Joyce Frieden

Sometimes, being equal is just not enough—at least, that's what the Progressive Policy Institute says.

A new paper from the institute, a liberal Washington think tank, suggests that rather than aiming for simple dollar-for-dollar parity with physical health benefits, advocates for mental health care parity should insist that mental health providers be held accountable for delivering high-quality, cost-effective services.

Some people in the business community are intrigued by this idea, noted David Kendall, senior fellow for health policy at the institute. “Employers see themselves as leaders in the outcomes disclosure field, and their argument has been all along that parity shouldn't mean unlimited entitlement to [mental health] services,” he said. “So if we can find ways to discipline the demand side with outcomes [data], that may help break the deadlock on parity.”

One reason the Progressive Policy Institute (PPI) published the paper is that President Bush has “dropped the ball” on reforming the mental health system, even though he himself called for such reforms about four years ago, Mr. Kendall said. “PPI looks for opportunities where progressive leaders can pursue reform.”

In the report, PPI notes that enhanced parity “would bring together a wave of cutting-edge reforms—some proposed, some already proven—that aim to promote effective treatments and tangible results, often reinforced by pay-for-performance or other incentives.”

One example would be Assertive Community Treatment (ACT), in which mobile interdisciplinary teams give 24-hour assistance to hard-to-reach mentally ill patients. “When states fail to adopt such practices, the cost of preventable hospitalization soars,” the report noted. What's worse, it continued, “Medicaid continues to waste money on ineffective programs such as dreary, hospital-style 'day treatment' that critics say are often just another version of the old state hospital wards, complete with cigarette breaks and televisions.”

Parity legislation should also “require the disclosure of performance results, not just reimbursement for any service provided,” the report said. “Without some form of accountability, mental health parity risks turning into a blank check for mediocre treatment-as-usual. Parity legislation should include a requirement to use at least some of the measurements that have been developed by the Substance Abuse and Mental Health Services Administration,” such as its Mental Health Consumer-Oriented Report Card.

Rep. Patrick Kennedy (D-R.I.), chief sponsor of a parity bill in the House of Representatives, said that although accountable mental health care is a laudable goal, Parity Plus is not the way to go about achieving it. “If we are to ever rid the prejudice associated with this country's mental health policy, we cannot at the same time require some kind of higher standard of accountability for mental health care,” he said at a PPI forum on Parity Plus. “Holding mental health to a higher standard in order to get the same coverage just perpetuates the stigma.”

Nicholas Meyers, director of government relations at the American Psychiatric Association in Arlington, Va., agreed. “We appreciate the interest of PPI in the parity issue, but framing and conditioning approval of parity on a range of performance initiatives is both a very dubious political strategy and perpetuates the stigma,” he said. “It's an assumption at the get-go that the only way mental health parity should be approved is if strict performance measures are imposed.”

Furthermore, performance measures are still in the early stages of development, especially in the area of “pay-for-performance” programs, Mr. Meyers continued. For example, he said, “There are a whole host of technical issues: Who owns the information that's being reported? Who has access to it? What protections are provided for confidentiality? How and by whom are measures developed and validated?”

Despite this opposition, PPI's Mr. Kendall thinks that there is one other way a Parity Plus proposal helps to advance the mental health care debate: It puts some of the onus for improvement squarely on the managed care plans. “If you have accountability measures, that's another way to hold managed care plans accountable for delivering quality care,” he said. “It's a tool slowly but surely consumer and provider groups are coming around to.”

Sometimes, being equal is just not enough—at least, that's what the Progressive Policy Institute says.

A new paper from the institute, a liberal Washington think tank, suggests that rather than aiming for simple dollar-for-dollar parity with physical health benefits, advocates for mental health care parity should insist that mental health providers be held accountable for delivering high-quality, cost-effective services.

Some people in the business community are intrigued by this idea, noted David Kendall, senior fellow for health policy at the institute. “Employers see themselves as leaders in the outcomes disclosure field, and their argument has been all along that parity shouldn't mean unlimited entitlement to [mental health] services,” he said. “So if we can find ways to discipline the demand side with outcomes [data], that may help break the deadlock on parity.”

One reason the Progressive Policy Institute (PPI) published the paper is that President Bush has “dropped the ball” on reforming the mental health system, even though he himself called for such reforms about four years ago, Mr. Kendall said. “PPI looks for opportunities where progressive leaders can pursue reform.”

In the report, PPI notes that enhanced parity “would bring together a wave of cutting-edge reforms—some proposed, some already proven—that aim to promote effective treatments and tangible results, often reinforced by pay-for-performance or other incentives.”

One example would be Assertive Community Treatment (ACT), in which mobile interdisciplinary teams give 24-hour assistance to hard-to-reach mentally ill patients. “When states fail to adopt such practices, the cost of preventable hospitalization soars,” the report noted. What's worse, it continued, “Medicaid continues to waste money on ineffective programs such as dreary, hospital-style 'day treatment' that critics say are often just another version of the old state hospital wards, complete with cigarette breaks and televisions.”

Parity legislation should also “require the disclosure of performance results, not just reimbursement for any service provided,” the report said. “Without some form of accountability, mental health parity risks turning into a blank check for mediocre treatment-as-usual. Parity legislation should include a requirement to use at least some of the measurements that have been developed by the Substance Abuse and Mental Health Services Administration,” such as its Mental Health Consumer-Oriented Report Card.

Rep. Patrick Kennedy (D-R.I.), chief sponsor of a parity bill in the House of Representatives, said that although accountable mental health care is a laudable goal, Parity Plus is not the way to go about achieving it. “If we are to ever rid the prejudice associated with this country's mental health policy, we cannot at the same time require some kind of higher standard of accountability for mental health care,” he said at a PPI forum on Parity Plus. “Holding mental health to a higher standard in order to get the same coverage just perpetuates the stigma.”

Nicholas Meyers, director of government relations at the American Psychiatric Association in Arlington, Va., agreed. “We appreciate the interest of PPI in the parity issue, but framing and conditioning approval of parity on a range of performance initiatives is both a very dubious political strategy and perpetuates the stigma,” he said. “It's an assumption at the get-go that the only way mental health parity should be approved is if strict performance measures are imposed.”

Furthermore, performance measures are still in the early stages of development, especially in the area of “pay-for-performance” programs, Mr. Meyers continued. For example, he said, “There are a whole host of technical issues: Who owns the information that's being reported? Who has access to it? What protections are provided for confidentiality? How and by whom are measures developed and validated?”

