Joyce Frieden

Declining Mental Illness Stigma

A mental illness diagnosis does not result in the fear or shame that it used to, according to a recent survey by the American Psychiatric Association. Nearly 90% of the 1,000 adults surveyed said that people with mental illness could live healthy lives, and 80% said mental health treatment was effective. In addition, 70% said seeing a psychiatrist was a sign of strength, according to the APA. Despite those encouraging signs, however, there were also some disturbing results, the association noted in a statement. For instance, 20% of respondents said they would not see a psychiatrist under any circumstances, and 57% said they were not concerned that they themselves or a family member might ever having to deal with a mental illness.

Mental Health Coverage Trends

The Mental Health Parity Act of 1996 has resulted in some gains in employee mental health coverage, but inequities remain, according to a report from the U.S. Department of Labor. Since the passage of the act, which requires employers to equalize dollar benefits for mental health and physical health coverage, the incidence of employees in medical plans that impose more restrictive dollar limits on inpatient mental health care coverage has decreased from 41% in 1997 to 7% in 2002. However, employees in plans that contain tighter restrictions on the number of days of inpatient mental health care compared with inpatient medical and surgical care–a disparity allowed under the law–rose from 61% to 77% in the same period. Differences in substance abuse coverage also remained, with only 8% of employees who had coverage for alcoholism treatment receiving the same coverage for that condition as for other conditions in 2002.

Depression and Marijuana Use

The evidence for a link between marijuana use and depression is getting stronger, according to the White House Office for National Drug Control Policy. “There certainly are people who self medicate, but the danger we're talking about is the growing evidence that use itself … may be triggering and may be worsening the onset of mental health problems,” ONDCP Director John Walters said at a Washington press conference. “Now, would some of those people have mental health problems anyway? That's entirely possible. But it's also entirely possible that some of these people may not subsequently show these mental health problems, and the evidence suggests that the use of marijuana may trigger the onset of problems that would not otherwise be there.” According to the office's National Survey on Drug Use and Health, among persons aged 18 years or older, those who first used marijuana before age 12 were twice as likely to have serious mental illness in the past year as those were who first used marijuana at age 18 or older.

AMA: Ban Booze Ads at NCAA Events

The American Medical Association has asked the National Collegiate Athletic Association to eliminate alcohol advertising associated with NCAA events. “The prevalence of alcohol advertising in college sports sends a damaging message about the core values of the NCAA and higher education,” AMA President-elect J. Edward Hill, M.D., said in a statement. “Allowing aggressive alcohol advertising during its events only encourages underage consumption of alcohol.” In a national poll sponsored by the AMA, 62% of adults said the NCAA should reverse its policy and not allow beer companies to advertise during college sporting events. NCAA spokesman Erik Christianson said that the association already limits alcohol advertisements to 60 seconds per hour of any broadcast NCAA event. In addition, Mr. Christianson noted that the NCAA executive committee was already planning to discuss the idea of banning the advertisements completely at an upcoming meeting, in response to a request from one of its divisions.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, reported Richard L. Kravitz, M.D., of the University of California, Davis (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations to participate in the study, which focused on advertising for prescription antidepressants. Standardized patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil.

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is needed to maximize the participation of private plans in the Part D benefit and to help reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

Declining Mental Illness Stigma

A mental illness diagnosis does not result in the fear or shame that it used to, according to a recent survey by the American Psychiatric Association. Nearly 90% of the 1,000 adults surveyed said that people with mental illness could live healthy lives, and 80% said mental health treatment was effective. In addition, 70% said seeing a psychiatrist was a sign of strength, according to the APA. Despite those encouraging signs, however, there were also some disturbing results, the association noted in a statement. For instance, 20% of respondents said they would not see a psychiatrist under any circumstances, and 57% said they were not concerned that they themselves or a family member might ever having to deal with a mental illness.

Mental Health Coverage Trends

The Mental Health Parity Act of 1996 has resulted in some gains in employee mental health coverage, but inequities remain, according to a report from the U.S. Department of Labor. Since the passage of the act, which requires employers to equalize dollar benefits for mental health and physical health coverage, the incidence of employees in medical plans that impose more restrictive dollar limits on inpatient mental health care coverage has decreased from 41% in 1997 to 7% in 2002. However, employees in plans that contain tighter restrictions on the number of days of inpatient mental health care compared with inpatient medical and surgical care–a disparity allowed under the law–rose from 61% to 77% in the same period. Differences in substance abuse coverage also remained, with only 8% of employees who had coverage for alcoholism treatment receiving the same coverage for that condition as for other conditions in 2002.

Depression and Marijuana Use

The evidence for a link between marijuana use and depression is getting stronger, according to the White House Office for National Drug Control Policy. “There certainly are people who self medicate, but the danger we're talking about is the growing evidence that use itself … may be triggering and may be worsening the onset of mental health problems,” ONDCP Director John Walters said at a Washington press conference. “Now, would some of those people have mental health problems anyway? That's entirely possible. But it's also entirely possible that some of these people may not subsequently show these mental health problems, and the evidence suggests that the use of marijuana may trigger the onset of problems that would not otherwise be there.” According to the office's National Survey on Drug Use and Health, among persons aged 18 years or older, those who first used marijuana before age 12 were twice as likely to have serious mental illness in the past year as those were who first used marijuana at age 18 or older.

AMA: Ban Booze Ads at NCAA Events

The American Medical Association has asked the National Collegiate Athletic Association to eliminate alcohol advertising associated with NCAA events. “The prevalence of alcohol advertising in college sports sends a damaging message about the core values of the NCAA and higher education,” AMA President-elect J. Edward Hill, M.D., said in a statement. “Allowing aggressive alcohol advertising during its events only encourages underage consumption of alcohol.” In a national poll sponsored by the AMA, 62% of adults said the NCAA should reverse its policy and not allow beer companies to advertise during college sporting events. NCAA spokesman Erik Christianson said that the association already limits alcohol advertisements to 60 seconds per hour of any broadcast NCAA event. In addition, Mr. Christianson noted that the NCAA executive committee was already planning to discuss the idea of banning the advertisements completely at an upcoming meeting, in response to a request from one of its divisions.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, reported Richard L. Kravitz, M.D., of the University of California, Davis (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations to participate in the study, which focused on advertising for prescription antidepressants. Standardized patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil.

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is needed to maximize the participation of private plans in the Part D benefit and to help reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

Declining Mental Illness Stigma

A mental illness diagnosis does not result in the fear or shame that it used to, according to a recent survey by the American Psychiatric Association. Nearly 90% of the 1,000 adults surveyed said that people with mental illness could live healthy lives, and 80% said mental health treatment was effective. In addition, 70% said seeing a psychiatrist was a sign of strength, according to the APA. Despite those encouraging signs, however, there were also some disturbing results, the association noted in a statement. For instance, 20% of respondents said they would not see a psychiatrist under any circumstances, and 57% said they were not concerned that they themselves or a family member might ever having to deal with a mental illness.

Mental Health Coverage Trends

The Mental Health Parity Act of 1996 has resulted in some gains in employee mental health coverage, but inequities remain, according to a report from the U.S. Department of Labor. Since the passage of the act, which requires employers to equalize dollar benefits for mental health and physical health coverage, the incidence of employees in medical plans that impose more restrictive dollar limits on inpatient mental health care coverage has decreased from 41% in 1997 to 7% in 2002. However, employees in plans that contain tighter restrictions on the number of days of inpatient mental health care compared with inpatient medical and surgical care–a disparity allowed under the law–rose from 61% to 77% in the same period. Differences in substance abuse coverage also remained, with only 8% of employees who had coverage for alcoholism treatment receiving the same coverage for that condition as for other conditions in 2002.

