list of payments published by the company. The list includes the names of about 3,700 U.S. physicians and other health care professionals who received speaking or consulting fees. The average payment was $3,909, according to the company. The disclosure is part of a growing industry effort to increase transparency. GlaxoSmithKline also said it will begin publishing payments made to researchers in 2011. The company also is posting results from more of its studies, including those of terminated compounds. The list of fees paid to health care providers is available online at

http://gsk-us.com/html/responsibility/index.html

Diabetes Expected to Double

The number of Americans living with diabetes will nearly double by 2034, and diabetes spending will nearly triple, according to a study published in the November issue of Diabetes Care. The predictions should hold true even if the prevalence of obesity in this country remains stable, wrote lead researcher Elbert S. Huang of the University of Chicago and his colleagues. Using a model of diabetes costs that accounts for trends in risk factors (such as obesity), the natural history of the disease, and the effects of treatments, the researchers concluded that the number of Americans who have diagnosed and undiagnosed diabetes will increase to 44.1 million during the 25-year period. Annual spending related to diabetes will rise to $336 billion (in 2007 dollars), the researchers indicated. They also predicted that among Medicare beneficiaries, prevalence should rise from 8.2 million Americans to 14.6 million, and associated spending would be expected to jump from $45 billion to $171 billion. “Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system,” Dr. Huang and his colleagues concluded.

Information Tech Gets Funding

The American Recovery and Reinvestment Act will fund $235 million in grants to strengthen the existing health information technology (HIT) infrastructure and increase information-exchange capabilities, according to the Department of Health and Human Services. The Beacon Community Program will fund 15 initiatives run by nonprofit organizations or government entities that already have HIT systems in place with wide adoption of electronic medical records. The goal of the program is to show how cutting-edge HIT programs can improve quality, safety, efficiency, and population health while maintaining strong privacy and security measures, according to the HHS. The results from the grant program will provide guidance for the use of electronic medical records throughout the United States, the primary goal of the federal government's HIT initiative, the agency said.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug manufacturers spent $20 billion (or about 11% of total U.S. sales) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal ads. The remainder of the spending was on direct-to-consumer ads. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending. Looking at classes of drugs, the CBO found that most consumer-directed spending promoted—in order—erectile dysfunction drugs, bone resorption inhibitors, nonbarbiturate sleep aids, autoimmune treatments, statins, serotonin norepinephrine reuptake inhibitor antidepressants, antiplatelet agents, drugs for seizure disorders, atypical antipsychotics, and central nervous system stimulants.

Medicare Strike Force Expands

Medicare's “strike force” against fraud has expanded its operations to include Brooklyn, N.Y.; Tampa, Fla.; and Baton Rouge, La., the Department of Justice announced. The multiagency team of federal, state, and local investigators focuses on data analysis and community policing. Strike force teams already were operating in Miami, Los Angeles, Detroit, and Houston. Since its inception in March 2007, the strike force has obtained indictments of more than 460 people and organizations for falsely billing Medicare for more than $1 billion collectively. In December, strike force officials charged 30 people in Miami, Detroit, and Brooklyn with scheming to submit more than $61 million in false Medicare claims. “Medicare fraud schemes are driven by greed—pure and simple,” said Assistant Attorney General Lanny A. Breuer. Mr. Breuer credited the strike force's “proven data analysis” with success to date and he predicted aggressive action in the group's new turf.

NIH Targets Obesity Prevention

The National Institutes of Health is committing $37 million to fund research on better ways to reduce obesity. The program, titled, “Translating Basic Behavioral and Social Science Discoveries Into Interventions to Reduce Obesity,” will fund interdisciplinary teams at seven sites. The program is led by the National Heart, Lung, and Blood Institute but includes several institutes. Dr. Francis S. Collins, director of the National Institutes of Health, said that the interventions being developed include new ways to promote awareness of eating behaviors, decrease the desire for high-calorie foods, reduce stress-related eating, increase motivation to adhere to weight-loss strategies, engage patients' social networks and communities to encourage physical activity, and improve sleep patterns.