Despite this opposition, PPI's Mr. Kendall thinks that there is one other way a Parity Plus proposal helps to advance the mental health care debate: It puts some of the onus for improvement squarely on the managed care plans. “If you have accountability measures, that's another way to hold managed care plans accountable for delivering quality care,” he said. “It's a tool slowly but surely consumer and provider groups are coming around to.”

Sometimes, being equal is just not enough—at least, that's what the Progressive Policy Institute says.

A new paper from the institute, a liberal Washington think tank, suggests that rather than aiming for simple dollar-for-dollar parity with physical health benefits, advocates for mental health care parity should insist that mental health providers be held accountable for delivering high-quality, cost-effective services.

Some people in the business community are intrigued by this idea, noted David Kendall, senior fellow for health policy at the institute. “Employers see themselves as leaders in the outcomes disclosure field, and their argument has been all along that parity shouldn't mean unlimited entitlement to [mental health] services,” he said. “So if we can find ways to discipline the demand side with outcomes [data], that may help break the deadlock on parity.”

One reason the Progressive Policy Institute (PPI) published the paper is that President Bush has “dropped the ball” on reforming the mental health system, even though he himself called for such reforms about four years ago, Mr. Kendall said. “PPI looks for opportunities where progressive leaders can pursue reform.”

In the report, PPI notes that enhanced parity “would bring together a wave of cutting-edge reforms—some proposed, some already proven—that aim to promote effective treatments and tangible results, often reinforced by pay-for-performance or other incentives.”

One example would be Assertive Community Treatment (ACT), in which mobile interdisciplinary teams give 24-hour assistance to hard-to-reach mentally ill patients. “When states fail to adopt such practices, the cost of preventable hospitalization soars,” the report noted. What's worse, it continued, “Medicaid continues to waste money on ineffective programs such as dreary, hospital-style 'day treatment' that critics say are often just another version of the old state hospital wards, complete with cigarette breaks and televisions.”

Parity legislation should also “require the disclosure of performance results, not just reimbursement for any service provided,” the report said. “Without some form of accountability, mental health parity risks turning into a blank check for mediocre treatment-as-usual. Parity legislation should include a requirement to use at least some of the measurements that have been developed by the Substance Abuse and Mental Health Services Administration,” such as its Mental Health Consumer-Oriented Report Card.

Rep. Patrick Kennedy (D-R.I.), chief sponsor of a parity bill in the House of Representatives, said that although accountable mental health care is a laudable goal, Parity Plus is not the way to go about achieving it. “If we are to ever rid the prejudice associated with this country's mental health policy, we cannot at the same time require some kind of higher standard of accountability for mental health care,” he said at a PPI forum on Parity Plus. “Holding mental health to a higher standard in order to get the same coverage just perpetuates the stigma.”

Nicholas Meyers, director of government relations at the American Psychiatric Association in Arlington, Va., agreed. “We appreciate the interest of PPI in the parity issue, but framing and conditioning approval of parity on a range of performance initiatives is both a very dubious political strategy and perpetuates the stigma,” he said. “It's an assumption at the get-go that the only way mental health parity should be approved is if strict performance measures are imposed.”

Furthermore, performance measures are still in the early stages of development, especially in the area of “pay-for-performance” programs, Mr. Meyers continued. For example, he said, “There are a whole host of technical issues: Who owns the information that's being reported? Who has access to it? What protections are provided for confidentiality? How and by whom are measures developed and validated?”

Despite this opposition, PPI's Mr. Kendall thinks that there is one other way a Parity Plus proposal helps to advance the mental health care debate: It puts some of the onus for improvement squarely on the managed care plans. “If you have accountability measures, that's another way to hold managed care plans accountable for delivering quality care,” he said. “It's a tool slowly but surely consumer and provider groups are coming around to.”

The voluntary guidelines are available at www.phrma.org/publications/policy//admin/2005-08-02.1194.pdf

New voluntary guidelines for direct-to-consumer prescription drug advertising released by the Pharmaceutical Research and Manufacturers of America have drawn criticism from politicians and consumer groups who say they don't go far enough.

“While I wish the PhRMA guidelines would have gone farther and proposed a moratorium on DTC [direct-to-consumer] advertising of newly approved drugs, I hope individual pharmaceutical manufacturers will seriously consider such a measure,” Senate Majority Leader Bill Frist, M.D. (R-Tenn.) said in a statement.

Sidney Wolfe, M.D., director of the Public Citizen Health Research Group, called the PhRMA announcement “a meaningless attempt to fool people into believing the guidelines are stronger than they really are.”

The guidelines were released in Dallas in early August at a meeting of the American Legislative Exchange Council.

Among other things, the guidelines call for pharmaceutical manufacturers to educate physicians and other health care providers about new drugs before advertising them to consumers.

“The centerpiece is the notion that the companies are committing an appropriate amount of time to educate health care professionals about new medications and new indications … to make sure physicians and other providers know about the medicines and benefits before” direct-to-consumer advertising campaigns are undertaken, Billy Tauzin, CEO of PhRMA and a former congressman from Louisiana, said at a press conference sponsored by PhRMA.

The length of time the companies will take to educate physicians will depend on several factors, including whether the drug is a life-saving one and how complex the risk-benefit profile is, Mr. Tauzin said. “We are also committed to continuing to educate health care professionals as additional info about a medication is obtained from all sources, even after medication has begun being marketed.”

Other provisions of the voluntary guidelines, which 23 companies have signed onto, include:

▸ DTC ads should be balanced, and discuss both the benefits and risks of the medication. The information should be presented in “clear, understandable language, without distraction from the content.”

▸ Ads should be targeted to avoid audiences that are not age-appropriate.

For example, Karen Katen, president of Pfizer Human Health, said that her company would not run a television advertisement for Viagra (sildenafil) during the Super Bowl, when young children may be watching.

▸ Companies should submit new DTC print and television advertisements to the FDA before releasing them. PhRMA board chair Bill Weldon said this does not mean that companies would submit an ad to the FDA on Tuesday and then run it on Wednesday.

“The intent is to make sure that FDA has been able to comment on any programs prior to advertising,” said Mr. Weldon, who is also chairman and CEO of Johnson & Johnson.

▸ Ads that identify a product by name should include the product's indications as well as its risks and benefits. This means no more ads that just give the name of the medication and tell what it's for, Mr. Tauzin said.