Depression and Marijuana Use

The evidence for a link between marijuana use and depression is getting stronger, according to the White House Office for National Drug Control Policy. “There certainly are people who self medicate, but the danger we're talking about is the growing evidence that use itself … may be triggering and may be worsening the onset of mental health problems,” ONDCP Director John Walters said at a Washington press conference. “Now, would some of those people have mental health problems anyway? That's entirely possible. But it's also entirely possible that some of these people may not subsequently show these mental health problems, and the evidence suggests that the use of marijuana may trigger the onset of problems that would not otherwise be there.” According to the office's National Survey on Drug Use and Health, among persons aged 18 years or older, those who first used marijuana before age 12 were twice as likely to have serious mental illness in the past year as those were who first used marijuana at age 18 or older.

AMA: Ban Booze Ads at NCAA Events

The American Medical Association has asked the National Collegiate Athletic Association to eliminate alcohol advertising associated with NCAA events. “The prevalence of alcohol advertising in college sports sends a damaging message about the core values of the NCAA and higher education,” AMA President-elect J. Edward Hill, M.D., said in a statement. “Allowing aggressive alcohol advertising during its events only encourages underage consumption of alcohol.” In a national poll sponsored by the AMA, 62% of adults said the NCAA should reverse its policy and not allow beer companies to advertise during college sporting events. NCAA spokesman Erik Christianson said that the association already limits alcohol advertisements to 60 seconds per hour of any broadcast NCAA event. In addition, Mr. Christianson noted that the NCAA executive committee was already planning to discuss the idea of banning the advertisements completely at an upcoming meeting, in response to a request from one of its divisions.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, reported Richard L. Kravitz, M.D., of the University of California, Davis (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations to participate in the study, which focused on advertising for prescription antidepressants. Standardized patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil.

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is needed to maximize the participation of private plans in the Part D benefit and to help reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established, and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa.

“When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?',” he said.

In fact, such changes have already begun to occur, he added.

“We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said that the feeling of partnership that comes from empowering consumers should spill over onto the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

In fact, physicians also have much to gain from being able to access hospital quality data, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum as well—both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals to specialists,” she said.

“We can't underestimate the impact that transparency has on changing everything. I feel very optimistic this will lead to lot of positive changes.”

One panelist warned that empowerment does have its limits. Charles N. “Chip” Kahn, president of the Federation of American Hospitals, said that as databases such as Hospital Compare begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out other than, 'This is either an okay place or a dreadful place' and you obviously want to stay away from dreadful places.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

Ms. O'Kane said she was confident that “intermediaries” would rise up to help consumers interpret the database information. And she also had a prediction.

“What we've seen so far is not hospitals that are excellent at everything or terrible at everything, but hospitals that are excellent at one thing and maybe not so great at others,” she said.

“As process engineering becomes more core to the hospitals, you'll see hospitals that will break out and be excellent across the board,” Ms. O'Kane predicted.

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established, and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa.

“When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?',” he said.

In fact, such changes have already begun to occur, he added.

“We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said that the feeling of partnership that comes from empowering consumers should spill over onto the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

In fact, physicians also have much to gain from being able to access hospital quality data, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum as well—both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals to specialists,” she said.

“We can't underestimate the impact that transparency has on changing everything. I feel very optimistic this will lead to lot of positive changes.”

One panelist warned that empowerment does have its limits. Charles N. “Chip” Kahn, president of the Federation of American Hospitals, said that as databases such as Hospital Compare begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out other than, 'This is either an okay place or a dreadful place' and you obviously want to stay away from dreadful places.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

Ms. O'Kane said she was confident that “intermediaries” would rise up to help consumers interpret the database information. And she also had a prediction.

“What we've seen so far is not hospitals that are excellent at everything or terrible at everything, but hospitals that are excellent at one thing and maybe not so great at others,” she said.

“As process engineering becomes more core to the hospitals, you'll see hospitals that will break out and be excellent across the board,” Ms. O'Kane predicted.

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established, and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa.

“When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?',” he said.

In fact, such changes have already begun to occur, he added.

“We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said that the feeling of partnership that comes from empowering consumers should spill over onto the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

In fact, physicians also have much to gain from being able to access hospital quality data, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum as well—both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals to specialists,” she said.

“We can't underestimate the impact that transparency has on changing everything. I feel very optimistic this will lead to lot of positive changes.”

One panelist warned that empowerment does have its limits. Charles N. “Chip” Kahn, president of the Federation of American Hospitals, said that as databases such as Hospital Compare begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out other than, 'This is either an okay place or a dreadful place' and you obviously want to stay away from dreadful places.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

Ms. O'Kane said she was confident that “intermediaries” would rise up to help consumers interpret the database information. And she also had a prediction.

“What we've seen so far is not hospitals that are excellent at everything or terrible at everything, but hospitals that are excellent at one thing and maybe not so great at others,” she said.

“As process engineering becomes more core to the hospitals, you'll see hospitals that will break out and be excellent across the board,” Ms. O'Kane predicted.

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug—a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold—plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. "There are certain drugs that I use that I can't buy for ASP plus 6%."

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. "The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'" Mr. Thompson said at the meeting.

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use "on a drug-by-drug basis." That recommendation passed easily.

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries who couldn't afford the copays.

"The contractor would be required to supply that drug to you," Mr. Thompson replied. "If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians," who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further. "These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?" he asked.

Mr. Thompson seemed to answer in the affirmative. "We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary," he said.

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug—a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold—plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. "There are certain drugs that I use that I can't buy for ASP plus 6%."

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. "The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'" Mr. Thompson said at the meeting.

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use "on a drug-by-drug basis." That recommendation passed easily.

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries who couldn't afford the copays.

"The contractor would be required to supply that drug to you," Mr. Thompson replied. "If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians," who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further. "These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?" he asked.

Mr. Thompson seemed to answer in the affirmative. "We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary," he said.

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug—a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold—plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. "There are certain drugs that I use that I can't buy for ASP plus 6%."

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. "The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'" Mr. Thompson said at the meeting.

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use "on a drug-by-drug basis." That recommendation passed easily.

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries who couldn't afford the copays.

"The contractor would be required to supply that drug to you," Mr. Thompson replied. "If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians," who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further. "These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?" he asked.

Mr. Thompson seemed to answer in the affirmative. "We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary," he said.

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

"I spent 2 years studying what went wrong in the Clinton debacle," he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful effort to get Congress to pass health care reform in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: "There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail."

Instead, "I decided to go 180 degrees the other way," he said. "We'll start it outside [Washington]."

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the working group will do, according to Sen. Wyden, is "tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised." The information will be made available online as well as in booklets and in libraries.

The working group also will hold public hearings to get input on what should be done to reform the system. "No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody," he said. "We're now going to have a real debate about how we create a system that works for everybody."

After publishing the spending information and listening to public comment, the working group will develop a set of tentative recommendations on a system that works for everybody.

"When they have the tentative set of recommendations, they go back to the public again for another crack," Sen. Wyden said. Then the recommendations go to Congress, and all committees with jurisdiction over health care will have to hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, "you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens," he said.

Sen. Wyden gave a specific example of the type of issue he hopes the working group will address. "We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life, and they can't do anything that's medically effective," he said.

"So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions?"

Even the semantics surrounding these issues are difficult to deal with, Sen. Wyden noted. For example, "it took me 3 months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'"

For more information on the working group, go to www.gao.gov/special.pubs/citizenshealthpr0228.pdf

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

"I spent 2 years studying what went wrong in the Clinton debacle," he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful effort to get Congress to pass health care reform in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: "There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail."

Instead, "I decided to go 180 degrees the other way," he said. "We'll start it outside [Washington]."