Firm Discloses Payments to Doctors

The drug giant GlaxoSmithKline paid $14.6 million to U.S. physicians between April 1 and June 30, 2009, according to a list of payments published by the company. The list includes the names of about 3,700 U.S. physicians and other health care professionals who received speaking or consulting fees. The average payment was $3,909, according to the company. The disclosure is part of a growing industry effort to increase transparency. GlaxoSmithKline also said it will begin publishing payments made to researchers in 2011. The company also is posting results from more of its studies, including those of terminated compounds. The list of fees paid to health care providers is available online at

http://gsk-us.com/html/responsibility/index.html

Diabetes Expected to Double

The number of Americans living with diabetes will nearly double by 2034, and diabetes spending will nearly triple, according to a study published in the November issue of Diabetes Care. The predictions should hold true even if the prevalence of obesity in this country remains stable, wrote lead researcher Elbert S. Huang of the University of Chicago and his colleagues. Using a model of diabetes costs that accounts for trends in risk factors (such as obesity), the natural history of the disease, and the effects of treatments, the researchers concluded that the number of Americans who have diagnosed and undiagnosed diabetes will increase to 44.1 million during the 25-year period. Annual spending related to diabetes will rise to $336 billion (in 2007 dollars), the researchers indicated. They also predicted that among Medicare beneficiaries, prevalence should rise from 8.2 million Americans to 14.6 million, and associated spending would be expected to jump from $45 billion to $171 billion. “Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system,” Dr. Huang and his colleagues concluded.

Information Tech Gets Funding

The American Recovery and Reinvestment Act will fund $235 million in grants to strengthen the existing health information technology (HIT) infrastructure and increase information-exchange capabilities, according to the Department of Health and Human Services. The Beacon Community Program will fund 15 initiatives run by nonprofit organizations or government entities that already have HIT systems in place with wide adoption of electronic medical records. The goal of the program is to show how cutting-edge HIT programs can improve quality, safety, efficiency, and population health while maintaining strong privacy and security measures, according to the HHS. The results from the grant program will provide guidance for the use of electronic medical records throughout the United States, the primary goal of the federal government's HIT initiative, the agency said.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug manufacturers spent $20 billion (or about 11% of total U.S. sales) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal ads. The remainder of the spending was on direct-to-consumer ads. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending. Looking at classes of drugs, the CBO found that most consumer-directed spending promoted—in order—erectile dysfunction drugs, bone resorption inhibitors, nonbarbiturate sleep aids, autoimmune treatments, statins, serotonin norepinephrine reuptake inhibitor antidepressants, antiplatelet agents, drugs for seizure disorders, atypical antipsychotics, and central nervous system stimulants.

Medicare Strike Force Expands

Medicare's “strike force” against fraud has expanded its operations to include Brooklyn, N.Y.; Tampa, Fla.; and Baton Rouge, La., the Department of Justice announced. The multiagency team of federal, state, and local investigators focuses on data analysis and community policing. Strike force teams already were operating in Miami, Los Angeles, Detroit, and Houston. Since its inception in March 2007, the strike force has obtained indictments of more than 460 people and organizations for falsely billing Medicare for more than $1 billion collectively. In December, strike force officials charged 30 people in Miami, Detroit, and Brooklyn with scheming to submit more than $61 million in false Medicare claims. “Medicare fraud schemes are driven by greed—pure and simple,” said Assistant Attorney General Lanny A. Breuer. Mr. Breuer credited the strike force's “proven data analysis” with success to date and he predicted aggressive action in the group's new turf.