PhRMA also will convene an independent board in about a year to get outside opinion on whether the companies are following the guidelines. The panel will include experts in health care, broadcasting, and other relevant disciplines.

The panel's report “will be made public, and also made available to the FDA,” Mr. Tauzin said.

The voluntary guidelines are available at www.phrma.org/publications/policy//admin/2005-08-02.1194.pdf

New voluntary guidelines for direct-to-consumer prescription drug advertising released by the Pharmaceutical Research and Manufacturers of America have drawn criticism from politicians and consumer groups who say they don't go far enough.

“While I wish the PhRMA guidelines would have gone farther and proposed a moratorium on DTC [direct-to-consumer] advertising of newly approved drugs, I hope individual pharmaceutical manufacturers will seriously consider such a measure,” Senate Majority Leader Bill Frist, M.D. (R-Tenn.) said in a statement.

Sidney Wolfe, M.D., director of the Public Citizen Health Research Group, called the PhRMA announcement “a meaningless attempt to fool people into believing the guidelines are stronger than they really are.”

The guidelines were released in Dallas in early August at a meeting of the American Legislative Exchange Council.

Among other things, the guidelines call for pharmaceutical manufacturers to educate physicians and other health care providers about new drugs before advertising them to consumers.

“The centerpiece is the notion that the companies are committing an appropriate amount of time to educate health care professionals about new medications and new indications … to make sure physicians and other providers know about the medicines and benefits before” direct-to-consumer advertising campaigns are undertaken, Billy Tauzin, CEO of PhRMA and a former congressman from Louisiana, said at a press conference sponsored by PhRMA.

The length of time the companies will take to educate physicians will depend on several factors, including whether the drug is a life-saving one and how complex the risk-benefit profile is, Mr. Tauzin said. “We are also committed to continuing to educate health care professionals as additional info about a medication is obtained from all sources, even after medication has begun being marketed.”

Other provisions of the voluntary guidelines, which 23 companies have signed onto, include:

▸ DTC ads should be balanced, and discuss both the benefits and risks of the medication. The information should be presented in “clear, understandable language, without distraction from the content.”

▸ Ads should be targeted to avoid audiences that are not age-appropriate.

For example, Karen Katen, president of Pfizer Human Health, said that her company would not run a television advertisement for Viagra (sildenafil) during the Super Bowl, when young children may be watching.

▸ Companies should submit new DTC print and television advertisements to the FDA before releasing them. PhRMA board chair Bill Weldon said this does not mean that companies would submit an ad to the FDA on Tuesday and then run it on Wednesday.

“The intent is to make sure that FDA has been able to comment on any programs prior to advertising,” said Mr. Weldon, who is also chairman and CEO of Johnson & Johnson.

▸ Ads that identify a product by name should include the product's indications as well as its risks and benefits. This means no more ads that just give the name of the medication and tell what it's for, Mr. Tauzin said.

PhRMA also will convene an independent board in about a year to get outside opinion on whether the companies are following the guidelines. The panel will include experts in health care, broadcasting, and other relevant disciplines.

The panel's report “will be made public, and also made available to the FDA,” Mr. Tauzin said.

The voluntary guidelines are available at www.phrma.org/publications/policy//admin/2005-08-02.1194.pdf

New voluntary guidelines for direct-to-consumer prescription drug advertising released by the Pharmaceutical Research and Manufacturers of America have drawn criticism from politicians and consumer groups who say they don't go far enough.

“While I wish the PhRMA guidelines would have gone farther and proposed a moratorium on DTC [direct-to-consumer] advertising of newly approved drugs, I hope individual pharmaceutical manufacturers will seriously consider such a measure,” Senate Majority Leader Bill Frist, M.D. (R-Tenn.) said in a statement.

Sidney Wolfe, M.D., director of the Public Citizen Health Research Group, called the PhRMA announcement “a meaningless attempt to fool people into believing the guidelines are stronger than they really are.”

The guidelines were released in Dallas in early August at a meeting of the American Legislative Exchange Council.

Among other things, the guidelines call for pharmaceutical manufacturers to educate physicians and other health care providers about new drugs before advertising them to consumers.

“The centerpiece is the notion that the companies are committing an appropriate amount of time to educate health care professionals about new medications and new indications … to make sure physicians and other providers know about the medicines and benefits before” direct-to-consumer advertising campaigns are undertaken, Billy Tauzin, CEO of PhRMA and a former congressman from Louisiana, said at a press conference sponsored by PhRMA.

The length of time the companies will take to educate physicians will depend on several factors, including whether the drug is a life-saving one and how complex the risk-benefit profile is, Mr. Tauzin said. “We are also committed to continuing to educate health care professionals as additional info about a medication is obtained from all sources, even after medication has begun being marketed.”

Other provisions of the voluntary guidelines, which 23 companies have signed onto, include:

▸ DTC ads should be balanced, and discuss both the benefits and risks of the medication. The information should be presented in “clear, understandable language, without distraction from the content.”

▸ Ads should be targeted to avoid audiences that are not age-appropriate.

For example, Karen Katen, president of Pfizer Human Health, said that her company would not run a television advertisement for Viagra (sildenafil) during the Super Bowl, when young children may be watching.

▸ Companies should submit new DTC print and television advertisements to the FDA before releasing them. PhRMA board chair Bill Weldon said this does not mean that companies would submit an ad to the FDA on Tuesday and then run it on Wednesday.

“The intent is to make sure that FDA has been able to comment on any programs prior to advertising,” said Mr. Weldon, who is also chairman and CEO of Johnson & Johnson.

▸ Ads that identify a product by name should include the product's indications as well as its risks and benefits. This means no more ads that just give the name of the medication and tell what it's for, Mr. Tauzin said.

PhRMA also will convene an independent board in about a year to get outside opinion on whether the companies are following the guidelines. The panel will include experts in health care, broadcasting, and other relevant disciplines.

The panel's report “will be made public, and also made available to the FDA,” Mr. Tauzin said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers. “Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers. “Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers. “Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

"Insurers are recognizing that the 45 million people who are uninsured are a market," said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. "Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month."

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. "I think that's a false set of arguments," he said. "Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance."

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

"Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care," she said. "We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet."

Mr. Laszewski added that although consumer-driven health care "is a wonderful thing," it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. "It's the sick people who blow through the deductibles and get to the out-of-pocket maximums," he said. "Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system."

