Alicia Ault

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays.

Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.” The report had been requested by Sen. Jay Rockefeller (D-W. Va.).

The agency noted that the proportion of Medicare Part B spending on imaging conducted in a physician office setting rose to 64% in 2006 from 58% in 2000.

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa) introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

To compile the report, the GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization.

The agency said that because of the rapid growth in imaging, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

But for Dr. Ted Epperly, president of the AAFP, that recommendation is a “draconian approach.”

“It deals with the front end of the system, and we should be moving away from [that] to the real issue—cost. Current MRI is overvalued and overpriced. Costs should be dropped, rather than penalizing by denying access and hassling physicians,” he said in an interview.

In addition, the measure presents “a substantial problem for family physicians in terms of patient care.”

“It is a barrier to good care,” he said in an interview. “The existing criteria were developed by specialists and radiologists without a clear patient-centered perspective. I would prefer that appropriate use criteria [be considered] and that we work to get the FP perspective” included.

Dr. Jack Lewin, the CEO of the American College of Cardiology, said in a statement that prior authorization “is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Lewin also noted that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and also noted that the report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of RBMs and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In summing up his own experiences in getting prior authorization for imaging, Dr. Epperly said he found the staff he dealt with were “good at following the guidelines, [but they] are not flexible and more of a one-size-fits- all approach. I see a lack of judgment on their part.”

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” the report stated. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs.

It also pointed out that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities so that the RBM recommendations could present a conflict for Medicare when considering payment.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays.

Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.” The report had been requested by Sen. Jay Rockefeller (D-W. Va.).

The agency noted that the proportion of Medicare Part B spending on imaging conducted in a physician office setting rose to 64% in 2006 from 58% in 2000.

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa) introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

To compile the report, the GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization.

The agency said that because of the rapid growth in imaging, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

But for Dr. Ted Epperly, president of the AAFP, that recommendation is a “draconian approach.”

“It deals with the front end of the system, and we should be moving away from [that] to the real issue—cost. Current MRI is overvalued and overpriced. Costs should be dropped, rather than penalizing by denying access and hassling physicians,” he said in an interview.

In addition, the measure presents “a substantial problem for family physicians in terms of patient care.”

“It is a barrier to good care,” he said in an interview. “The existing criteria were developed by specialists and radiologists without a clear patient-centered perspective. I would prefer that appropriate use criteria [be considered] and that we work to get the FP perspective” included.

Dr. Jack Lewin, the CEO of the American College of Cardiology, said in a statement that prior authorization “is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Lewin also noted that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and also noted that the report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of RBMs and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In summing up his own experiences in getting prior authorization for imaging, Dr. Epperly said he found the staff he dealt with were “good at following the guidelines, [but they] are not flexible and more of a one-size-fits- all approach. I see a lack of judgment on their part.”

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” the report stated. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs.

It also pointed out that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities so that the RBM recommendations could present a conflict for Medicare when considering payment.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

The Government Accountability Office is urging Congress to require Medicare to adopt prior authorization procedures for outpatient imaging services, saying that the federal health program's current approach has allowed costs to balloon.

According to the GAO, from 2000 to 2006, Medicare Part B spending on imaging services more than doubled to $14 billion. In particular, spending on more technically demanding imaging studies, such as computed tomography, magnetic resonance imaging, and nuclear medicine, rose 17% a year, compared with 9% annual growth for less complex studies such as x-rays.

Imaging studies have increasingly shifted to the outpatient sector and the proportion of physician income from imaging is steadily rising, said the GAO in its report, “Medicare Part B Imaging Services.” The report had been requested by Sen. Jay Rockefeller (D-W. Va.).

The agency noted that the proportion of Medicare Part B spending on imaging conducted in a physician office setting rose to 64% in 2006 from 58% in 2000.

Shortly after the report was issued, Sen. Charles Grassley (R-Iowa) introduced legislation (S. 3343) that would require physicians making referrals for MRIs, CTs, PET scans, and potentially other modalities to disclose to patients in writing if they have ownership in the imaging facility. The proposal was initially included in the bill that canceled Medicare physician fee cuts but was dropped in the final package.