Health professionals participating in Medicare's Physician Quality Reporting Initiative received $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That's nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. These payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. There were more than 153,000 participants in the program during 2008, but only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

Health professionals participating in Medicare's Physician Quality Reporting Initiative received $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That's nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. These payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. There were more than 153,000 participants in the program during 2008, but only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

Health professionals participating in Medicare's Physician Quality Reporting Initiative received $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That's nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. These payments amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. There were more than 153,000 participants in the program during 2008, but only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, the agency's national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

The Medical Group Management Association said in a statement that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” It cites “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission; “potentially difficult meaningful use attestation after the first year;” and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

The proposed regulations, fact sheets, and instructions on how to comment on the proposed regulations can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, the agency's national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

The Medical Group Management Association said in a statement that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” It cites “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission; “potentially difficult meaningful use attestation after the first year;” and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

The proposed regulations, fact sheets, and instructions on how to comment on the proposed regulations can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, the agency's national coordinator for health information technology, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

The Medical Group Management Association said in a statement that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” It cites “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission; “potentially difficult meaningful use attestation after the first year;” and a requirement that physician offices provide patients and others with electronic copies of medical records among its objections.

The proposed regulations, fact sheets, and instructions on how to comment on the proposed regulations can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, CMS noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“[T]he substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures—almost all of which deal with clinical performance—were developed in cooperation with physician and health care quality organizations. The CMS also added two measures that focus on the use of electronic health records and electronic prescribing technology.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with management of diabetes, kidney disease, and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, nearly 96% were successful and received an incentive payment.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, CMS noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“[T]he substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures—almost all of which deal with clinical performance—were developed in cooperation with physician and health care quality organizations. The CMS also added two measures that focus on the use of electronic health records and electronic prescribing technology.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with management of diabetes, kidney disease, and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, nearly 96% were successful and received an incentive payment.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, CMS noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“[T]he substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008. The measures—almost all of which deal with clinical performance—were developed in cooperation with physician and health care quality organizations. The CMS also added two measures that focus on the use of electronic health records and electronic prescribing technology.

Providers also had the option in 2008 of reporting to the CMS through use of one of the 31 qualified medical registries. Many providers already were using registries to report data to researchers dealing with management of diabetes, kidney disease, and preventive medicine. Nearly 8% of the PQRI participants in 2008 attempted to use a registry to submit data; of these, nearly 96% were successful and received an incentive payment.

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health IT, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one outlining proposals governing the incentive programs and an interim final regulation that sets initial standards, specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations await public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health IT, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one outlining proposals governing the incentive programs and an interim final regulation that sets initial standards, specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations await public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health IT, said in a Dec. 30 conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

HHS issued two rules: one outlining proposals governing the incentive programs and an interim final regulation that sets initial standards, specifications, and certification criteria for electronic health record (EHR) technology. Both are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations await public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The proposed regulations, fact sheets, and instructions on how to comment can be found at www.cms.hhs.gov/Recovery/11_HealthIT.asp

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations were still awaiting public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations were still awaiting public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

The Health and Human Services Department has released long-awaited, proposed “meaningful use” criteria for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health information systems.

“We've tried to build in flexibility in these standards and certification criteria as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call. “We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that.”

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.

HHS issued two rules: one that outlines proposed provisions governing the incentive programs and an interim final regulation that sets initial standards, implementation specifications, and certification criteria for electronic health record (EHR) technology. Both regulations are open for 60 days of public comment.

The criteria for achieving meaningful use start with certain minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, meaningful-use requirements include:

▸ Use of computerized entry for 80% of all patient orders.

▸ Use of electronic prescribing for 75% of all permissible prescriptions.

▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.

▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.

▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.

There are also requirements dealing with reporting quality data, filing claims electronically, encouraging patients to be more active in their care, improving care coordination, and ensuring privacy of health records.

In 2012, the rules tighten for submitting quality data. While providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.

“CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” according to an agency statement. “By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.”

Dr. Blumenthal emphasized that the regulations were still awaiting public comment.