Efforts to measure physician quality also came in for much discussion. "While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage," said Ms. Arnold. "The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers."

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. "They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard."

The second initiative involves a group of employers and consultants who are exploring "care-focused" purchasing—that is, getting health plans to aggregate their provider data so employers and consumers can see which are the highest quality providers. "Any one health plan can't give you a full picture of [a physician]," she said.

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market.

"It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon," he said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

"Insurers are recognizing that the 45 million people who are uninsured are a market," said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. "Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month."

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. "I think that's a false set of arguments," he said. "Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance."

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

"Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care," she said. "We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet."

Mr. Laszewski added that although consumer-driven health care "is a wonderful thing," it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. "It's the sick people who blow through the deductibles and get to the out-of-pocket maximums," he said. "Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system."

Efforts to measure physician quality also came in for much discussion. "While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage," said Ms. Arnold. "The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers."

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. "They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard."

The second initiative involves a group of employers and consultants who are exploring "care-focused" purchasing—that is, getting health plans to aggregate their provider data so employers and consumers can see which are the highest quality providers. "Any one health plan can't give you a full picture of [a physician]," she said.

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market.

"It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon," he said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

"Insurers are recognizing that the 45 million people who are uninsured are a market," said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. "Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50-$100 per month."

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. "I think that's a false set of arguments," he said. "Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance."

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

"Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care," she said. "We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet."

Mr. Laszewski added that although consumer-driven health care "is a wonderful thing," it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. "It's the sick people who blow through the deductibles and get to the out-of-pocket maximums," he said. "Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system."

Efforts to measure physician quality also came in for much discussion. "While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage," said Ms. Arnold. "The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers."

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality. "They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard."

The second initiative involves a group of employers and consultants who are exploring "care-focused" purchasing—that is, getting health plans to aggregate their provider data so employers and consumers can see which are the highest quality providers. "Any one health plan can't give you a full picture of [a physician]," she said.

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market.

"It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon," he said.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

"We're concerned about the ability of beneficiaries to get a fair and favorable hearing," said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

"Older people and people with disabilities will have problems" with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three "regions" for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

"We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing," he said. "So logistics must come in play. That doesn't mean we'll take a year to do it."

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

"The changes are supposed to protect beneficiaries," but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. "There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work."

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. "The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules," Ms. Gottlich said.

Mr. Hall said that his agency "has gone to great lengths to be sure this is a fair process." Questions about how well the new system will work "are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now."

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. "We have concerns about how effective arbitration or review will be through a distance," said Jennifer Miller, external relations liaison at MGMA's Washington office. "How effective can someone be to advocate their position over teleconference?"

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. and they are not concerned that being hired by HHS will bias the judges too much, she added.

Several senators expressed concern about the changes. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges "shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance." The measure also calls for appeal hearings to be in-person "unless such individual requests that the hearing be conducted using tele- or video conference technologies." The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

"We're concerned about the ability of beneficiaries to get a fair and favorable hearing," said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

"Older people and people with disabilities will have problems" with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three "regions" for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

"We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing," he said. "So logistics must come in play. That doesn't mean we'll take a year to do it."

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

"The changes are supposed to protect beneficiaries," but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. "There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work."

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. "The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules," Ms. Gottlich said.

Mr. Hall said that his agency "has gone to great lengths to be sure this is a fair process." Questions about how well the new system will work "are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now."

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. "We have concerns about how effective arbitration or review will be through a distance," said Jennifer Miller, external relations liaison at MGMA's Washington office. "How effective can someone be to advocate their position over teleconference?"

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. and they are not concerned that being hired by HHS will bias the judges too much, she added.

Several senators expressed concern about the changes. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges "shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance." The measure also calls for appeal hearings to be in-person "unless such individual requests that the hearing be conducted using tele- or video conference technologies." The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

"We're concerned about the ability of beneficiaries to get a fair and favorable hearing," said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

"Older people and people with disabilities will have problems" with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three "regions" for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

"We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing," he said. "So logistics must come in play. That doesn't mean we'll take a year to do it."

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

"The changes are supposed to protect beneficiaries," but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. "There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work."

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. "The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules," Ms. Gottlich said.

Mr. Hall said that his agency "has gone to great lengths to be sure this is a fair process." Questions about how well the new system will work "are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now."

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. "We have concerns about how effective arbitration or review will be through a distance," said Jennifer Miller, external relations liaison at MGMA's Washington office. "How effective can someone be to advocate their position over teleconference?"

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. and they are not concerned that being hired by HHS will bias the judges too much, she added.

Several senators expressed concern about the changes. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges "shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance." The measure also calls for appeal hearings to be in-person "unless such individual requests that the hearing be conducted using tele- or video conference technologies." The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concern among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concerns among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concerns among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

A new process for appealing Medicare coverage denials is raising concerns among some advocates for senior citizens.

“We're concerned about the ability of beneficiaries to get a fair and favorable hearing,” said Vicki Gottlich, senior policy attorney at the Center for Medicare Advocacy, a Mansfield, Conn.-based group that helps beneficiaries with the appeals process. “Our organization and other organizations that do this kind of work have a very high success rate [for Medicare appeals] and we're concerned that the rate is going to go down.”

That could mean collection snags for physicians, she added. For example, if the physician accepts assignment for Medicare, Medicare denies coverage for a claim, and the denial is unsuccessfully appealed by the patient, “the doctor will then have to go collect from the patient. They don't want to do that.”

Under the new process, which began on July 1, beneficiaries and providers whose claims are denied will be asked to appeal their claims to an administrative law judge (ALJ) via teleconference. Previously, these appeals were made in person.

“Older people and people with disabilities will have problems” with teleconferences, especially if their vision or hearing is impaired, Ms. Gottlich said. And if they ask for an in-person hearing instead, beneficiaries will waive their right to a timely decision if that request is granted. The new process also specifies that there will be three “regions” for hearing cases in person, rather than beneficiaries being allowed to have hearings in their home states.

Department of Health and Human Services spokesman Bill Hall said there are logistical reasons for waiving the right to speedy resolution in the case of an in-person hearing.

“We have to schedule everyone, allow time for them to travel, and set up a facility for the hearing,” he said. “So logistics must come in play. That doesn't mean we'll take a year to do it.”

Ms. Gottlich noted that the changes were made in the first place in part because members of Congress were dissatisfied with how long it was taking for beneficiaries to make their way through the appeals process.

