Leanne Sullivan

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such renal insufficiency and diabetes that are common in the Medicare population.

To improve the relevance of the data used for coverage decisions, the authors suggested that future studies include demographic information. They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

Of 135 studies that reported clinical trial location, most (51.1%) were done in Europe. DR. REDBERG

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such renal insufficiency and diabetes that are common in the Medicare population.

To improve the relevance of the data used for coverage decisions, the authors suggested that future studies include demographic information. They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

Of 135 studies that reported clinical trial location, most (51.1%) were done in Europe. DR. REDBERG

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such renal insufficiency and diabetes that are common in the Medicare population.

To improve the relevance of the data used for coverage decisions, the authors suggested that future studies include demographic information. They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

Of 135 studies that reported clinical trial location, most (51.1%) were done in Europe. DR. REDBERG

Sleep-disordered breathing in hospitalized patients is more common in those who are obese and those who have heart failure.

“There may be more [sleep-disordered breathing] in hospitalized patients than has been recognized,” concluded Dr. Kim Goring and Dr. Nancy Collop, of Johns Hopkins University Hospital and Bayview Medical Center, both in Baltimore.

“There is a need for a higher clinical suspicion, especially in patients with underlying cardiopulmonary disease,” the researchers said.

In a chart review of 94 inpatients referred for polysomnography at two tertiary care facilities, a body mass index (BMI) of 40 kg/m

The patients (51 women, 43 men) were admitted to Johns Hopkins or Bayview between January 2003 and September 2004 for acute illnesses, mostly chronic obstructive pulmonary disease or heart failure; the next most common diagnoses were interstitial lung disease, acute pulmonary embolism, and pulmonary hypertension.

The mean age of the participants was 54 years (range, 20–82 years), and their mean BMI was 40 (range, 18–70). Of the total sample, 86% were obese (BMI greater than 30), the researchers reported.

The patients underwent overnight polysomnography to detect sleep apnea (defined as complete or almost complete cessation of airflow—less than 25% of baseline—lasting 10 seconds or longer) and hypopnea (defined as a fall in oxygen saturation of at least 4%, or an arousal from sleep). An apnea-hypopnea index (AHI) greater than 10 was classified as sleep-disordered breathing (J. Clin. Sleep Med. 2008;4:105–10).

Of the 94 patients, 77% had sleep-disordered breathing, and of those with the condition, 95% had obstructive sleep apnea.

“This high prevalence of [sleep-disordered breathing] is most likely due to the overwhelming influence of obesity,” Dr. Goring and Dr. Collop wrote. They found “a statistically significant increase in the [odds ratio] of sleep apnea with every unit increase in BMI” after adjusting for all other variables, with the vast majority of the study patients with a BMI over 40 positive for sleep apnea.

Weight has been shown to strongly predict sleep-disordered breathing. In this study, “there was a probable bias on the part of the referring physicians in targeting obese patients for inpatient polysomnography, given that 86% of those referred were obese.”

Although 60% of normal-weight patients with interstitial lung disease, neuromuscular disease, or acute pulmonary embolism had sleep-disordered breathing, it was difficult to draw statistically significant conclusions because of the small numbers of subjects, they wrote.

The association between sleep apnea and heart failure was significant, but the investigators cited difficulty in assessing the effect of obesity on the likelihood of sleep-disordered breathing in patients with heart failure.

No link was found between sleep apnea and any of the other acute illnesses in these patients.

The study was supported by grants from the National Institutes of Health. Neither researcher had a financial conflict of interest.

Sleep-disordered breathing in hospitalized patients is more common in those who are obese and those who have heart failure.

“There may be more [sleep-disordered breathing] in hospitalized patients than has been recognized,” concluded Dr. Kim Goring and Dr. Nancy Collop, of Johns Hopkins University Hospital and Bayview Medical Center, both in Baltimore.

“There is a need for a higher clinical suspicion, especially in patients with underlying cardiopulmonary disease,” the researchers said.

In a chart review of 94 inpatients referred for polysomnography at two tertiary care facilities, a body mass index (BMI) of 40 kg/m

The patients (51 women, 43 men) were admitted to Johns Hopkins or Bayview between January 2003 and September 2004 for acute illnesses, mostly chronic obstructive pulmonary disease or heart failure; the next most common diagnoses were interstitial lung disease, acute pulmonary embolism, and pulmonary hypertension.