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the working group will do, according to Sen. Wyden, is "tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised." The information will be made available online as well as in booklets and in libraries.

The working group also will hold public hearings to get input on what should be done to reform the system. "No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody," he said. "We're now going to have a real debate about how we create a system that works for everybody."

After publishing the spending information and listening to public comment, the working group will develop a set of tentative recommendations on a system that works for everybody.

"When they have the tentative set of recommendations, they go back to the public again for another crack," Sen. Wyden said. Then the recommendations go to Congress, and all committees with jurisdiction over health care will have to hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, "you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens," he said.

Sen. Wyden gave a specific example of the type of issue he hopes the working group will address. "We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life, and they can't do anything that's medically effective," he said.

"So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions?"

Even the semantics surrounding these issues are difficult to deal with, Sen. Wyden noted. For example, "it took me 3 months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'"

For more information on the working group, go to www.gao.gov/special.pubs/citizenshealthpr0228.pdf

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

"I spent 2 years studying what went wrong in the Clinton debacle," he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful effort to get Congress to pass health care reform in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: "There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail."

Instead, "I decided to go 180 degrees the other way," he said. "We'll start it outside [Washington]."

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the working group will do, according to Sen. Wyden, is "tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised." The information will be made available online as well as in booklets and in libraries.

The working group also will hold public hearings to get input on what should be done to reform the system. "No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody," he said. "We're now going to have a real debate about how we create a system that works for everybody."

After publishing the spending information and listening to public comment, the working group will develop a set of tentative recommendations on a system that works for everybody.

"When they have the tentative set of recommendations, they go back to the public again for another crack," Sen. Wyden said. Then the recommendations go to Congress, and all committees with jurisdiction over health care will have to hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, "you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens," he said.

Sen. Wyden gave a specific example of the type of issue he hopes the working group will address. "We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life, and they can't do anything that's medically effective," he said.

"So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions?"

Even the semantics surrounding these issues are difficult to deal with, Sen. Wyden noted. For example, "it took me 3 months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'"

For more information on the working group, go to www.gao.gov/special.pubs/citizenshealthpr0228.pdf

WASHINGTON — Consumer-driven health care may be all the rage right now, but there's no single cure for the nation's ailing health care system, several experts said at a health care congress sponsored by the Wall Street Journal and CNBC.

"There are no silver bullets," said Douglas Holtz-Eakin, Ph.D., director of the Congressional Budget Office (CBO). "There is no single item—technology, disease management, tort law—that is likely to prove to be the answer to aligning incentives, providing high-quality care at reasonable costs, and financing it in a way that's economically viable. More likely, we'll have a series of incremental changes" that will shore up the system.

"Rising health care costs represent the central domestic issue at this time," Dr. Holtz-Eakin said. For example, over the next 50 years, if nothing is done, "the cost of Medicare and Medicaid will rise from 4% of the gross domestic product to 20%—the current size of the entire federal budget."

Because the population is aging, "we indeed may spend more than we do now" on health care, Dr. Holtz-Eakin continued. "But the key issue is to make sure we do not overspend, that the dollars per unit of high-quality care match up with our desires."

Robert Reischauer, Ph.D., a former CBO director who is now president of the Urban Institute, noted that Medicare was a particular concern, since Medicare spending is expected to grow very rapidly over the next 10 years. He listed four possible solutions for the Medicare budget crisis.

The first possibility is to reduce the scope of coverage, but "that isn't a practical course of action," he said. "All forces are moving in just the opposite direction."

Another option is to restrain the growth in payments to providers, but already, Medicare is considered "not too generous," compared with private payers, since it pays on average only about 80% of the private rate. "[Payment restraint] is clearly not going to happen," he said.

The third option is to make beneficiaries pay more for care in the form of higher premiums, deductibles, and cost sharing.

"Some people think that will cause beneficiaries to purchase more rationally and cut out low-value services, but we have to remember, the vast bulk of spending is on individuals who are very sick, have many chronic conditions, and aren't in a position to comparison-shop," he said. "Moreover, the services that they're purchasing are extremely complex and confusing, and providers play a very significant role in determining the demand for and type of services received by beneficiaries.

"Before we bet the ranch on this approach," he continued, "we're going to have to see what happens to spending patterns among the under-65 population as they are faced with high-deductible plans, health savings accounts, consumer-driven health plans, and other approaches to incentivize them to purchase more rationally. If this proves to be a successful approach for the under-65 population, one can see it gradually angling into the bag of tools that Medicare has."

However, Dr. Reischauer noted, the potential for shifting more costs onto beneficiaries is limited, "because they already spend a considerable amount of their incomes on Medicare cost-sharing of one sort or another. By 2025, the average 65-year-old Medicare beneficiary will be paying more than the size of their Social Security check in cost-sharing and deductibles."

A fourth approach is to restructure Medicare in ways to generate competition among providers, Dr. Reischauer said. This would mean emphasizing technologies that improve efficiency, such as electronic health records and electronic prescribing. It also would involve decreasing the volume of unneeded services being provided.

He noted that researchers at Dartmouth University have looked at health care utilization across geographic areas and found that beneficiaries receiving higher volumes of services generally have poorer health outcomes, even after differences in their health status are accounted for.

"It's conceivable that as our ability to measure differences in quality and to reward quality effectively improves, the Medicare system could be transformed into one that pays only for care which is both necessary and beneficial, but this is likely to be a long and difficult row to hoe," he said.

Gail Wilensky, a former administrator of the Centers for Medicare and Medicaid Services who is now a senior fellow at Project HOPE, in Bethesda, Md., expressed disappointment that Congress did not do more to address the issue of rising costs when it passed the Medicare Modernization Act of 2003.

That law "is a good example of eating dessert first," she said. "There was an opportunity to try and slow down spending in a significant way while a new benefit was being introduced, but primarily, what [the law] does is provide a new benefit and some additional payments to providers of services, but not very much in terms of trying to restructure Medicare for the future."

One little-known provision of the law does attempt to address the cost issue, she added. "Starting in 2007, Part B will be much more related to income. The subsidy will start declining significantly for those with higher incomes. As the baby boomers begin to retire, some of them with higher incomes and assets, this is at least one opportunity" to help with the cost problem.

Americans are going to need to rethink the entire issue of retirement, Dr. Wilensky predicted.

"A couple of weeks ago, [Rep.] Bill Thomas [R-Calif.] talked about the need to think about Social Security and Medicare together. Both represent transfers from the working population to the dependent, nonworking population. To begin thinking about this as a joint issue may allow us to make more sensible decisions," Dr. Wilensky said.

For example, Americans should consider "how we can change both fiscal policies and cultural expectations so our whole concept of retirement begins to … reflect the increasing longevity and, for many individuals, the increased well-being and health status they have at age 65 relative to what 65 meant when Medicare was introduced in 1965," she said. "We need to think about fiscal policies to encourage continued labor force participation for people at 65 and 70."

WASHINGTON — Consumer-driven health care may be all the rage right now, but there's no single cure for the nation's ailing health care system, several experts said at a health care congress sponsored by the Wall Street Journal and CNBC.

"There are no silver bullets," said Douglas Holtz-Eakin, Ph.D., director of the Congressional Budget Office (CBO). "There is no single item—technology, disease management, tort law—that is likely to prove to be the answer to aligning incentives, providing high-quality care at reasonable costs, and financing it in a way that's economically viable. More likely, we'll have a series of incremental changes" that will shore up the system.

"Rising health care costs represent the central domestic issue at this time," Dr. Holtz-Eakin said. For example, over the next 50 years, if nothing is done, "the cost of Medicare and Medicaid will rise from 4% of the gross domestic product to 20%—the current size of the entire federal budget."