“The changes are supposed to protect beneficiaries,” but the system needs better funding to make sure everyone gets their chance to be heard in a timely way, she said. “There are some cases where teleconferencing could work, but for an individual beneficiary who's gone through the whole inhuman system and wants to see a real person, the system doesn't really work.”

Another change in the process places administrative law judges under the jurisdiction of HHS, rather than the Social Security Administration. Further, judges are instructed to place more weight on Medicare regulations than they were before. “The [law] says the administrative law judge is supposed to be independent of [the Centers for Medicare and Medicaid Services], but now they are supposed to give deference to their rules,” Ms. Gottlich said.

Mr. Hall said that his agency “has gone to great lengths to be sure this is a fair process.” Questions about how well the new system will work “are virtually impossible to answer because we haven't even heard the first case yet. I think it's a lot more fair to ask these questions a year from now.”

The Medical Group Management Association, which represents medical practice managers, is one group that is very interested in how the appeals process plays out. “We have concerns about how effective arbitration or review will be through a distance,” said Jennifer Miller, external relations liaison at MGMA's Washington office. “How effective can someone be to advocate their position over teleconference? When the rubber hits the road and we start seeing more [cases], we'll have a better feel for it.”

Ms. Miller added that MGMA supports having the judges hired by HHS rather than the Social Security Administration. “Before now, someone dealing with disability issues would be trying to adjudicate what may be their third case of this type out of 300 cases, so they may not be as familiar with it,” she said. “Now there will be a specialized group of magistrates—it's going to be a new breed of ALJ.”

MGMA is not concerned that being hired by HHS will bias the judges too much, she added. “That is a concern many still share; however, ALJs historically have enjoyed a great deal of flexibility, and that's the genius behind the review process,” Ms. Miller said.

Several senators expressed concern about changes to the appeals process. A bill, the Justice for Medicare Beneficiaries Act, sponsored by Sens. Christopher Dodd (D-Conn.), Edward M. Kennedy (D-Mass.), John Kerry (D-Mass.), and Jeff Bingaman (D-N.M.) was introduced earlier this summer and would reverse many of the changes.

For instance, the bill says that judges “shall not be required to give substantial deference to local coverage determination, local medical review policies, or Centers for Medicare and Medicaid Services program guidance.” The measure also calls for appeal hearings to be in-person “unless such individual requests that the hearing be conducted using tele- or video conference technologies.” The bill was referred to the Senate Finance Committee.

Michigan physicians are divided over efforts by Gov. Jennifer Granholm (D) to pass a physician tax that would help increase payments to Medicaid providers in the state.

Under the governor's proposal, a 2.28% gross receipts tax would be levied on all physicians in the state. The tax would raise $96 million, which would then be put into the Medicaid program and would increase the amount of matching funds the program received from the federal government.

“In that scenario, the state keeps $40 million, and then the $56 million left would be paired with Medicaid matching dollars, so we can return $125 million to providers, bringing up to Medicare rates our physicians who've long complained that Medicaid [reimbursement] rates were too low,” commented T.J. Bucholz, who is a spokesman for the Michigan Department of Community Health in Lansing.

In the case of physicians who have at least 3.5% of their practice revenue coming from Medicaid, “they will get more back in terms of Medicaid reimbursement” than they paid into the system in taxes, he noted.

But the Michigan State Medical Society (MSMS) isn't buying it. “Inherent in that is an underlying current of a lot of trust, and for those of us who have paid attention to legislative and gubernatorial activities in the state over the last decade, a track record of trust is one that needs to be earned. People have a lot of questions about that,” said Gregory Forzley, M.D., a member of the society's board of directors.

For instance, “when they introduced the state lottery, it was going to benefit K-12 education programs and colleges in the state, but it appears they used the lottery money in place of other governmental funding,” said Dr. Forzley, a family physician in Grand Rapids. “So when they come with a similar-sounding proposal in a system already fraught with cutbacks and underfunding, most people say, 'I don't believe you when you say you are going to put safeguards in.'”

But Stephen DeSilva, M.D., president of Michigan Doctors Making a Difference, said that some of these problems could be overcome. For example, the law could be written so that “when the federal matching funds go away, the tax would automatically sunset,” he said.

Dr. DeSilva, who is an orthopedic surgeon, noted that similar tax assessments in the state have worked very well for hospitals, pharmacies, and nursing homes. “It would work well for physicians, but it's difficult to overcome the knee-jerk reaction to taxes as well as the paranoia about how the state will use the money.”

He acknowledged that his own 750-member practice group at Wayne State University in Detroit would have a lot to gain if the proposal became law, since about 20% of the group's patients are on Medicaid.

“In Michigan, Medicaid pays $22 per work unit, and Medicare pays almost $38 per work unit, so you can see it's a big increase,” he said. “For our group, it would mean an extra $30 million to our bottom line.”

But the main reason to support the program is that it would improve access for Medicaid patients, according to Dr. DeSilva.

“Right now, they either go without or use the emergency room for primary care, because very few physicians are willing to see patients at that very low reimbursement rate,” he said. “If you look in the 50 states, there is a direct correlation between access to physician office practices and the ratio of Medicare to Medicaid reimbursement. In states where the ratio approaches [1:1], access is usually good, but as rates fall, access usually falls as well. In New York and New Jersey, which are near the bottom, almost no physician will see a Medicaid patient.”

Like Dr. DeSilva, Dr. Forzley said he thinks the Michigan Medicaid program needs fixing, but he doesn't think a physician tax is the way to do it. “There are some areas where we can get more creative,” he said. For example, “a long time ago, a lot of studies showed that if you provide people with transportation to their physician, they stay out of the hospital. It's worth it to look at those experiments out there and see how we can make a broader effort to touch rural and urban populations most effectively.”

“We're willing to work with the governor on trying to create a solution, and we don't think a tax is the best solution,” he added. That may mean using a Band-Aid approach—such as the cut in Medicaid rates currently in place in the state—while all parties work on a long-term fix, he said.

Michigan is not the only state to have considered provider taxes. Outgoing Washington Gov. Gary Locke (D) also proposed such a tax in January, but Christine Gregoire (D), the current governor, did not include it in her budget proposal, nor has the state legislature moved to implement it.