To compile the report, the GAO analyzed Medicare claims data and also interviewed health plans and radiology benefit management companies (RBMs), which the private sector has used to implement prior authorization.

The agency said that because of the rapid growth in imaging, “we recommend that [the Centers for Medicare and Medicaid Services] examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”

But for Dr. Ted Epperly, president of the AAFP, that recommendation is a “draconian approach.”

“It deals with the front end of the system, and we should be moving away from [that] to the real issue—cost. Current MRI is overvalued and overpriced. Costs should be dropped, rather than penalizing by denying access and hassling physicians,” he said in an interview.

In addition, the measure presents “a substantial problem for family physicians in terms of patient care.”

“It is a barrier to good care,” he said in an interview. “The existing criteria were developed by specialists and radiologists without a clear patient-centered perspective. I would prefer that appropriate use criteria [be considered] and that we work to get the FP perspective” included.

Dr. Jack Lewin, the CEO of the American College of Cardiology, said in a statement that prior authorization “is a Band-Aid to the utilization issue and not a viable solution. Medicare should look to accreditation, appropriate use criteria, and improved communication to lower utilization and improve quality.”

Dr. Lewin also noted that “the agency did not take into account physician input, nor did it use data from 2007 showing a decline in imaging growth.”

The Medical Imaging Technology Alliance (MITA) issued a similar critique, and also noted that the report did not take into account appropriateness and accreditation criteria that were part of the just-passed Medicare bill that eliminated a scheduled reduction in physician fees. The law will require imaging facilities to be accredited starting in 2012.

Appropriateness and accreditation will “ensure that an image is taken at the right time by the right person and in an appropriate manner,” MITA vice president Andrew Whitman said in an interview. MITA is the medical technology trade association of the National Electrical Manufacturers Association.

Mr. Whitman also criticized the GAO's support of RBMs and other tools to rein in costs. RBMs do not readily share guidelines and appropriateness criteria and are not well regulated, he said.

In summing up his own experiences in getting prior authorization for imaging, Dr. Epperly said he found the staff he dealt with were “good at following the guidelines, [but they] are not flexible and more of a one-size-fits- all approach. I see a lack of judgment on their part.”

In response to the GAO report, the Health and Human Services department said it, too, had concerns about the “administrative burden” of using RBMs, “as well as the advisability of prior authorization for the Medicare program,” the report stated. HHS pointed out that there were no independent data showing that RBMs could successfully manage imaging costs.

It also pointed out that proprietary guidelines in use by RBMs might conflict with those being promoted by federal health authorities so that the RBM recommendations could present a conflict for Medicare when considering payment.

“We do not dispute HHS's reservations about prior authorization, and agree that these concerns will require careful examination within the context of Medicare statutes and regulations,” said the GAO report.

Chantix Has Most Adverse Events

Varenicline (Chantix) accounted for the largest number of adverse drug reactions reported to the Food and Drug Administration in the first quarter of this year, according to an analysis of agency data by the Institute for Safe Medicine Practices. There were 1,001 reports of injuries and 50 deaths potentially related to the drug; 226 of the reports were self-injury or suicide. The FDA has been “carefully evaluating” the varenicline reports, according to a statement. The agency also confirmed that it has received reports of accidents, including traffic accidents, after varenicline use. ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP, which noted that a small number of drugs accounted for a large volume of reports. Rounding out the top 10 drugs associated with adverse reactions are heparin (specifically a tainted version tied to Chinese suppliers), fentanyl, interferon beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Midlife Whites Top Suicide Risk

The epidemiology of suicide has changed, with middle-aged whites now at highest risk, and hanging and suffocation on the rise, a new study from researchers at Johns Hopkins Bloomberg School of Public Health suggests. The researchers studied mortality data from the federal Web-based Injury Statistics Query and Reporting system. From 1999 to 2005, suicide rates increased for whites aged 40–64 years, but did not rise for any other age or racial group. The overall suicide rate increased 0.7% a year, driven by a 4.9% increase each year in hanging and suffocation, and a 1.8% increase annually in poisonings. Suicide by firearm decreased 1.1% a year, but it was still the dominant method, accounting for 52% of all suicides in 2005. The authors said that of four racial groups, only whites showed a significant increase in suicide, increasing 1.1% per year. The study will appear in the December issue of the American Journal of Preventive Medicine.