“These standards are intended to be iterative,” he said. “They are subject to comment, and we'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”

The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

On the other hand, there are several report recommendations that gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So, the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

On the other hand, there are several report recommendations that gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So, the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

A public-private institution launched by the Department of Health and Human Services would be the best way to raise standards and quality for continuing health education, according to a report issued by the Institute of Medicine.

There are serious flaws in the way that continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the 200-page report “Redesigning Continuing Education in the Health Professions.” They added, “The science underpinning continuing education for health professionals is fragmented and underdeveloped.”

“Establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” the authors said. The report was sponsored by the Josiah Macy, Jr. Foundation.

The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.

That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. The institute also would develop priorities for research in continuing health education and recognize effective education models.

The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair Dr. Gail Warden.

“We believe that academic institutions need to be much more engaged than they have been in continuing education,” Dr. Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference. “The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety.”

Continuing medical education (CME) vendors had mixed reactions to the committee's report.

Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”

But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model,” he said. “There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”

For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.

“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”

Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.

Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.

On the other hand, there are several report recommendations that gave Dr. Cleeman pause.

“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each discipline should be determined by its own governing body. So, the idea of having one government committee saying, 'This is continuing education for all fields of health care'—that is going to be a problem. I think you're going to scare away innovation.”

Instead, “I think it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”

The Institute of Medicine report, “Redesigning Continuing Education in the Health Professions,” is available online at www.iom.edu/continuinged

'There have been a lot of changes in CME … that were completely overlooked by the committee.'

Source DR. KENNISON

Overall cancer incidence and mortality rates are declining in the United States, according to a report issued by the National Cancer Institute.

These reductions are attributed mostly to decreases in both incidence and mortality for lung, prostate, and colorectal cancer in men, and breast and colorectal cancer in women. For all types of cancers combined, new diagnoses dropped an average of almost 1% per year from 1999 to 2006, and deaths from cancer declined an average of 1.6% per year from 2001 to 2006.

In terms of gender, cancer rates overall are still higher for men than for women, although cancer incidence and mortality decreased more in men. In particular, for colorectal cancer—the second-leading cause of cancer deaths in the United States—overall rates are declining, but the rising incidence in men and women under age 50 years is worrisome, the report said.

The researchers also found that incidence rates in men have declined for cancers of the oral cavity, stomach, and brain, but have risen for kidney/renal, liver, and esophageal cancers, as well as for leukemia, myeloma, and melanoma. In women, incidence rates have decreased for uterine, ovarian, cervical, and oral-cavity cancers, but have increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non–Hodgkin's lymphoma, melanoma, and leukemia.

Among racial and ethnic groups, cancer mortality rates were highest in blacks and lowest among Asian/Pacific Islanders. In addition, death rates from pancreatic cancer increased among whites but decreased among blacks.

The report also included a special section on colorectal cancer, with an emphasis on strategies to reduce its mortality rate. The authors modeled projections of colorectal cancer rates and found that by getting more patients to adopt lifestyle changes such as quitting smoking and by increasing the use of colonoscopy and other screening techniques, overall colorectal cancer mortality could be cut in half by 2020.

The report was written by researchers from the NCI, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries. It was published online in the journal Cancer (2009, Dec. 7 [doi:10.1002/cncr.24760]).

Information on newly diagnosed invasive cancers was obtained from population-based cancer registries that participate in the NCI's Surveillance, Epidemiology, and End Results program and/or the CDC's National Program of Cancer Registries.

All participating cancer registries also belong to the NAACCR. The cause of death is based on death certificate information reported to state vital statistics offices.

For most states, population estimates as of July 1 of each year were used to calculate annual incidence and death rates; these estimates are presumed to reflect the average population of a defined geographic area for a calendar year, the authors noted.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” Dr. John E. Niederhuber, NCI director, said in a statement. “Yet, we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

Overall cancer incidence and mortality rates are declining in the United States, according to a report issued by the National Cancer Institute.