Physician concerns about taxing providers actually reflect issues revolving around Medicaid copayments, said Diana Ewert, senior manager for state government relations at the American Academy of Family Physicians. These are proposals in which “if you contract with the state to provide Medicaid services … they would require you to take the patient, whether or not the patient pays the copay, and the state will still deduct the copay on the other end because you should have collected it,” she explained. “That makes the losing proposition of taking Medicaid patients even more critical, which we believe will impact the safety net and result in less access.”

Ms. Ewert expressed concern regarding states enacting legislation such as provider taxes to increase federal Medicaid matching funds—a strategy known as intergovernmental transfers (IGTs)—for the coming fiscal year. She noted that the federally chartered commission on Medicaid will be looking at all financing mechanisms, including IGTs, in a preliminary report due to Congress on Sept. 1.

The goal is to cut $10 billion from Medicaid over the next 5 years.

“If states are depending upon IGTs to offset Medicaid costs and for some reason that doesn't come through, that may put states in an untenable situation,” she said.

In July, Health and Human Services Secretary Mike Leavitt announced that former Tennessee Gov. Don Sundquist (R) will chair the 13-member commission and former Maine Gov. Angus King (I) will serve as vice chair. In addition, the secretary was holding open two vacancies on the commission for current governors so that they could join after Sept. 1, when the commission begins focusing on longer-term changes.

Back in Michigan, both the state house of representatives and the state senate did not include the provider tax in their budget proposals, although it is still in the governor's budget proposal.

Dr. DeSilva is not very hopeful that the provider tax will become law this year, but he said his group would consider pushing for other ways to increase Medicaid reimbursement.

Without any fixes for the program, “we may be forced to limit access and reduce the number of Medicaid patients we're seeing,” he said of his own group. “We're not in the red yet, but we're having a hard time recruiting and retaining physicians.”

Michigan physicians are divided over efforts by Gov. Jennifer Granholm (D) to pass a physician tax that would help increase payments to Medicaid providers in the state.

Under the governor's proposal, a 2.28% gross receipts tax would be levied on all physicians in the state. The tax would raise $96 million, which would then be put into the Medicaid program and would increase the amount of matching funds the program received from the federal government.

“In that scenario, the state keeps $40 million, and then the $56 million left would be paired with Medicaid matching dollars, so we can return $125 million to providers, bringing up to Medicare rates our physicians who've long complained that Medicaid [reimbursement] rates were too low,” commented T.J. Bucholz, who is a spokesman for the Michigan Department of Community Health in Lansing.

In the case of physicians who have at least 3.5% of their practice revenue coming from Medicaid, “they will get more back in terms of Medicaid reimbursement” than they paid into the system in taxes, he noted.

But the Michigan State Medical Society (MSMS) isn't buying it. “Inherent in that is an underlying current of a lot of trust, and for those of us who have paid attention to legislative and gubernatorial activities in the state over the last decade, a track record of trust is one that needs to be earned. People have a lot of questions about that,” said Gregory Forzley, M.D., a member of the society's board of directors.

For instance, “when they introduced the state lottery, it was going to benefit K-12 education programs and colleges in the state, but it appears they used the lottery money in place of other governmental funding,” said Dr. Forzley, a family physician in Grand Rapids. “So when they come with a similar-sounding proposal in a system already fraught with cutbacks and underfunding, most people say, 'I don't believe you when you say you are going to put safeguards in.'”

But Stephen DeSilva, M.D., president of Michigan Doctors Making a Difference, said that some of these problems could be overcome. For example, the law could be written so that “when the federal matching funds go away, the tax would automatically sunset,” he said.

Dr. DeSilva, who is an orthopedic surgeon, noted that similar tax assessments in the state have worked very well for hospitals, pharmacies, and nursing homes. “It would work well for physicians, but it's difficult to overcome the knee-jerk reaction to taxes as well as the paranoia about how the state will use the money.”

He acknowledged that his own 750-member practice group at Wayne State University in Detroit would have a lot to gain if the proposal became law, since about 20% of the group's patients are on Medicaid.

“In Michigan, Medicaid pays $22 per work unit, and Medicare pays almost $38 per work unit, so you can see it's a big increase,” he said. “For our group, it would mean an extra $30 million to our bottom line.”

But the main reason to support the program is that it would improve access for Medicaid patients, according to Dr. DeSilva.

“Right now, they either go without or use the emergency room for primary care, because very few physicians are willing to see patients at that very low reimbursement rate,” he said. “If you look in the 50 states, there is a direct correlation between access to physician office practices and the ratio of Medicare to Medicaid reimbursement. In states where the ratio approaches [1:1], access is usually good, but as rates fall, access usually falls as well. In New York and New Jersey, which are near the bottom, almost no physician will see a Medicaid patient.”

Like Dr. DeSilva, Dr. Forzley said he thinks the Michigan Medicaid program needs fixing, but he doesn't think a physician tax is the way to do it. “There are some areas where we can get more creative,” he said. For example, “a long time ago, a lot of studies showed that if you provide people with transportation to their physician, they stay out of the hospital. It's worth it to look at those experiments out there and see how we can make a broader effort to touch rural and urban populations most effectively.”

“We're willing to work with the governor on trying to create a solution, and we don't think a tax is the best solution,” he added. That may mean using a Band-Aid approach—such as the cut in Medicaid rates currently in place in the state—while all parties work on a long-term fix, he said.

Michigan is not the only state to have considered provider taxes. Outgoing Washington Gov. Gary Locke (D) also proposed such a tax in January, but Christine Gregoire (D), the current governor, did not include it in her budget proposal, nor has the state legislature moved to implement it.

Physician concerns about taxing providers actually reflect issues revolving around Medicaid copayments, said Diana Ewert, senior manager for state government relations at the American Academy of Family Physicians. These are proposals in which “if you contract with the state to provide Medicaid services … they would require you to take the patient, whether or not the patient pays the copay, and the state will still deduct the copay on the other end because you should have collected it,” she explained. “That makes the losing proposition of taking Medicaid patients even more critical, which we believe will impact the safety net and result in less access.”

Ms. Ewert expressed concern regarding states enacting legislation such as provider taxes to increase federal Medicaid matching funds—a strategy known as intergovernmental transfers (IGTs)—for the coming fiscal year. She noted that the federally chartered commission on Medicaid will be looking at all financing mechanisms, including IGTs, in a preliminary report due to Congress on Sept. 1.

The goal is to cut $10 billion from Medicaid over the next 5 years.

“If states are depending upon IGTs to offset Medicaid costs and for some reason that doesn't come through, that may put states in an untenable situation,” she said.