Lilly: $1.5 Billion Zyprexa Charge

Eli Lilly & Co. will take close to a $1.5 billion charge against its earnings to account for the resolution of investigations of Zyprexa (olanzapine) by the U.S. Attorney for the Eastern District of Pennsylvania and by 32 states and the District of Columbia. Lilly already said it would pay $62 million to the 32 states to resolve charges that it was engaged in illegal off-label marketing. But there has been no resolution with the U.S. Attorney, or with 11 other states that did not participate in that settlement. The $1.33 per share charge was revealed in its third-quarter earnings report. As a result, Lilly recorded a net loss of $466 million in the third quarter, compared with net income of $926 million in the same quarter in 2007.

Disparities in Mental Health

Three studies in the November issue of Psychiatric Services find persistent and deep disparities in mental health treatment of minorities. The lead study, by Margarita Alegria, Ph.D., and colleagues, found that 63% of Hispanics, 69% of Asians, and 59% of African Americans with depressive disorder in the past year did not access any mental health treatment, compared with 40% of non-Hispanic whites. The authors used pooled data from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys, which has a special emphasis on minorities. They focused on 1,082 respondents with current depression and 7,680 who did not meet criteria for past-year substance abuse or psychiatric disorder. Current depression was more common in whites than in minorities. But overall, all minorities were significantly less likely to receive mental health care than whites were. Some of the factors associated with disparities included a fear among low-income minorities of losing pay during treatment; stigma of mental illness in some racial and ethnic groups; minority distrust of health professionals; and lack of mental health service funding for the uninsured and Medicaid recipients.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reach out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Nationwide RAC Launched

The Centers for Medicare and Medicaid Services has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingent basis, soon will begin to contact providers about the program, the CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to the CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. The CMS also said it would begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Chantix Has Most Adverse Events

Varenicline (Chantix) accounted for the largest number of adverse drug reactions reported to the Food and Drug Administration in the first quarter of this year, according to an analysis of agency data by the Institute for Safe Medicine Practices. There were 1,001 reports of injuries and 50 deaths potentially related to the drug; 226 of the reports were self-injury or suicide. The FDA has been “carefully evaluating” the varenicline reports, according to a statement. The agency also confirmed that it has received reports of accidents, including traffic accidents, after varenicline use. ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP, which noted that a small number of drugs accounted for a large volume of reports. Rounding out the top 10 drugs associated with adverse reactions are heparin (specifically a tainted version tied to Chinese suppliers), fentanyl, interferon beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Midlife Whites Top Suicide Risk

The epidemiology of suicide has changed, with middle-aged whites now at highest risk, and hanging and suffocation on the rise, a new study from researchers at Johns Hopkins Bloomberg School of Public Health suggests. The researchers studied mortality data from the federal Web-based Injury Statistics Query and Reporting system. From 1999 to 2005, suicide rates increased for whites aged 40–64 years, but did not rise for any other age or racial group. The overall suicide rate increased 0.7% a year, driven by a 4.9% increase each year in hanging and suffocation, and a 1.8% increase annually in poisonings. Suicide by firearm decreased 1.1% a year, but it was still the dominant method, accounting for 52% of all suicides in 2005. The authors said that of four racial groups, only whites showed a significant increase in suicide, increasing 1.1% per year. The study will appear in the December issue of the American Journal of Preventive Medicine.

Lilly: $1.5 Billion Zyprexa Charge

Eli Lilly & Co. will take close to a $1.5 billion charge against its earnings to account for the resolution of investigations of Zyprexa (olanzapine) by the U.S. Attorney for the Eastern District of Pennsylvania and by 32 states and the District of Columbia. Lilly already said it would pay $62 million to the 32 states to resolve charges that it was engaged in illegal off-label marketing. But there has been no resolution with the U.S. Attorney, or with 11 other states that did not participate in that settlement. The $1.33 per share charge was revealed in its third-quarter earnings report. As a result, Lilly recorded a net loss of $466 million in the third quarter, compared with net income of $926 million in the same quarter in 2007.