Because the population is aging, "we indeed may spend more than we do now" on health care, Dr. Holtz-Eakin continued. "But the key issue is to make sure we do not overspend, that the dollars per unit of high-quality care match up with our desires."

Robert Reischauer, Ph.D., a former CBO director who is now president of the Urban Institute, noted that Medicare was a particular concern, since Medicare spending is expected to grow very rapidly over the next 10 years. He listed four possible solutions for the Medicare budget crisis.

The first possibility is to reduce the scope of coverage, but "that isn't a practical course of action," he said. "All forces are moving in just the opposite direction."

Another option is to restrain the growth in payments to providers, but already, Medicare is considered "not too generous," compared with private payers, since it pays on average only about 80% of the private rate. "[Payment restraint] is clearly not going to happen," he said.

The third option is to make beneficiaries pay more for care in the form of higher premiums, deductibles, and cost sharing.

"Some people think that will cause beneficiaries to purchase more rationally and cut out low-value services, but we have to remember, the vast bulk of spending is on individuals who are very sick, have many chronic conditions, and aren't in a position to comparison-shop," he said. "Moreover, the services that they're purchasing are extremely complex and confusing, and providers play a very significant role in determining the demand for and type of services received by beneficiaries.

"Before we bet the ranch on this approach," he continued, "we're going to have to see what happens to spending patterns among the under-65 population as they are faced with high-deductible plans, health savings accounts, consumer-driven health plans, and other approaches to incentivize them to purchase more rationally. If this proves to be a successful approach for the under-65 population, one can see it gradually angling into the bag of tools that Medicare has."

However, Dr. Reischauer noted, the potential for shifting more costs onto beneficiaries is limited, "because they already spend a considerable amount of their incomes on Medicare cost-sharing of one sort or another. By 2025, the average 65-year-old Medicare beneficiary will be paying more than the size of their Social Security check in cost-sharing and deductibles."

A fourth approach is to restructure Medicare in ways to generate competition among providers, Dr. Reischauer said. This would mean emphasizing technologies that improve efficiency, such as electronic health records and electronic prescribing. It also would involve decreasing the volume of unneeded services being provided.

He noted that researchers at Dartmouth University have looked at health care utilization across geographic areas and found that beneficiaries receiving higher volumes of services generally have poorer health outcomes, even after differences in their health status are accounted for.

"It's conceivable that as our ability to measure differences in quality and to reward quality effectively improves, the Medicare system could be transformed into one that pays only for care which is both necessary and beneficial, but this is likely to be a long and difficult row to hoe," he said.

Gail Wilensky, a former administrator of the Centers for Medicare and Medicaid Services who is now a senior fellow at Project HOPE, in Bethesda, Md., expressed disappointment that Congress did not do more to address the issue of rising costs when it passed the Medicare Modernization Act of 2003.

That law "is a good example of eating dessert first," she said. "There was an opportunity to try and slow down spending in a significant way while a new benefit was being introduced, but primarily, what [the law] does is provide a new benefit and some additional payments to providers of services, but not very much in terms of trying to restructure Medicare for the future."

One little-known provision of the law does attempt to address the cost issue, she added. "Starting in 2007, Part B will be much more related to income. The subsidy will start declining significantly for those with higher incomes. As the baby boomers begin to retire, some of them with higher incomes and assets, this is at least one opportunity" to help with the cost problem.

Americans are going to need to rethink the entire issue of retirement, Dr. Wilensky predicted.

"A couple of weeks ago, [Rep.] Bill Thomas [R-Calif.] talked about the need to think about Social Security and Medicare together. Both represent transfers from the working population to the dependent, nonworking population. To begin thinking about this as a joint issue may allow us to make more sensible decisions," Dr. Wilensky said.

For example, Americans should consider "how we can change both fiscal policies and cultural expectations so our whole concept of retirement begins to … reflect the increasing longevity and, for many individuals, the increased well-being and health status they have at age 65 relative to what 65 meant when Medicare was introduced in 1965," she said. "We need to think about fiscal policies to encourage continued labor force participation for people at 65 and 70."

WASHINGTON — Consumer-driven health care may be all the rage right now, but there's no single cure for the nation's ailing health care system, several experts said at a health care congress sponsored by the Wall Street Journal and CNBC.

"There are no silver bullets," said Douglas Holtz-Eakin, Ph.D., director of the Congressional Budget Office (CBO). "There is no single item—technology, disease management, tort law—that is likely to prove to be the answer to aligning incentives, providing high-quality care at reasonable costs, and financing it in a way that's economically viable. More likely, we'll have a series of incremental changes" that will shore up the system.

"Rising health care costs represent the central domestic issue at this time," Dr. Holtz-Eakin said. For example, over the next 50 years, if nothing is done, "the cost of Medicare and Medicaid will rise from 4% of the gross domestic product to 20%—the current size of the entire federal budget."

Because the population is aging, "we indeed may spend more than we do now" on health care, Dr. Holtz-Eakin continued. "But the key issue is to make sure we do not overspend, that the dollars per unit of high-quality care match up with our desires."

Robert Reischauer, Ph.D., a former CBO director who is now president of the Urban Institute, noted that Medicare was a particular concern, since Medicare spending is expected to grow very rapidly over the next 10 years. He listed four possible solutions for the Medicare budget crisis.

The first possibility is to reduce the scope of coverage, but "that isn't a practical course of action," he said. "All forces are moving in just the opposite direction."

Another option is to restrain the growth in payments to providers, but already, Medicare is considered "not too generous," compared with private payers, since it pays on average only about 80% of the private rate. "[Payment restraint] is clearly not going to happen," he said.

The third option is to make beneficiaries pay more for care in the form of higher premiums, deductibles, and cost sharing.

"Some people think that will cause beneficiaries to purchase more rationally and cut out low-value services, but we have to remember, the vast bulk of spending is on individuals who are very sick, have many chronic conditions, and aren't in a position to comparison-shop," he said. "Moreover, the services that they're purchasing are extremely complex and confusing, and providers play a very significant role in determining the demand for and type of services received by beneficiaries.

"Before we bet the ranch on this approach," he continued, "we're going to have to see what happens to spending patterns among the under-65 population as they are faced with high-deductible plans, health savings accounts, consumer-driven health plans, and other approaches to incentivize them to purchase more rationally. If this proves to be a successful approach for the under-65 population, one can see it gradually angling into the bag of tools that Medicare has."

However, Dr. Reischauer noted, the potential for shifting more costs onto beneficiaries is limited, "because they already spend a considerable amount of their incomes on Medicare cost-sharing of one sort or another. By 2025, the average 65-year-old Medicare beneficiary will be paying more than the size of their Social Security check in cost-sharing and deductibles."

A fourth approach is to restructure Medicare in ways to generate competition among providers, Dr. Reischauer said. This would mean emphasizing technologies that improve efficiency, such as electronic health records and electronic prescribing. It also would involve decreasing the volume of unneeded services being provided.

He noted that researchers at Dartmouth University have looked at health care utilization across geographic areas and found that beneficiaries receiving higher volumes of services generally have poorer health outcomes, even after differences in their health status are accounted for.

"It's conceivable that as our ability to measure differences in quality and to reward quality effectively improves, the Medicare system could be transformed into one that pays only for care which is both necessary and beneficial, but this is likely to be a long and difficult row to hoe," he said.

Gail Wilensky, a former administrator of the Centers for Medicare and Medicaid Services who is now a senior fellow at Project HOPE, in Bethesda, Md., expressed disappointment that Congress did not do more to address the issue of rising costs when it passed the Medicare Modernization Act of 2003.

That law "is a good example of eating dessert first," she said. "There was an opportunity to try and slow down spending in a significant way while a new benefit was being introduced, but primarily, what [the law] does is provide a new benefit and some additional payments to providers of services, but not very much in terms of trying to restructure Medicare for the future."