These reductions are attributed mostly to decreases in both incidence and mortality for lung, prostate, and colorectal cancer in men, and breast and colorectal cancer in women. For all types of cancers combined, new diagnoses dropped an average of almost 1% per year from 1999 to 2006, and deaths from cancer declined an average of 1.6% per year from 2001 to 2006.

In terms of gender, cancer rates overall are still higher for men than for women, although cancer incidence and mortality decreased more in men. In particular, for colorectal cancer—the second-leading cause of cancer deaths in the United States—overall rates are declining, but the rising incidence in men and women under age 50 years is worrisome, the report said.

The researchers also found that incidence rates in men have declined for cancers of the oral cavity, stomach, and brain, but have risen for kidney/renal, liver, and esophageal cancers, as well as for leukemia, myeloma, and melanoma. In women, incidence rates have decreased for uterine, ovarian, cervical, and oral-cavity cancers, but have increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non–Hodgkin's lymphoma, melanoma, and leukemia.

Among racial and ethnic groups, cancer mortality rates were highest in blacks and lowest among Asian/Pacific Islanders. In addition, death rates from pancreatic cancer increased among whites but decreased among blacks.

The report also included a special section on colorectal cancer, with an emphasis on strategies to reduce its mortality rate. The authors modeled projections of colorectal cancer rates and found that by getting more patients to adopt lifestyle changes such as quitting smoking and by increasing the use of colonoscopy and other screening techniques, overall colorectal cancer mortality could be cut in half by 2020.

The report was written by researchers from the NCI, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries. It was published online in the journal Cancer (2009, Dec. 7 [doi:10.1002/cncr.24760]).

Information on newly diagnosed invasive cancers was obtained from population-based cancer registries that participate in the NCI's Surveillance, Epidemiology, and End Results program and/or the CDC's National Program of Cancer Registries.

All participating cancer registries also belong to the NAACCR. The cause of death is based on death certificate information reported to state vital statistics offices.

For most states, population estimates as of July 1 of each year were used to calculate annual incidence and death rates; these estimates are presumed to reflect the average population of a defined geographic area for a calendar year, the authors noted.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” Dr. John E. Niederhuber, NCI director, said in a statement. “Yet, we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

Overall cancer incidence and mortality rates are declining in the United States, according to a report issued by the National Cancer Institute.

These reductions are attributed mostly to decreases in both incidence and mortality for lung, prostate, and colorectal cancer in men, and breast and colorectal cancer in women. For all types of cancers combined, new diagnoses dropped an average of almost 1% per year from 1999 to 2006, and deaths from cancer declined an average of 1.6% per year from 2001 to 2006.

In terms of gender, cancer rates overall are still higher for men than for women, although cancer incidence and mortality decreased more in men. In particular, for colorectal cancer—the second-leading cause of cancer deaths in the United States—overall rates are declining, but the rising incidence in men and women under age 50 years is worrisome, the report said.

The researchers also found that incidence rates in men have declined for cancers of the oral cavity, stomach, and brain, but have risen for kidney/renal, liver, and esophageal cancers, as well as for leukemia, myeloma, and melanoma. In women, incidence rates have decreased for uterine, ovarian, cervical, and oral-cavity cancers, but have increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non–Hodgkin's lymphoma, melanoma, and leukemia.

Among racial and ethnic groups, cancer mortality rates were highest in blacks and lowest among Asian/Pacific Islanders. In addition, death rates from pancreatic cancer increased among whites but decreased among blacks.

The report also included a special section on colorectal cancer, with an emphasis on strategies to reduce its mortality rate. The authors modeled projections of colorectal cancer rates and found that by getting more patients to adopt lifestyle changes such as quitting smoking and by increasing the use of colonoscopy and other screening techniques, overall colorectal cancer mortality could be cut in half by 2020.

The report was written by researchers from the NCI, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries. It was published online in the journal Cancer (2009, Dec. 7 [doi:10.1002/cncr.24760]).

Information on newly diagnosed invasive cancers was obtained from population-based cancer registries that participate in the NCI's Surveillance, Epidemiology, and End Results program and/or the CDC's National Program of Cancer Registries.