In July, Health and Human Services Secretary Mike Leavitt announced that former Tennessee Gov. Don Sundquist (R) will chair the 13-member commission and former Maine Gov. Angus King (I) will serve as vice chair. In addition, the secretary was holding open two vacancies on the commission for current governors so that they could join after Sept. 1, when the commission begins focusing on longer-term changes.

Back in Michigan, both the state house of representatives and the state senate did not include the provider tax in their budget proposals, although it is still in the governor's budget proposal.

Dr. DeSilva is not very hopeful that the provider tax will become law this year, but he said his group would consider pushing for other ways to increase Medicaid reimbursement.

Without any fixes for the program, “we may be forced to limit access and reduce the number of Medicaid patients we're seeing,” he said of his own group. “We're not in the red yet, but we're having a hard time recruiting and retaining physicians.”

Michigan physicians are divided over efforts by Gov. Jennifer Granholm (D) to pass a physician tax that would help increase payments to Medicaid providers in the state.

Under the governor's proposal, a 2.28% gross receipts tax would be levied on all physicians in the state. The tax would raise $96 million, which would then be put into the Medicaid program and would increase the amount of matching funds the program received from the federal government.

“In that scenario, the state keeps $40 million, and then the $56 million left would be paired with Medicaid matching dollars, so we can return $125 million to providers, bringing up to Medicare rates our physicians who've long complained that Medicaid [reimbursement] rates were too low,” commented T.J. Bucholz, who is a spokesman for the Michigan Department of Community Health in Lansing.

In the case of physicians who have at least 3.5% of their practice revenue coming from Medicaid, “they will get more back in terms of Medicaid reimbursement” than they paid into the system in taxes, he noted.

But the Michigan State Medical Society (MSMS) isn't buying it. “Inherent in that is an underlying current of a lot of trust, and for those of us who have paid attention to legislative and gubernatorial activities in the state over the last decade, a track record of trust is one that needs to be earned. People have a lot of questions about that,” said Gregory Forzley, M.D., a member of the society's board of directors.

For instance, “when they introduced the state lottery, it was going to benefit K-12 education programs and colleges in the state, but it appears they used the lottery money in place of other governmental funding,” said Dr. Forzley, a family physician in Grand Rapids. “So when they come with a similar-sounding proposal in a system already fraught with cutbacks and underfunding, most people say, 'I don't believe you when you say you are going to put safeguards in.'”

But Stephen DeSilva, M.D., president of Michigan Doctors Making a Difference, said that some of these problems could be overcome. For example, the law could be written so that “when the federal matching funds go away, the tax would automatically sunset,” he said.

Dr. DeSilva, who is an orthopedic surgeon, noted that similar tax assessments in the state have worked very well for hospitals, pharmacies, and nursing homes. “It would work well for physicians, but it's difficult to overcome the knee-jerk reaction to taxes as well as the paranoia about how the state will use the money.”

He acknowledged that his own 750-member practice group at Wayne State University in Detroit would have a lot to gain if the proposal became law, since about 20% of the group's patients are on Medicaid.

“In Michigan, Medicaid pays $22 per work unit, and Medicare pays almost $38 per work unit, so you can see it's a big increase,” he said. “For our group, it would mean an extra $30 million to our bottom line.”

But the main reason to support the program is that it would improve access for Medicaid patients, according to Dr. DeSilva.

“Right now, they either go without or use the emergency room for primary care, because very few physicians are willing to see patients at that very low reimbursement rate,” he said. “If you look in the 50 states, there is a direct correlation between access to physician office practices and the ratio of Medicare to Medicaid reimbursement. In states where the ratio approaches [1:1], access is usually good, but as rates fall, access usually falls as well. In New York and New Jersey, which are near the bottom, almost no physician will see a Medicaid patient.”

Like Dr. DeSilva, Dr. Forzley said he thinks the Michigan Medicaid program needs fixing, but he doesn't think a physician tax is the way to do it. “There are some areas where we can get more creative,” he said. For example, “a long time ago, a lot of studies showed that if you provide people with transportation to their physician, they stay out of the hospital. It's worth it to look at those experiments out there and see how we can make a broader effort to touch rural and urban populations most effectively.”

“We're willing to work with the governor on trying to create a solution, and we don't think a tax is the best solution,” he added. That may mean using a Band-Aid approach—such as the cut in Medicaid rates currently in place in the state—while all parties work on a long-term fix, he said.

Michigan is not the only state to have considered provider taxes. Outgoing Washington Gov. Gary Locke (D) also proposed such a tax in January, but Christine Gregoire (D), the current governor, did not include it in her budget proposal, nor has the state legislature moved to implement it.

Physician concerns about taxing providers actually reflect issues revolving around Medicaid copayments, said Diana Ewert, senior manager for state government relations at the American Academy of Family Physicians. These are proposals in which “if you contract with the state to provide Medicaid services … they would require you to take the patient, whether or not the patient pays the copay, and the state will still deduct the copay on the other end because you should have collected it,” she explained. “That makes the losing proposition of taking Medicaid patients even more critical, which we believe will impact the safety net and result in less access.”

Ms. Ewert expressed concern regarding states enacting legislation such as provider taxes to increase federal Medicaid matching funds—a strategy known as intergovernmental transfers (IGTs)—for the coming fiscal year. She noted that the federally chartered commission on Medicaid will be looking at all financing mechanisms, including IGTs, in a preliminary report due to Congress on Sept. 1.

The goal is to cut $10 billion from Medicaid over the next 5 years.

“If states are depending upon IGTs to offset Medicaid costs and for some reason that doesn't come through, that may put states in an untenable situation,” she said.

In July, Health and Human Services Secretary Mike Leavitt announced that former Tennessee Gov. Don Sundquist (R) will chair the 13-member commission and former Maine Gov. Angus King (I) will serve as vice chair. In addition, the secretary was holding open two vacancies on the commission for current governors so that they could join after Sept. 1, when the commission begins focusing on longer-term changes.

Back in Michigan, both the state house of representatives and the state senate did not include the provider tax in their budget proposals, although it is still in the governor's budget proposal.

Dr. DeSilva is not very hopeful that the provider tax will become law this year, but he said his group would consider pushing for other ways to increase Medicaid reimbursement.

Without any fixes for the program, “we may be forced to limit access and reduce the number of Medicaid patients we're seeing,” he said of his own group. “We're not in the red yet, but we're having a hard time recruiting and retaining physicians.”