One little-known provision of the law does attempt to address the cost issue, she added. "Starting in 2007, Part B will be much more related to income. The subsidy will start declining significantly for those with higher incomes. As the baby boomers begin to retire, some of them with higher incomes and assets, this is at least one opportunity" to help with the cost problem.

Americans are going to need to rethink the entire issue of retirement, Dr. Wilensky predicted.

"A couple of weeks ago, [Rep.] Bill Thomas [R-Calif.] talked about the need to think about Social Security and Medicare together. Both represent transfers from the working population to the dependent, nonworking population. To begin thinking about this as a joint issue may allow us to make more sensible decisions," Dr. Wilensky said.

For example, Americans should consider "how we can change both fiscal policies and cultural expectations so our whole concept of retirement begins to … reflect the increasing longevity and, for many individuals, the increased well-being and health status they have at age 65 relative to what 65 meant when Medicare was introduced in 1965," she said. "We need to think about fiscal policies to encourage continued labor force participation for people at 65 and 70."

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa. “When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?'”

Such changes already have begun, he said. “We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said the feeling of partnership that comes from empowering consumers should spill over to the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

Physicians also have much to gain, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum —both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals,” she said.

One panelist warned empowerment does have its limits. Charles N. “Chip” Kahn, who is the president of the Federation of American Hospitals, said as databases begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa. “When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?'”

Such changes already have begun, he said. “We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said the feeling of partnership that comes from empowering consumers should spill over to the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

Physicians also have much to gain, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum —both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals,” she said.

One panelist warned empowerment does have its limits. Charles N. “Chip” Kahn, who is the president of the Federation of American Hospitals, said as databases begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

WASHINGTON — The new database on hospital quality from the Centers for Medicare and Medicaid Services may herald a new era in patient assertiveness in terms of health care preferences, several experts said at a briefing sponsored by the Alliance for Health Reform.

“We're beginning a change in how doctor-patient relations are established and [considering] how paternalistic they have been, I think we'll see major changes in the future where they become less that way,” said Elliot Sussman, M.D., president and CEO of Lehigh Valley Hospital and Health Network in Allentown, Pa. “When people come into a community, they'll look at measures like this and say, 'Which are the kinds of places I want to be cared for at, and who are doctors on staff at those places?'”

Such changes already have begun, he said. “We've seen experiences where people change their doctor relationship because 'I really like Dr. Jones, but he's not on the staff of what seems to be the best hospital. Either he does that or I'm going to find myself a new physician.'”

CMS launched its “Hospital Compare” database on April 1. Available online at www.hospitalcompare.hhs.gov

Gerald M. Shea, assistant to the president for government affairs at the AFL-CIO, said the feeling of partnership that comes from empowering consumers should spill over to the physician side of the equation.

“I could make the argument that there are very serious limits to how much consumers can drive change in the health decision making process,” he said. “An equally fruitful strategy would be trying to change the preparation and education of physicians, so they come to this suggesting that a partnership would be a good idea.”

Physicians also have much to gain, said Margaret E. O'Kane, president of the National Committee for Quality Assurance.

“Physicians have been working in an information vacuum —both doctors involved in performing particular procedures in the hospital, and the primary care physicians who are making referrals,” she said.

One panelist warned empowerment does have its limits. Charles N. “Chip” Kahn, who is the president of the Federation of American Hospitals, said as databases begin adding more measures, “it will be more and more difficult for the average consumer … to figure things out.”

In the end, he said, databases like this “are more about using accountability to improve care than they are about consumers making more decisions.”

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug —a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold —plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty; they could not get reimbursed ASP plus 6% for one drug and then buy another drug directly from the vendor, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. “There are certain drugs that I use that I can't buy for ASP plus 6%.”

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. “The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'” Mr. Thompson said at the meeting. “But once a drug is in a category, the physician cannot opt in and out for that drug.”

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use “on a drug-by-drug basis.” That recommendation passed easily.

Both Dr. Castellanos and council member Barbara McAneny, M.D., an Albuquerque oncologist, expressed concern about what would happen to beneficiaries —usually, those without Medicare supplemental coverage —who couldn't afford the copays for the drugs. “I want manufacturers to show up with free drugs for patients who have no bucks,” Dr. McAneny said. “Physicians, because we're not good businessmen, have eaten that money, but now it's hard to do that because we're not making enough on ASP plus 6%.”

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries even if they didn't have the needed copays.

“The contractor would be required to supply that drug to you,” Mr. Thompson replied. “If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians,” who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further.

“These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?” he asked during the meeting.

Mr. Thompson seemed to answer in the affirmative. “We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary,” he said.

Council members also wanted to make sure that they could get drugs for off-label use under the new system. The group has recommended that CMS require contractors to provide medications for off-label use “when the evidence supports such use.”

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug —a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold —plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty; they could not get reimbursed ASP plus 6% for one drug and then buy another drug directly from the vendor, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. “There are certain drugs that I use that I can't buy for ASP plus 6%.”

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. “The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'” Mr. Thompson said at the meeting. “But once a drug is in a category, the physician cannot opt in and out for that drug.”

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use “on a drug-by-drug basis.” That recommendation passed easily.

Both Dr. Castellanos and council member Barbara McAneny, M.D., an Albuquerque oncologist, expressed concern about what would happen to beneficiaries —usually, those without Medicare supplemental coverage —who couldn't afford the copays for the drugs. “I want manufacturers to show up with free drugs for patients who have no bucks,” Dr. McAneny said. “Physicians, because we're not good businessmen, have eaten that money, but now it's hard to do that because we're not making enough on ASP plus 6%.”

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries even if they didn't have the needed copays.

“The contractor would be required to supply that drug to you,” Mr. Thompson replied. “If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians,” who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further.

“These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?” he asked during the meeting.

Mr. Thompson seemed to answer in the affirmative. “We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary,” he said.

Council members also wanted to make sure that they could get drugs for off-label use under the new system. The group has recommended that CMS require contractors to provide medications for off-label use “when the evidence supports such use.”

WASHINGTON — Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.

Medicare currently pays physicians the average sales price (ASP) of the drug —a number that is supposed to represent the total paid for the drug by all buyers divided by the number of units sold —plus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.

The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty; they could not get reimbursed ASP plus 6% for one drug and then buy another drug directly from the vendor, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.

But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. “There are certain drugs that I use that I can't buy for ASP plus 6%.”

Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. “The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'” Mr. Thompson said at the meeting. “But once a drug is in a category, the physician cannot opt in and out for that drug.”

Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use “on a drug-by-drug basis.” That recommendation passed easily.

Both Dr. Castellanos and council member Barbara McAneny, M.D., an Albuquerque oncologist, expressed concern about what would happen to beneficiaries —usually, those without Medicare supplemental coverage —who couldn't afford the copays for the drugs. “I want manufacturers to show up with free drugs for patients who have no bucks,” Dr. McAneny said. “Physicians, because we're not good businessmen, have eaten that money, but now it's hard to do that because we're not making enough on ASP plus 6%.”

Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries even if they didn't have the needed copays.

“The contractor would be required to supply that drug to you,” Mr. Thompson replied. “If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians,” who can waive the copay on a case-by-case basis, he said.

Dr. Castellanos pressed further.

“These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?” he asked during the meeting.

Mr. Thompson seemed to answer in the affirmative. “We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary,” he said.

Council members also wanted to make sure that they could get drugs for off-label use under the new system. The group has recommended that CMS require contractors to provide medications for off-label use “when the evidence supports such use.”

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

“I spent 2 years studying what went wrong in the Clinton debacle,” he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful health care reform effort in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: “There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail.”