The mean age of the participants was 54 years (range, 20–82 years), and their mean BMI was 40 (range, 18–70). Of the total sample, 86% were obese (BMI greater than 30), the researchers reported.

The patients underwent overnight polysomnography to detect sleep apnea (defined as complete or almost complete cessation of airflow—less than 25% of baseline—lasting 10 seconds or longer) and hypopnea (defined as a fall in oxygen saturation of at least 4%, or an arousal from sleep). An apnea-hypopnea index (AHI) greater than 10 was classified as sleep-disordered breathing (J. Clin. Sleep Med. 2008;4:105–10).

Of the 94 patients, 77% had sleep-disordered breathing, and of those with the condition, 95% had obstructive sleep apnea.

“This high prevalence of [sleep-disordered breathing] is most likely due to the overwhelming influence of obesity,” Dr. Goring and Dr. Collop wrote. They found “a statistically significant increase in the [odds ratio] of sleep apnea with every unit increase in BMI” after adjusting for all other variables, with the vast majority of the study patients with a BMI over 40 positive for sleep apnea.

Weight has been shown to strongly predict sleep-disordered breathing. In this study, “there was a probable bias on the part of the referring physicians in targeting obese patients for inpatient polysomnography, given that 86% of those referred were obese.”

Although 60% of normal-weight patients with interstitial lung disease, neuromuscular disease, or acute pulmonary embolism had sleep-disordered breathing, it was difficult to draw statistically significant conclusions because of the small numbers of subjects, they wrote.

The association between sleep apnea and heart failure was significant, but the investigators cited difficulty in assessing the effect of obesity on the likelihood of sleep-disordered breathing in patients with heart failure.

No link was found between sleep apnea and any of the other acute illnesses in these patients.

The study was supported by grants from the National Institutes of Health. Neither researcher had a financial conflict of interest.

Sleep-disordered breathing in hospitalized patients is more common in those who are obese and those who have heart failure.

“There may be more [sleep-disordered breathing] in hospitalized patients than has been recognized,” concluded Dr. Kim Goring and Dr. Nancy Collop, of Johns Hopkins University Hospital and Bayview Medical Center, both in Baltimore.

“There is a need for a higher clinical suspicion, especially in patients with underlying cardiopulmonary disease,” the researchers said.

In a chart review of 94 inpatients referred for polysomnography at two tertiary care facilities, a body mass index (BMI) of 40 kg/m

The patients (51 women, 43 men) were admitted to Johns Hopkins or Bayview between January 2003 and September 2004 for acute illnesses, mostly chronic obstructive pulmonary disease or heart failure; the next most common diagnoses were interstitial lung disease, acute pulmonary embolism, and pulmonary hypertension.

The mean age of the participants was 54 years (range, 20–82 years), and their mean BMI was 40 (range, 18–70). Of the total sample, 86% were obese (BMI greater than 30), the researchers reported.

The patients underwent overnight polysomnography to detect sleep apnea (defined as complete or almost complete cessation of airflow—less than 25% of baseline—lasting 10 seconds or longer) and hypopnea (defined as a fall in oxygen saturation of at least 4%, or an arousal from sleep). An apnea-hypopnea index (AHI) greater than 10 was classified as sleep-disordered breathing (J. Clin. Sleep Med. 2008;4:105–10).

Of the 94 patients, 77% had sleep-disordered breathing, and of those with the condition, 95% had obstructive sleep apnea.

“This high prevalence of [sleep-disordered breathing] is most likely due to the overwhelming influence of obesity,” Dr. Goring and Dr. Collop wrote. They found “a statistically significant increase in the [odds ratio] of sleep apnea with every unit increase in BMI” after adjusting for all other variables, with the vast majority of the study patients with a BMI over 40 positive for sleep apnea.

Weight has been shown to strongly predict sleep-disordered breathing. In this study, “there was a probable bias on the part of the referring physicians in targeting obese patients for inpatient polysomnography, given that 86% of those referred were obese.”

Although 60% of normal-weight patients with interstitial lung disease, neuromuscular disease, or acute pulmonary embolism had sleep-disordered breathing, it was difficult to draw statistically significant conclusions because of the small numbers of subjects, they wrote.

The association between sleep apnea and heart failure was significant, but the investigators cited difficulty in assessing the effect of obesity on the likelihood of sleep-disordered breathing in patients with heart failure.