Disparities in Mental Health

Three studies in the November issue of Psychiatric Services find persistent and deep disparities in mental health treatment of minorities. The lead study, by Margarita Alegria, Ph.D., and colleagues, found that 63% of Hispanics, 69% of Asians, and 59% of African Americans with depressive disorder in the past year did not access any mental health treatment, compared with 40% of non-Hispanic whites. The authors used pooled data from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys, which has a special emphasis on minorities. They focused on 1,082 respondents with current depression and 7,680 who did not meet criteria for past-year substance abuse or psychiatric disorder. Current depression was more common in whites than in minorities. But overall, all minorities were significantly less likely to receive mental health care than whites were. Some of the factors associated with disparities included a fear among low-income minorities of losing pay during treatment; stigma of mental illness in some racial and ethnic groups; minority distrust of health professionals; and lack of mental health service funding for the uninsured and Medicaid recipients.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reach out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Nationwide RAC Launched

The Centers for Medicare and Medicaid Services has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingent basis, soon will begin to contact providers about the program, the CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to the CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. The CMS also said it would begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

Chantix Has Most Adverse Events

Varenicline (Chantix) accounted for the largest number of adverse drug reactions reported to the Food and Drug Administration in the first quarter of this year, according to an analysis of agency data by the Institute for Safe Medicine Practices. There were 1,001 reports of injuries and 50 deaths potentially related to the drug; 226 of the reports were self-injury or suicide. The FDA has been “carefully evaluating” the varenicline reports, according to a statement. The agency also confirmed that it has received reports of accidents, including traffic accidents, after varenicline use. ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP, which noted that a small number of drugs accounted for a large volume of reports. Rounding out the top 10 drugs associated with adverse reactions are heparin (specifically a tainted version tied to Chinese suppliers), fentanyl, interferon beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Midlife Whites Top Suicide Risk

The epidemiology of suicide has changed, with middle-aged whites now at highest risk, and hanging and suffocation on the rise, a new study from researchers at Johns Hopkins Bloomberg School of Public Health suggests. The researchers studied mortality data from the federal Web-based Injury Statistics Query and Reporting system. From 1999 to 2005, suicide rates increased for whites aged 40–64 years, but did not rise for any other age or racial group. The overall suicide rate increased 0.7% a year, driven by a 4.9% increase each year in hanging and suffocation, and a 1.8% increase annually in poisonings. Suicide by firearm decreased 1.1% a year, but it was still the dominant method, accounting for 52% of all suicides in 2005. The authors said that of four racial groups, only whites showed a significant increase in suicide, increasing 1.1% per year. The study will appear in the December issue of the American Journal of Preventive Medicine.

Lilly: $1.5 Billion Zyprexa Charge

Eli Lilly & Co. will take close to a $1.5 billion charge against its earnings to account for the resolution of investigations of Zyprexa (olanzapine) by the U.S. Attorney for the Eastern District of Pennsylvania and by 32 states and the District of Columbia. Lilly already said it would pay $62 million to the 32 states to resolve charges that it was engaged in illegal off-label marketing. But there has been no resolution with the U.S. Attorney, or with 11 other states that did not participate in that settlement. The $1.33 per share charge was revealed in its third-quarter earnings report. As a result, Lilly recorded a net loss of $466 million in the third quarter, compared with net income of $926 million in the same quarter in 2007.