All participating cancer registries also belong to the NAACCR. The cause of death is based on death certificate information reported to state vital statistics offices.

For most states, population estimates as of July 1 of each year were used to calculate annual incidence and death rates; these estimates are presumed to reflect the average population of a defined geographic area for a calendar year, the authors noted.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” Dr. John E. Niederhuber, NCI director, said in a statement. “Yet, we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

New draft hyperthyroidism treatment guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists emphasize that although radioactive iodine is a good treatment for the disorder, patients need to consult with their physicians about all three available treatment options: radioactive iodine, surgery, and antithyroid medications, according to Dr. Rebecca Bahn.

“Physicians in the United States have long considered radioactive iodine to be the preferred treatment for Grave's disease,” Dr. Bahn, chair of the guideline task force, said in an interview. “We're recommending that the patient and the physician have a careful and clear discussion about the three treatment options, and that any of the three options are viable.” Dr. Bahn presented the draft guidelines at the annual meeting of the American Thyroid Association in Palm Beach, Fla.

That is not to say that there aren't some situations in which one procedure is preferable, said Dr. Bahn, professor of medicine and a consultant in endocrinology at the Mayo Clinic, Rochester, Minn. “Pregnant women should not receive radioactive iodine, and patients with medical problems that put them at high risk for surgery should not choose surgery. But our overall recommendation is that the patient and the physician should make the decision following a careful discussion.”

Another major change in the guidelines deals with antithyroid drug therapy. “It used to be that propylthiouracil (PTU) or methimazole could be used interchangeably, but there's now good evidence that there's a very serious hepatic necrosis associated with PTU; it's rare, but it's not at all associated with methimazole,” she said. “So our guidelines will say that if you're going to use antithyroid drugs you should use methimazole except in certain instances. This is especially true of children, who are particularly susceptible to [this liver complication].”

On the other hand, women who have Grave's disease that is diagnosed in the first trimester of pregnancy should be started on PTU, because methimazole is associated with certain birth defects such as cutis aplasia and choanal or esophageal atresia, Dr. Bahn said.

“Also, if the patient is found to have minor side effects with methimazole, in some cases PTU might be used,” she continued.

In the case of hyperthyroidism caused by nodules, “for definitive treatment we don't recommend antithyroid drugs because the patient would have to be on those essentially forever,” she said.

“In some instances, such as patients with a relatively short life expectancy or iodine-induced disease, these medications may be used, but in general, the treatment is surgery or RAI.” In particular, the task force is recommending that for toxic multinodular goiter, near-total or total thyroidectomy should be performed, preferably by a high-volume thyroid surgeon.

Dr. Bahn said that she expected a final draft of the guidelines to be ready to submit to both Thyroid and Endocrine Practice early this year for eventual simultaneous publication.

Dr. Bahn reported having no conflicts to declare with regard to the guidelines.

New draft hyperthyroidism treatment guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists emphasize that although radioactive iodine is a good treatment for the disorder, patients need to consult with their physicians about all three available treatment options: radioactive iodine, surgery, and antithyroid medications, according to Dr. Rebecca Bahn.

“Physicians in the United States have long considered radioactive iodine to be the preferred treatment for Grave's disease,” Dr. Bahn, chair of the guideline task force, said in an interview. “We're recommending that the patient and the physician have a careful and clear discussion about the three treatment options, and that any of the three options are viable.” Dr. Bahn presented the draft guidelines at the annual meeting of the American Thyroid Association in Palm Beach, Fla.

That is not to say that there aren't some situations in which one procedure is preferable, said Dr. Bahn, professor of medicine and a consultant in endocrinology at the Mayo Clinic, Rochester, Minn. “Pregnant women should not receive radioactive iodine, and patients with medical problems that put them at high risk for surgery should not choose surgery. But our overall recommendation is that the patient and the physician should make the decision following a careful discussion.”