No link was found between sleep apnea and any of the other acute illnesses in these patients.

The study was supported by grants from the National Institutes of Health. Neither researcher had a financial conflict of interest.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but "the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ," the authors wrote.

"Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex," they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men. Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions "are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions." The trial populations are "younger, healthier, male, non-U.S. populations," reflecting a "persistent underrepresentation of women and elderly people" in clinical trials in general, the authors noted.

The authors suggested that all future studies include demographic information, as "the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex." They also suggested that the CMS adopt a policy requiring data on women and the elderly. An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

"Closer linkage of evidence to coverage would promote better value and improved outcomes" for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but "the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ," the authors wrote.

"Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex," they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men. Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions "are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions." The trial populations are "younger, healthier, male, non-U.S. populations," reflecting a "persistent underrepresentation of women and elderly people" in clinical trials in general, the authors noted.

The authors suggested that all future studies include demographic information, as "the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex." They also suggested that the CMS adopt a policy requiring data on women and the elderly. An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

"Closer linkage of evidence to coverage would promote better value and improved outcomes" for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population. Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years). Several trials excluded older patients, but "the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ," the authors wrote.

"Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex," they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men. Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions "are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions." The trial populations are "younger, healthier, male, non-U.S. populations," reflecting a "persistent underrepresentation of women and elderly people" in clinical trials in general, the authors noted.

The authors suggested that all future studies include demographic information, as "the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex." They also suggested that the CMS adopt a policy requiring data on women and the elderly. An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

"Closer linkage of evidence to coverage would promote better value and improved outcomes" for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions.

The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco.

The university, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population.

Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years).

Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.”

The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

To improve the relevance of the data used for coverage decisions, the authors suggested that all future studies include demographic information, as “the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex.”

They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions.

The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco.

The university, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population.

Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years).

Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.”

The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

To improve the relevance of the data used for coverage decisions, the authors suggested that all future studies include demographic information, as “the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex.”

They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions.

The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco.

The university, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136–40).

Significant differences were found between the study populations and the Medicare population.

Participants in the trials described in the technology assessments were significantly younger (mean age, 60.1 years) than were most Medicare beneficiaries (mean age 70.8 years).

Several trials excluded older patients, but “the mean age in studies with explicit age exclusions (59.0 years) and those without such exclusions (60.9 years) did not differ,” the authors wrote.

“Studies for each cardiovascular [technology assessment] also differed significantly from the Medicare population in terms of sex,” they continued. Of the study participants, 75.4% were men, compared with 43.7% of Medicare beneficiaries. Several of the studies had excluded women, but none excluded men.

Clinical trial location also was not representative of the Medicare population. Of 135 studies that reported location, 37% took place at least partly in the United States. However, most (51.1%) were done in Europe, 8.9% in Asia, and 6.7% in other locations. Overall, 40% of the technology assessment study participants were U.S. residents, compared with 100% of the Medicare population.

In addition, many of the trials excluded patients with conditions such as renal insufficiency, arrhythmias, and diabetes that are common in the Medicare population.

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.”

The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

To improve the relevance of the data used for coverage decisions, the authors suggested that all future studies include demographic information, as “the accuracy and risk-benefit profiles of many diagnostic tests and therapies differ substantially by age and often by sex.”

They also suggested that the CMS adopt a policy requiring data on women and the elderly, which would encourage trial investigators to include such data.

An alternative approach would be for the CMS to issue coverage decisions dependent on the addition of subgroup data within a specified period of time.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136-40).

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.” The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136-40).

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.” The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

Data reviewed by the Centers for Medicaid and Medicare Services to inform Medicare treatment coverage decisions reflect populations that are significantly different from the Medicare beneficiary population, a recent analysis has shown.

In 1998, the CMS established a panel of physicians and other professionals to review the evidence base before the agency makes national Medicare coverage decisions. The independent panel, now called the Medicare Evidence Development and Coverage Advisory Committee (MedCAC), reviews the literature described in a technology assessment and votes on the evidence to determine the health benefit of the medical procedure or device, wrote Sanket S. Dhruva and Dr. Rita F. Redberg, both of the University of California, San Francisco, which, along with the Robert Wood Johnson Foundation, provided support for the study. Dr. Redberg is a member of MedCAC, but had no financial conflicts of interest to disclose.