HHS Awards Alzheimer's Grants

The Administration on Aging is awarding $10.5 million to support innovative approaches to care both for Alzheimer's patients and their caregivers. “While there has been significant progress in the understanding and treatment of Alzheimer's disease, unless a cure or prevention is found, it is estimated that 14 million Americans will have Alzheimer's disease by 2050,” Josefina Carbonell, Assistant Secretary of Aging, said in announcing the awards. “These grants will provide training and support to persons with Alzheimer's and their family caregivers to help them cope with their day-to-day challenges until a cure can be found.” The awards include $2.6 million to expand 3-year demonstration programs in nine states, as well as an award to a 1-year demonstration program in New Jersey. In addition to those awards, nearly $8 million in continuation funding was recently awarded to 28 states.

Shortages in Parkinson's Trials

The majority of physicians who treat patients with Parkinson's disease have never referred a patient to a clinical trial, according to a survey of 500 physicians and more than 500 patients that was sponsored by the Michael J. Fox Foundation for Parkinson's Research. The survey, which was conducted by Harris Interactive, also found that 65% of neurologists and 54% of primary care physicians and gerontologists have discussed clinical trials with 10% or less of their patients. Lack of information about ongoing trials was a major barrier: Only 14% of primary care physicians and 21% of neurologists said they were somewhat or very satisfied with the amount of information available about Parkinson's clinical trials. “People are not getting the information they need to make decisions as to whether to participate in a trial,” said Michael J. Fox, the group's founder. “The fewer people who go into trials, the longer it will take to develop new treatments.” The foundation has launched a new Web site,

www.PDtrials.org

Neurologist's Nobel Intact

The Nobel Foundation is rejecting efforts by a group of physicians and family members of lobotomy patients to revoke the 1949 Nobel Prize in Medicine awarded to late neurologist Egas Moniz, the developer of the procedure. “The Nobel Committee has never taken responsibility for the fact that they awarded a prize for an operation that was a total failure and without any scientific merit,” said a statement on the Web site

www.psychosurgery.org

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees of the National Institutes of Health more time to report prohibited financial interests and to divest stock investments. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day, the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias A. Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

HHS Awards Alzheimer's Grants

The Administration on Aging is awarding $10.5 million to support innovative approaches to care both for Alzheimer's patients and their caregivers. “While there has been significant progress in the understanding and treatment of Alzheimer's disease, unless a cure or prevention is found, it is estimated that 14 million Americans will have Alzheimer's disease by 2050,” Josefina Carbonell, Assistant Secretary of Aging, said in announcing the awards. “These grants will provide training and support to persons with Alzheimer's and their family caregivers to help them cope with their day-to-day challenges until a cure can be found.” The awards include $2.6 million to expand 3-year demonstration programs in nine states, as well as an award to a 1-year demonstration program in New Jersey. In addition to those awards, nearly $8 million in continuation funding was recently awarded to 28 states.

Shortages in Parkinson's Trials

The majority of physicians who treat patients with Parkinson's disease have never referred a patient to a clinical trial, according to a survey of 500 physicians and more than 500 patients that was sponsored by the Michael J. Fox Foundation for Parkinson's Research. The survey, which was conducted by Harris Interactive, also found that 65% of neurologists and 54% of primary care physicians and gerontologists have discussed clinical trials with 10% or less of their patients. Lack of information about ongoing trials was a major barrier: Only 14% of primary care physicians and 21% of neurologists said they were somewhat or very satisfied with the amount of information available about Parkinson's clinical trials. “People are not getting the information they need to make decisions as to whether to participate in a trial,” said Michael J. Fox, the group's founder. “The fewer people who go into trials, the longer it will take to develop new treatments.” The foundation has launched a new Web site,

www.PDtrials.org

Neurologist's Nobel Intact

The Nobel Foundation is rejecting efforts by a group of physicians and family members of lobotomy patients to revoke the 1949 Nobel Prize in Medicine awarded to late neurologist Egas Moniz, the developer of the procedure. “The Nobel Committee has never taken responsibility for the fact that they awarded a prize for an operation that was a total failure and without any scientific merit,” said a statement on the Web site

www.psychosurgery.org

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees of the National Institutes of Health more time to report prohibited financial interests and to divest stock investments. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day, the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias A. Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

HHS Awards Alzheimer's Grants

The Administration on Aging is awarding $10.5 million to support innovative approaches to care both for Alzheimer's patients and their caregivers. “While there has been significant progress in the understanding and treatment of Alzheimer's disease, unless a cure or prevention is found, it is estimated that 14 million Americans will have Alzheimer's disease by 2050,” Josefina Carbonell, Assistant Secretary of Aging, said in announcing the awards. “These grants will provide training and support to persons with Alzheimer's and their family caregivers to help them cope with their day-to-day challenges until a cure can be found.” The awards include $2.6 million to expand 3-year demonstration programs in nine states, as well as an award to a 1-year demonstration program in New Jersey. In addition to those awards, nearly $8 million in continuation funding was recently awarded to 28 states.

Shortages in Parkinson's Trials

The majority of physicians who treat patients with Parkinson's disease have never referred a patient to a clinical trial, according to a survey of 500 physicians and more than 500 patients that was sponsored by the Michael J. Fox Foundation for Parkinson's Research. The survey, which was conducted by Harris Interactive, also found that 65% of neurologists and 54% of primary care physicians and gerontologists have discussed clinical trials with 10% or less of their patients. Lack of information about ongoing trials was a major barrier: Only 14% of primary care physicians and 21% of neurologists said they were somewhat or very satisfied with the amount of information available about Parkinson's clinical trials. “People are not getting the information they need to make decisions as to whether to participate in a trial,” said Michael J. Fox, the group's founder. “The fewer people who go into trials, the longer it will take to develop new treatments.” The foundation has launched a new Web site,

www.PDtrials.org

Neurologist's Nobel Intact

The Nobel Foundation is rejecting efforts by a group of physicians and family members of lobotomy patients to revoke the 1949 Nobel Prize in Medicine awarded to late neurologist Egas Moniz, the developer of the procedure. “The Nobel Committee has never taken responsibility for the fact that they awarded a prize for an operation that was a total failure and without any scientific merit,” said a statement on the Web site

www.psychosurgery.org

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees of the National Institutes of Health more time to report prohibited financial interests and to divest stock investments. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day, the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias A. Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.