Disparities in Mental Health

Three studies in the November issue of Psychiatric Services find persistent and deep disparities in mental health treatment of minorities. The lead study, by Margarita Alegria, Ph.D., and colleagues, found that 63% of Hispanics, 69% of Asians, and 59% of African Americans with depressive disorder in the past year did not access any mental health treatment, compared with 40% of non-Hispanic whites. The authors used pooled data from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys, which has a special emphasis on minorities. They focused on 1,082 respondents with current depression and 7,680 who did not meet criteria for past-year substance abuse or psychiatric disorder. Current depression was more common in whites than in minorities. But overall, all minorities were significantly less likely to receive mental health care than whites were. Some of the factors associated with disparities included a fear among low-income minorities of losing pay during treatment; stigma of mental illness in some racial and ethnic groups; minority distrust of health professionals; and lack of mental health service funding for the uninsured and Medicaid recipients.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reach out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Nationwide RAC Launched

The Centers for Medicare and Medicaid Services has launched its national recovery audit contractor program as part of its “aggressive new steps to find and prevent waste, fraud and abuse in Medicare.” The new RACs, which will be paid on a contingent basis, soon will begin to contact providers about the program, the CMS said. The 3-year RAC demonstration program in California, Florida, New York, Massachusetts, South Carolina, and Arizona collected more than $900 million in overpayments, according to the CMS. However, the program has drawn strong criticism from physician groups, who have maintained that RAC audits were overly burdensome. The CMS also said it would begin to work directly with beneficiaries to make certain they receive the durable medical equipment or home health services for which Medicare has been billed, and that the items or services were medically necessary.

WASHINGTON – More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

The Centers for Medicare and Medicaid Services designated the matching funds in January for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51.

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. According to Dr. Un, Aetna has the systems in place to pay claims with the SBI codes and its behavioral health specialists will work with primary care physicians in an effort to encourage screening.

The National Institute on Drug Abuse is developing a resource guide for physicians that will be posted on the agency's Web site, said Dr. Wilson Compton, NIDA director of the division of epidemiology, services, and prevention research.

Some online training is already available at www.mdalcoholtraining.org

WASHINGTON – More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

The Centers for Medicare and Medicaid Services designated the matching funds in January for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51.

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. According to Dr. Un, Aetna has the systems in place to pay claims with the SBI codes and its behavioral health specialists will work with primary care physicians in an effort to encourage screening.

The National Institute on Drug Abuse is developing a resource guide for physicians that will be posted on the agency's Web site, said Dr. Wilson Compton, NIDA director of the division of epidemiology, services, and prevention research.

Some online training is already available at www.mdalcoholtraining.org

WASHINGTON – More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

The Centers for Medicare and Medicaid Services designated the matching funds in January for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51.

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. According to Dr. Un, Aetna has the systems in place to pay claims with the SBI codes and its behavioral health specialists will work with primary care physicians in an effort to encourage screening.

The National Institute on Drug Abuse is developing a resource guide for physicians that will be posted on the agency's Web site, said Dr. Wilson Compton, NIDA director of the division of epidemiology, services, and prevention research.

Some online training is already available at www.mdalcoholtraining.org

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum held this fall.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts by senators, House members, and accrediting organizations to promote greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed a tightening of restrictions on commercial support of CME, and possibly even banning industry funding of CME programs.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME can produce changes knowledge, skills, and patient outcomes, Dr. Lundberg said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.”

The manufacturers have a responsibility to educate clinicians on how to use their products, he said.

The pressure for greater transparency is leading to what Dr. Weber called censorship.

He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said that he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said.

And, Dr. Lewin said, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support Dr. Lewin's claim. Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said that “despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group.

“Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue,” the organization said.

Drugmakers to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will disclose grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include CME. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site. Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum held this fall.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts by senators, House members, and accrediting organizations to promote greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed a tightening of restrictions on commercial support of CME, and possibly even banning industry funding of CME programs.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME can produce changes knowledge, skills, and patient outcomes, Dr. Lundberg said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.”

The manufacturers have a responsibility to educate clinicians on how to use their products, he said.

The pressure for greater transparency is leading to what Dr. Weber called censorship.

He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said that he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said.

And, Dr. Lewin said, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support Dr. Lewin's claim. Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said that “despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group.

“Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue,” the organization said.

Drugmakers to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will disclose grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include CME. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site. Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum held this fall.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts by senators, House members, and accrediting organizations to promote greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed a tightening of restrictions on commercial support of CME, and possibly even banning industry funding of CME programs.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME can produce changes knowledge, skills, and patient outcomes, Dr. Lundberg said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.”