To examine whether the data used by MedCAC was generalizable to the Medicare population, Mr. Dhruva and Dr. Redberg looked at all six MedCAC decisions involving a cardiovascular product or service and analyzed the sample size, participant demographics, inclusion criteria, study location, and outcome stratification of the relevant technology assessments. The data in the technology assessments used for these six decisions included 141 peer-reviewed reports and 40,009 patients (Arch. Intern. Med. 2008;168:136-40).

The researchers concluded that the data used by MedCAC as evidence on which to base national treatment coverage decisions “are derived from populations that differ significantly from the Medicare beneficiary population in terms of age, sex, country of residence, and comorbid conditions.” The trial populations are “younger, healthier, male, non-U.S. populations,” reflecting a “persistent underrepresentation of women and elderly people” in clinical trials in general, the authors noted.

“Closer linkage of evidence to coverage would promote better value and improved outcomes” for Medicare patients, the researchers concluded.

HIV Policy Changes Urged

A small change in how the Centers for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” the NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, together with Senator Clinton and Senator Kennedy, plans to set up a working group with the CDC to try to enact the changes, a spokesperson for the NWAC said.

Abstinence Programs Don't Work

There is no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to findings in a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More investigation is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all of the health savings account/high-deductible health plans (HSA/HDHPs) that are offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million HSA/HDHP enrollees nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All of the plans that were surveyed covered mammograms, Pap smears, and annual physicals, and most of them covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders who were surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) of the respondents thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% of them saying that the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most of the respondents (88%) felt that the adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Generics and Part D

Under Medicare Part D plans, 56% of drugs dispensed were generics, and generics were dispensed 88% of the time when they were available, according to a November 2007 report by the Office of Inspector General of the Department of Health and Human Services. However, 37% of prescriptions were for drugs with no generic substitute, said the report. Overall utilization of generic drugs varied among Part D plans, from a low of 37% to a high of 83%. The data were derived from 341 million Part D prescriptions dispensed in January through June 2006. The generic usage rates of Part D plans are comparable to those of state Medicaid programs in 2004.

HIV Policy Changes Urged

A small change in how the Centers for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” the NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, together with Senator Clinton and Senator Kennedy, plans to set up a working group with the CDC to try to enact the changes, a spokesperson for the NWAC said.

Abstinence Programs Don't Work

There is no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to findings in a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More investigation is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all of the health savings account/high-deductible health plans (HSA/HDHPs) that are offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million HSA/HDHP enrollees nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All of the plans that were surveyed covered mammograms, Pap smears, and annual physicals, and most of them covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders who were surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) of the respondents thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% of them saying that the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most of the respondents (88%) felt that the adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Generics and Part D

Under Medicare Part D plans, 56% of drugs dispensed were generics, and generics were dispensed 88% of the time when they were available, according to a November 2007 report by the Office of Inspector General of the Department of Health and Human Services. However, 37% of prescriptions were for drugs with no generic substitute, said the report. Overall utilization of generic drugs varied among Part D plans, from a low of 37% to a high of 83%. The data were derived from 341 million Part D prescriptions dispensed in January through June 2006. The generic usage rates of Part D plans are comparable to those of state Medicaid programs in 2004.

HIV Policy Changes Urged

A small change in how the Centers for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” the NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, together with Senator Clinton and Senator Kennedy, plans to set up a working group with the CDC to try to enact the changes, a spokesperson for the NWAC said.

Abstinence Programs Don't Work

There is no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to findings in a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More investigation is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all of the health savings account/high-deductible health plans (HSA/HDHPs) that are offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million HSA/HDHP enrollees nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All of the plans that were surveyed covered mammograms, Pap smears, and annual physicals, and most of them covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders who were surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) of the respondents thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% of them saying that the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most of the respondents (88%) felt that the adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Generics and Part D

Under Medicare Part D plans, 56% of drugs dispensed were generics, and generics were dispensed 88% of the time when they were available, according to a November 2007 report by the Office of Inspector General of the Department of Health and Human Services. However, 37% of prescriptions were for drugs with no generic substitute, said the report. Overall utilization of generic drugs varied among Part D plans, from a low of 37% to a high of 83%. The data were derived from 341 million Part D prescriptions dispensed in January through June 2006. The generic usage rates of Part D plans are comparable to those of state Medicaid programs in 2004.