Instead, “I decided to go 180 degrees the other way,” he said. “We'll start it outside [Washington].”

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the group will do, according to Sen. Wyden, is “tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised.” The information will be made available online as well as in booklets and in libraries.

The group also will hold public hearings to get input on what should be done to reform the system. “No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody,” he said. “We're now going to have a real debate about how we create a system that works for everybody.”

After publishing the spending information and listening to public comment, the working group will develop recommendations on a system that works for everybody.

“When they have the tentative set of recommendations, they go back to the public again for another crack, so people will get to weigh in twice,” Sen. Wyden said. Then the proposals go to Congress, and all committees with jurisdiction over health care will hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, “you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens,” he said.

Sen. Wyden gave an example of the type of issue he hopes the group will address. “We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life.

“So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions, and use the savings for children, pregnant moms, and people who've fallen through the cracks in the system? It's a difficult conversation to have, but this is the kind of issue that we've got to” talk about.

Even semantics can be difficult, Sen. Wyden noted. “It took me three months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'”

Finally, the senator proposed the current title.

For more information on the working group, go towww.gao.gov/special.pubs/citizenshealthpr0228.pdf

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

“I spent 2 years studying what went wrong in the Clinton debacle,” he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful health care reform effort in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: “There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail.”

Instead, “I decided to go 180 degrees the other way,” he said. “We'll start it outside [Washington].”

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the group will do, according to Sen. Wyden, is “tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised.” The information will be made available online as well as in booklets and in libraries.

The group also will hold public hearings to get input on what should be done to reform the system. “No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody,” he said. “We're now going to have a real debate about how we create a system that works for everybody.”

After publishing the spending information and listening to public comment, the working group will develop recommendations on a system that works for everybody.

“When they have the tentative set of recommendations, they go back to the public again for another crack, so people will get to weigh in twice,” Sen. Wyden said. Then the proposals go to Congress, and all committees with jurisdiction over health care will hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, “you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens,” he said.

Sen. Wyden gave an example of the type of issue he hopes the group will address. “We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life.

“So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions, and use the savings for children, pregnant moms, and people who've fallen through the cracks in the system? It's a difficult conversation to have, but this is the kind of issue that we've got to” talk about.

Even semantics can be difficult, Sen. Wyden noted. “It took me three months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'”

Finally, the senator proposed the current title.

For more information on the working group, go towww.gao.gov/special.pubs/citizenshealthpr0228.pdf

WASHINGTON — Sen. Ron Wyden (D-Ore.) says that the answer to America's health care problem does not lie with Congress—at least, not initially.

“I spent 2 years studying what went wrong in the Clinton debacle,” he said at a meeting sponsored by America's Health Insurance Plans. Sen. Wyden was referring to President Bill Clinton's unsuccessful health care reform effort in the 1990s. He also looked at a similar effort in the 1940s by President Harry S Truman.

His conclusion: “There is a remarkable parallel in 60 years of failure. … For 6 decades, the effort has involved trying to write a piece of federal legislation in Washington, D.C. [But] the special interests would attack the legislation and each other, and everything would fail.”

Instead, “I decided to go 180 degrees the other way,” he said. “We'll start it outside [Washington].”

In March, Sen. Wyden, along with Sen. Orrin Hatch (R-Utah) and Comptroller General David Walker, announced the formation of the Citizens' Working Group on Health Care. The group is composed of 14 people from across the country, including physicians, health advocates, hospital administrators, academicians, nurses, and a union representative. Health and Human Services Secretary Mike Leavitt will serve as the 15th member.

The group is one result of a new law known as the Health Care That Works for All Americans Act, which was cosponsored by the two senators. One thing the group will do, according to Sen. Wyden, is “tell people where the $1.8 trillion spent on health care actually goes. … I think people will be pretty surprised.” The information will be made available online as well as in booklets and in libraries.

The group also will hold public hearings to get input on what should be done to reform the system. “No one has walked the public through the choices and tradeoffs that come with a health care system that works for everybody,” he said. “We're now going to have a real debate about how we create a system that works for everybody.”

After publishing the spending information and listening to public comment, the working group will develop recommendations on a system that works for everybody.

“When they have the tentative set of recommendations, they go back to the public again for another crack, so people will get to weigh in twice,” Sen. Wyden said. Then the proposals go to Congress, and all committees with jurisdiction over health care will hold hearings within 60 days of getting the recommendations.

Although there is no mandate for Congress to take any further action on the recommendations once it has held hearings, “you will have a citizens' road map of where the country feels we ought to be headed in health care, and if at that point the Congressional committees decide they want to ignore what the citizens have to say, then it will be really clear who they're siding with—powerful Washington interests rather than the citizens,” he said.

Sen. Wyden gave an example of the type of issue he hopes the group will address. “We know that a big chunk of the health care dollar gets spent in the last few months of someone's life. And we know in many of those instances, the best doctors and hospitals can't do anything to increase the quality of the person's life.

“So the question for the country that the political leaders have been ducking—and that they aren't going to be able to duck any longer—is, in those kinds of instances, do we want to start spending more money on hospice and in-home services and less on expensive treatments and interventions, and use the savings for children, pregnant moms, and people who've fallen through the cracks in the system? It's a difficult conversation to have, but this is the kind of issue that we've got to” talk about.

Even semantics can be difficult, Sen. Wyden noted. “It took me three months to negotiate the title of this bill. When we started, the Democrats wanted the words 'universal coverage,' but the Republicans said, 'We're not going there; that's socialism.' The Republicans wanted to call it universal access, but the Democrats said, 'We're not going there; no one will ever get anything.'”

Finally, the senator proposed the current title.

For more information on the working group, go towww.gao.gov/special.pubs/citizenshealthpr0228.pdf

Medicare Expands Stent Coverage

The Centers for Medicare and Medicaid Services (CMS) has expanded Medicare coverage of percutaneous transluminal angioplasty of the carotid artery concurrent with stent placement. Previously, CMS only covered carotid artery stenting in clinical trials being conducted prior to Food and Drug Administration approval and, more recently, in postapproval studies. The new policy expands coverage to include high-risk patients with symptomatic narrowing of the carotid artery of 70% or more.

'Migraine Calculator' Debuts

Employers will be able to calculate how much employees' migraines are costing their businesses, thanks to a new “migraine calculator” from the Pharmaceutical Research and Manufacturers of America (PhRMA). The calculator, developed by consulting firm HSM Group of Scottsdale, Ariz., estimates both the incidence of migraine and its financial impact based on the company's size, type of industry, location, and age and gender of employees. It also projects the potential net savings the company can expect if employees obtain treatment, taking the cost of treatment into account. The calculator “is an important tool that allows employers to see the whole picture on the economics and value of getting patients with migraines needed treatment,” said HSM Group president Sheryl Bronkesh. It is available at

http://www.migrainecalculator.com/Welcome.asp

Physicians Prefer Paper

When it comes to recording patient health information, most doctors and hospitals still prefer paper to the computer, the Centers for Disease Control and Prevention reported. Ambulatory medical care surveys conducted from 2001 to 2003 revealed that only 17% of physicians' offices had electronic medical records to support patient care. Less than a third of hospital facilities (31% of hospital emergency departments and 29% of outpatient departments) had electronic records. Physicians under age 50 years were twice as likely as those over that age to use computerized physician order entry systems, the CDC reported.