Another major change in the guidelines deals with antithyroid drug therapy. “It used to be that propylthiouracil (PTU) or methimazole could be used interchangeably, but there's now good evidence that there's a very serious hepatic necrosis associated with PTU; it's rare, but it's not at all associated with methimazole,” she said. “So our guidelines will say that if you're going to use antithyroid drugs you should use methimazole except in certain instances. This is especially true of children, who are particularly susceptible to [this liver complication].”

On the other hand, women who have Grave's disease that is diagnosed in the first trimester of pregnancy should be started on PTU, because methimazole is associated with certain birth defects such as cutis aplasia and choanal or esophageal atresia, Dr. Bahn said.

“Also, if the patient is found to have minor side effects with methimazole, in some cases PTU might be used,” she continued.

In the case of hyperthyroidism caused by nodules, “for definitive treatment we don't recommend antithyroid drugs because the patient would have to be on those essentially forever,” she said.

“In some instances, such as patients with a relatively short life expectancy or iodine-induced disease, these medications may be used, but in general, the treatment is surgery or RAI.” In particular, the task force is recommending that for toxic multinodular goiter, near-total or total thyroidectomy should be performed, preferably by a high-volume thyroid surgeon.

Dr. Bahn said that she expected a final draft of the guidelines to be ready to submit to both Thyroid and Endocrine Practice early this year for eventual simultaneous publication.

Dr. Bahn reported having no conflicts to declare with regard to the guidelines.

New draft hyperthyroidism treatment guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists emphasize that although radioactive iodine is a good treatment for the disorder, patients need to consult with their physicians about all three available treatment options: radioactive iodine, surgery, and antithyroid medications, according to Dr. Rebecca Bahn.

“Physicians in the United States have long considered radioactive iodine to be the preferred treatment for Grave's disease,” Dr. Bahn, chair of the guideline task force, said in an interview. “We're recommending that the patient and the physician have a careful and clear discussion about the three treatment options, and that any of the three options are viable.” Dr. Bahn presented the draft guidelines at the annual meeting of the American Thyroid Association in Palm Beach, Fla.

That is not to say that there aren't some situations in which one procedure is preferable, said Dr. Bahn, professor of medicine and a consultant in endocrinology at the Mayo Clinic, Rochester, Minn. “Pregnant women should not receive radioactive iodine, and patients with medical problems that put them at high risk for surgery should not choose surgery. But our overall recommendation is that the patient and the physician should make the decision following a careful discussion.”

Another major change in the guidelines deals with antithyroid drug therapy. “It used to be that propylthiouracil (PTU) or methimazole could be used interchangeably, but there's now good evidence that there's a very serious hepatic necrosis associated with PTU; it's rare, but it's not at all associated with methimazole,” she said. “So our guidelines will say that if you're going to use antithyroid drugs you should use methimazole except in certain instances. This is especially true of children, who are particularly susceptible to [this liver complication].”

On the other hand, women who have Grave's disease that is diagnosed in the first trimester of pregnancy should be started on PTU, because methimazole is associated with certain birth defects such as cutis aplasia and choanal or esophageal atresia, Dr. Bahn said.

“Also, if the patient is found to have minor side effects with methimazole, in some cases PTU might be used,” she continued.

In the case of hyperthyroidism caused by nodules, “for definitive treatment we don't recommend antithyroid drugs because the patient would have to be on those essentially forever,” she said.

“In some instances, such as patients with a relatively short life expectancy or iodine-induced disease, these medications may be used, but in general, the treatment is surgery or RAI.” In particular, the task force is recommending that for toxic multinodular goiter, near-total or total thyroidectomy should be performed, preferably by a high-volume thyroid surgeon.

Dr. Bahn said that she expected a final draft of the guidelines to be ready to submit to both Thyroid and Endocrine Practice early this year for eventual simultaneous publication.

Dr. Bahn reported having no conflicts to declare with regard to the guidelines.