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists were also queried. Only 11% of women said they thought it was safe to take a depression medication during pregnancy, compared with 68% of physicians. Less-educated and lower-income women and African American women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” The NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokesperson said.

Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All plans surveyed covered mammograms, Pap smears, and annual physicals; most covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% saying the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most (88%) felt that adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists were also queried. Only 11% of women said they thought it was safe to take a depression medication during pregnancy, compared with 68% of physicians. Less-educated and lower-income women and African American women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” The NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokesperson said.

Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All plans surveyed covered mammograms, Pap smears, and annual physicals; most covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% saying the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most (88%) felt that adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists were also queried. Only 11% of women said they thought it was safe to take a depression medication during pregnancy, compared with 68% of physicians. Less-educated and lower-income women and African American women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” The NWAC said in a statement. “As such, a data collection method that takes into account only high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” The NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokesperson said.

Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so. The 36 companies surveyed had more than 1.7 million HSA/HDHP enrollees (there are 4.5 million nationwide). The preventive care services commonly covered include recommended immunizations and preventive screenings. All plans surveyed covered mammograms, Pap smears, and annual physicals; most covered colonoscopies and prostate cancer screening.

Improvement Through Transparency

Transparency of quality and price information is important or very important for improving the U.S. health care system, according to 77% of 241 health care opinion leaders surveyed in October 2007 by Harris Interactive on behalf of the Commonwealth Fund and Modern Healthcare. Stimulating provider performance-improvement activities was rated as an important or very important goal of transparency by 84% of respondents; 76% also cited encouraging payers to reward quality, and 66% thought helping patients make informed choices was an important or very important goal. More than half (56%) thought that a new public-private national entity should be responsible for setting the standards for measurement and reporting, with 75% saying the costs of such measurement and reporting should be shared by providers, insurers, and the government. Most (88%) felt that adoption of health information technology was an important or very important component of any system of transparency. The online poll surveyed peer-identified leaders and experts in academia, research, health care delivery, business, insurance, government, and labor and advocacy groups.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Calif.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Calif.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Calif.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Ca.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Ca.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by the year 2010. “Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year,” said a letter from the coalition, which includes Aetna Inc., Consumers Union, the Corporate Health Care Coalition, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee. “In the report, the IOM called on all physicians to adopt electronic prescribing (e-prescribing) by 2010 to address this problem. Unfortunately, fewer than 1 in 10 physicians are meeting this challenge.” The coalition has urged Congress to approve legislation this year calling for full physician adoption of e-prescribing in Medicare.

Medicaid Enrollment Declines

Enrollment in Medicaid declined in 2007 for the first time in nearly a decade, primarily because new documentation requirements have caused significant delays in processing applications and because the strong economy and lower unemployment have reduced enrollment, according to a new 50-state survey from the Kaiser Family Foundation. But states expect enrollment and spending to increase in 2008 as they move forward with program enhancements, according to the survey. “States are turning to Medicaid to address the rising number of uninsured to help fill in the gaps for low-income families,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said in a statement. With the nation's growing uninsured population, 42 states report efforts to expand coverage for the uninsured using Medicaid as a financing vehicle. In addition, every state implemented at least one provider payment increase in 2007, and almost all the states have adopted an increase for 2008.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Traditional Medicare a Better Deal

Private Medicare Part D plans have higher administrative expenses and negotiated lower drug rebates, compared with traditional Medicare, according to a report released in October by the House Committee on Oversight and Government Reform. The total 2007 administrative costs of the 12 leading private Part D plans (9.8% of total benefit costs) were almost six times those of Medicare (1.7%), and will reach $4.6 billion this year, $1 billion of which is profit. In addition, the private insurers negotiated drug rebates from manufacturers of only 8%, compared with 26% obtained by Medicaid; the drug prices paid by enrollees of Part D insurers are no better than prices at discounters like Costco and Wal-Mart. However, private insurers will pocket $1 billion in rebates on drugs that are paid for entirely by beneficiaries during coverage gap periods. “The program's inflated administrative costs and meager drug rebates will cost taxpayers and seniors $15 billion this year alone,” Committee chairman Henry A. Waxman (D-Ca.) said in a statement. The report can be found at

www.oversight.house.gov

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule likely will result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians likely would also suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule likely will result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians likely would also suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule likely will result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians likely would also suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.