Chiropractic Coverage Demo

On April 1, CMS began covering an expanded array of chiropractic services provided to Medicare beneficiaries in Maine, New Mexico, and parts of Illinois, Iowa, and Virginia. Under the 2-year demonstration project, newly covered services include extraspinal manipulation, x-rays, EMG and nerve conduction studies, clinical lab tests, electrotherapy, ultrasound therapy, and evaluation and management services. Chiropractors also will be allowed to order MRIs, CT scans, and clinical lab services and to make referrals for physical therapy. Currently, Medicare chiropractic coverage is limited to manual spinal manipulation and therapy to treat neuromusculoskeletal conditions. “By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down,” said CMS Administrator Mark B. McClellan, M.D.

Bill on Livestock Antibiotics

Sen. Edward M. Kennedy (D-Mass.) and Sen. Olympia Snowe (R-Maine) have introduced a bill to cut down on the amount of antibiotics used in livestock, citing evidence that increased antibiotic use in animals leads to reduced effectiveness in humans. “Antibiotics are among the greatest miracles of modern medicine, yet we are destroying them faster than the pharmaceutical industry can create replacements,” Sen. Kennedy said in a statement. “If doctors lose these critical remedies, the most vulnerable among us will suffer the most—children, the elderly, and persons with HIV/AIDS, who are most in danger of resistant infections.” The measure would require the Food and Drug Administration to withdraw approval for nontherapeutic use of eight classes of antibiotics in food-producing animals after 2 years if the use has not been proven harmless during that time. It also requires manufacturers of animal drugs or drug-containing feed to make their sales records available to government regulators for tracking emerging antimicrobial resistance.

How Now, Mad Cow?

The Department of Agriculture appears to be considering returning “downer cattle” to the food supply. USDA is performing a surveillance program to see whether the ill cattle are infected with bovine spongiform encephalopathy (BSE). In testing 314,000 animals in the last year “we have not found another case of BSE,” Agriculture Secretary Mike Johanns told the Food and Agriculture Policy Conference.

Medicare Expands Stent Coverage

The Centers for Medicare and Medicaid Services (CMS) has expanded Medicare coverage of percutaneous transluminal angioplasty of the carotid artery concurrent with stent placement. Previously, CMS only covered carotid artery stenting in clinical trials being conducted prior to Food and Drug Administration approval and, more recently, in postapproval studies. The new policy expands coverage to include high-risk patients with symptomatic narrowing of the carotid artery of 70% or more.

'Migraine Calculator' Debuts

Employers will be able to calculate how much employees' migraines are costing their businesses, thanks to a new “migraine calculator” from the Pharmaceutical Research and Manufacturers of America (PhRMA). The calculator, developed by consulting firm HSM Group of Scottsdale, Ariz., estimates both the incidence of migraine and its financial impact based on the company's size, type of industry, location, and age and gender of employees. It also projects the potential net savings the company can expect if employees obtain treatment, taking the cost of treatment into account. The calculator “is an important tool that allows employers to see the whole picture on the economics and value of getting patients with migraines needed treatment,” said HSM Group president Sheryl Bronkesh. It is available at

http://www.migrainecalculator.com/Welcome.asp

Physicians Prefer Paper

When it comes to recording patient health information, most doctors and hospitals still prefer paper to the computer, the Centers for Disease Control and Prevention reported. Ambulatory medical care surveys conducted from 2001 to 2003 revealed that only 17% of physicians' offices had electronic medical records to support patient care. Less than a third of hospital facilities (31% of hospital emergency departments and 29% of outpatient departments) had electronic records. Physicians under age 50 years were twice as likely as those over that age to use computerized physician order entry systems, the CDC reported.

Chiropractic Coverage Demo

On April 1, CMS began covering an expanded array of chiropractic services provided to Medicare beneficiaries in Maine, New Mexico, and parts of Illinois, Iowa, and Virginia. Under the 2-year demonstration project, newly covered services include extraspinal manipulation, x-rays, EMG and nerve conduction studies, clinical lab tests, electrotherapy, ultrasound therapy, and evaluation and management services. Chiropractors also will be allowed to order MRIs, CT scans, and clinical lab services and to make referrals for physical therapy. Currently, Medicare chiropractic coverage is limited to manual spinal manipulation and therapy to treat neuromusculoskeletal conditions. “By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down,” said CMS Administrator Mark B. McClellan, M.D.

Bill on Livestock Antibiotics

Sen. Edward M. Kennedy (D-Mass.) and Sen. Olympia Snowe (R-Maine) have introduced a bill to cut down on the amount of antibiotics used in livestock, citing evidence that increased antibiotic use in animals leads to reduced effectiveness in humans. “Antibiotics are among the greatest miracles of modern medicine, yet we are destroying them faster than the pharmaceutical industry can create replacements,” Sen. Kennedy said in a statement. “If doctors lose these critical remedies, the most vulnerable among us will suffer the most—children, the elderly, and persons with HIV/AIDS, who are most in danger of resistant infections.” The measure would require the Food and Drug Administration to withdraw approval for nontherapeutic use of eight classes of antibiotics in food-producing animals after 2 years if the use has not been proven harmless during that time. It also requires manufacturers of animal drugs or drug-containing feed to make their sales records available to government regulators for tracking emerging antimicrobial resistance.

How Now, Mad Cow?

The Department of Agriculture appears to be considering returning “downer cattle” to the food supply. USDA is performing a surveillance program to see whether the ill cattle are infected with bovine spongiform encephalopathy (BSE). In testing 314,000 animals in the last year “we have not found another case of BSE,” Agriculture Secretary Mike Johanns told the Food and Agriculture Policy Conference.

Medicare Expands Stent Coverage

The Centers for Medicare and Medicaid Services (CMS) has expanded Medicare coverage of percutaneous transluminal angioplasty of the carotid artery concurrent with stent placement. Previously, CMS only covered carotid artery stenting in clinical trials being conducted prior to Food and Drug Administration approval and, more recently, in postapproval studies. The new policy expands coverage to include high-risk patients with symptomatic narrowing of the carotid artery of 70% or more.

'Migraine Calculator' Debuts

Employers will be able to calculate how much employees' migraines are costing their businesses, thanks to a new “migraine calculator” from the Pharmaceutical Research and Manufacturers of America (PhRMA). The calculator, developed by consulting firm HSM Group of Scottsdale, Ariz., estimates both the incidence of migraine and its financial impact based on the company's size, type of industry, location, and age and gender of employees. It also projects the potential net savings the company can expect if employees obtain treatment, taking the cost of treatment into account. The calculator “is an important tool that allows employers to see the whole picture on the economics and value of getting patients with migraines needed treatment,” said HSM Group president Sheryl Bronkesh. It is available at

http://www.migrainecalculator.com/Welcome.asp

Physicians Prefer Paper

When it comes to recording patient health information, most doctors and hospitals still prefer paper to the computer, the Centers for Disease Control and Prevention reported. Ambulatory medical care surveys conducted from 2001 to 2003 revealed that only 17% of physicians' offices had electronic medical records to support patient care. Less than a third of hospital facilities (31% of hospital emergency departments and 29% of outpatient departments) had electronic records. Physicians under age 50 years were twice as likely as those over that age to use computerized physician order entry systems, the CDC reported.

Chiropractic Coverage Demo

On April 1, CMS began covering an expanded array of chiropractic services provided to Medicare beneficiaries in Maine, New Mexico, and parts of Illinois, Iowa, and Virginia. Under the 2-year demonstration project, newly covered services include extraspinal manipulation, x-rays, EMG and nerve conduction studies, clinical lab tests, electrotherapy, ultrasound therapy, and evaluation and management services. Chiropractors also will be allowed to order MRIs, CT scans, and clinical lab services and to make referrals for physical therapy. Currently, Medicare chiropractic coverage is limited to manual spinal manipulation and therapy to treat neuromusculoskeletal conditions. “By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down,” said CMS Administrator Mark B. McClellan, M.D.

Bill on Livestock Antibiotics

Sen. Edward M. Kennedy (D-Mass.) and Sen. Olympia Snowe (R-Maine) have introduced a bill to cut down on the amount of antibiotics used in livestock, citing evidence that increased antibiotic use in animals leads to reduced effectiveness in humans. “Antibiotics are among the greatest miracles of modern medicine, yet we are destroying them faster than the pharmaceutical industry can create replacements,” Sen. Kennedy said in a statement. “If doctors lose these critical remedies, the most vulnerable among us will suffer the most—children, the elderly, and persons with HIV/AIDS, who are most in danger of resistant infections.” The measure would require the Food and Drug Administration to withdraw approval for nontherapeutic use of eight classes of antibiotics in food-producing animals after 2 years if the use has not been proven harmless during that time. It also requires manufacturers of animal drugs or drug-containing feed to make their sales records available to government regulators for tracking emerging antimicrobial resistance.

How Now, Mad Cow?

The Department of Agriculture appears to be considering returning “downer cattle” to the food supply. USDA is performing a surveillance program to see whether the ill cattle are infected with bovine spongiform encephalopathy (BSE). In testing 314,000 animals in the last year “we have not found another case of BSE,” Agriculture Secretary Mike Johanns told the Food and Agriculture Policy Conference.

Although the recent spotlight has been on what the federal government will do to rein in the rising numbers of medical imaging procedures, states also are doing their part.

In Maryland, state law requires that only licensed radiologists perform advanced imaging procedures such as CTs, MRIs, or PET scans. Radiologists say that laws like this help decrease the use of inappropriate imaging, which they say is done largely by nonradiologists who use the equipment in their offices.

“We believe Maryland's law is a model that we would like to see in other states,” said Josh Cooper, senior director of government relations at the American College of Radiology, in Reston, Va. Florida has a similar law, but it is not as restrictive as Maryland's, he said.

Another way states are trying to manage the use of imaging equipment is through “certificate of need” laws that require physicians and others setting up imaging facilities to obtain a certificate of need to document that there is a demand in the community for such a facility. Rhode Island has such a law, Mr. Cooper said.

While the radiologists and their college are keen to support state and federal laws that limit imaging utilization, other physicians say the radiologists are just trying to keep the business for themselves.

“The radiology community … claims that growth in imaging is due to 'self-referral' by physicians who own their imaging equipment, and that the quality of images and interpretations by nonradiologists is inferior to those by radiologists,” the Lewin Group, a Falls Church, Va., consulting firm, said in a report for the Coalition for Patient-Centered Imaging, a coalition of medical specialties that wants specialists to be able to perform in-office imaging procedures.

“Our findings suggest that self-referral is not the primary driver of growth in imaging services. Some of the fastest-growing imaging services, such as MRI and CT scans, are primarily done by radiologists.”

State legislatures are seeking fresh approaches to the issue. A bill currently in the California legislature would exempt only radiologists and cardiac rehabilitation physicians from a ban on physician self-referral.

The California Medical Association (CMA) is opposed to the bill, according to spokeswoman Karen Nikos. The group's opposition is based on its self-referral policy, adopted in 1993, which states: “While CMA recognizes that there is nothing inherently wrong when a physician invests in a facility or when a physician refers a patient to a facility in which the physician has an ownership interest, CMA recognizes that serious ethical questions are raised when referrals are made purely for a profit motive.

“CMA has a responsibility to create policy and support legislation that would prevent abusive practices such as overutilization and overcharging.”

Although the recent spotlight has been on what the federal government will do to rein in the rising numbers of medical imaging procedures, states also are doing their part.

In Maryland, state law requires that only licensed radiologists perform advanced imaging procedures such as CTs, MRIs, or PET scans. Radiologists say that laws like this help decrease the use of inappropriate imaging, which they say is done largely by nonradiologists who use the equipment in their offices.

“We believe Maryland's law is a model that we would like to see in other states,” said Josh Cooper, senior director of government relations at the American College of Radiology, in Reston, Va. Florida has a similar law, but it is not as restrictive as Maryland's, he said.

Another way states are trying to manage the use of imaging equipment is through “certificate of need” laws that require physicians and others setting up imaging facilities to obtain a certificate of need to document that there is a demand in the community for such a facility. Rhode Island has such a law, Mr. Cooper said.

While the radiologists and their college are keen to support state and federal laws that limit imaging utilization, other physicians say the radiologists are just trying to keep the business for themselves.

“The radiology community … claims that growth in imaging is due to 'self-referral' by physicians who own their imaging equipment, and that the quality of images and interpretations by nonradiologists is inferior to those by radiologists,” the Lewin Group, a Falls Church, Va., consulting firm, said in a report for the Coalition for Patient-Centered Imaging, a coalition of medical specialties that wants specialists to be able to perform in-office imaging procedures.

“Our findings suggest that self-referral is not the primary driver of growth in imaging services. Some of the fastest-growing imaging services, such as MRI and CT scans, are primarily done by radiologists.”

State legislatures are seeking fresh approaches to the issue. A bill currently in the California legislature would exempt only radiologists and cardiac rehabilitation physicians from a ban on physician self-referral.

The California Medical Association (CMA) is opposed to the bill, according to spokeswoman Karen Nikos. The group's opposition is based on its self-referral policy, adopted in 1993, which states: “While CMA recognizes that there is nothing inherently wrong when a physician invests in a facility or when a physician refers a patient to a facility in which the physician has an ownership interest, CMA recognizes that serious ethical questions are raised when referrals are made purely for a profit motive.

“CMA has a responsibility to create policy and support legislation that would prevent abusive practices such as overutilization and overcharging.”

Although the recent spotlight has been on what the federal government will do to rein in the rising numbers of medical imaging procedures, states also are doing their part.

In Maryland, state law requires that only licensed radiologists perform advanced imaging procedures such as CTs, MRIs, or PET scans. Radiologists say that laws like this help decrease the use of inappropriate imaging, which they say is done largely by nonradiologists who use the equipment in their offices.

“We believe Maryland's law is a model that we would like to see in other states,” said Josh Cooper, senior director of government relations at the American College of Radiology, in Reston, Va. Florida has a similar law, but it is not as restrictive as Maryland's, he said.

Another way states are trying to manage the use of imaging equipment is through “certificate of need” laws that require physicians and others setting up imaging facilities to obtain a certificate of need to document that there is a demand in the community for such a facility. Rhode Island has such a law, Mr. Cooper said.

While the radiologists and their college are keen to support state and federal laws that limit imaging utilization, other physicians say the radiologists are just trying to keep the business for themselves.

“The radiology community … claims that growth in imaging is due to 'self-referral' by physicians who own their imaging equipment, and that the quality of images and interpretations by nonradiologists is inferior to those by radiologists,” the Lewin Group, a Falls Church, Va., consulting firm, said in a report for the Coalition for Patient-Centered Imaging, a coalition of medical specialties that wants specialists to be able to perform in-office imaging procedures.

“Our findings suggest that self-referral is not the primary driver of growth in imaging services. Some of the fastest-growing imaging services, such as MRI and CT scans, are primarily done by radiologists.”

State legislatures are seeking fresh approaches to the issue. A bill currently in the California legislature would exempt only radiologists and cardiac rehabilitation physicians from a ban on physician self-referral.

The California Medical Association (CMA) is opposed to the bill, according to spokeswoman Karen Nikos. The group's opposition is based on its self-referral policy, adopted in 1993, which states: “While CMA recognizes that there is nothing inherently wrong when a physician invests in a facility or when a physician refers a patient to a facility in which the physician has an ownership interest, CMA recognizes that serious ethical questions are raised when referrals are made purely for a profit motive.

“CMA has a responsibility to create policy and support legislation that would prevent abusive practices such as overutilization and overcharging.”