The manufacturers have a responsibility to educate clinicians on how to use their products, he said.

The pressure for greater transparency is leading to what Dr. Weber called censorship.

He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said that he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said.

And, Dr. Lewin said, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support Dr. Lewin's claim. Public Citizen's Health Research Group, in comments sent to the ACCME on its proposal to limit or ban industry support of CME, said that “despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group.

“Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue,” the organization said.

Drugmakers to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that it will disclose grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include CME. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site. Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according to a new report by the Pew Hispanic Center, "Hispanics and Health Care in the United States: Access, Information and Knowledge." The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention (CDC) has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics—approximately 8 million adults—lacked a usual health care provider, said Ms. Minushkin. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those who have a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Twenty-seven percent of diagnosed diabetics answered at least three of a battery of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. Mexicans and Central Americans were most likely to lack a usual provider.

However, 45% of those who did not have a usual provider had health insurance.

The primary reason—given by 41% of respondents—for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician. Eleven percent said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though the vast majority—78%—rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. "I can't comment on whether the information they are getting is good or bad," said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, "those who do get information from the media make changes in their behavior." About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

WASHINGTON — Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according to a new report by the Pew Hispanic Center, "Hispanics and Health Care in the United States: Access, Information and Knowledge." The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention (CDC) has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics—approximately 8 million adults—lacked a usual health care provider, said Ms. Minushkin. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those who have a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Twenty-seven percent of diagnosed diabetics answered at least three of a battery of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. Mexicans and Central Americans were most likely to lack a usual provider.

However, 45% of those who did not have a usual provider had health insurance.

The primary reason—given by 41% of respondents—for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician. Eleven percent said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though the vast majority—78%—rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. "I can't comment on whether the information they are getting is good or bad," said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, "those who do get information from the media make changes in their behavior." About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

WASHINGTON — Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according to a new report by the Pew Hispanic Center, "Hispanics and Health Care in the United States: Access, Information and Knowledge." The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention (CDC) has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics—approximately 8 million adults—lacked a usual health care provider, said Ms. Minushkin. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those who have a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Twenty-seven percent of diagnosed diabetics answered at least three of a battery of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. Mexicans and Central Americans were most likely to lack a usual provider.

However, 45% of those who did not have a usual provider had health insurance.

The primary reason—given by 41% of respondents—for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician. Eleven percent said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though the vast majority—78%—rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. "I can't comment on whether the information they are getting is good or bad," said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, "those who do get information from the media make changes in their behavior." About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a recent forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. "CME in the U.S. is a great success story," said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, "not a luxury."

The manufacturers have a responsibility to educate physicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another physician speaking at the forum, Dr. Jack Lewin, said he had "serious, serious concerns about the recent attacks" on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site. About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, "Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels."

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. "Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue."

Eli Lilly, Merck Become First Pharmaceutical Companies to Disclose Physician Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company.

The physician payment registry will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act.

That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, by the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was "fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted."

Merck began disclosing the grants to patient organizations, professional societies, and others for "independent professional education initiatives," which includes continuing medical education, in October.

Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions.

The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a recent forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. "CME in the U.S. is a great success story," said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, "not a luxury."

The manufacturers have a responsibility to educate physicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another physician speaking at the forum, Dr. Jack Lewin, said he had "serious, serious concerns about the recent attacks" on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site. About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, "Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels."

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. "Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue."

Eli Lilly, Merck Become First Pharmaceutical Companies to Disclose Physician Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company.

The physician payment registry will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act.

That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, by the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was "fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted."

Merck began disclosing the grants to patient organizations, professional societies, and others for "independent professional education initiatives," which includes continuing medical education, in October.

Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions.

The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a recent forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus.

A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. "CME in the U.S. is a great success story," said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, "not a luxury."

The manufacturers have a responsibility to educate physicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another physician speaking at the forum, Dr. Jack Lewin, said he had "serious, serious concerns about the recent attacks" on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000 to $3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site. About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, "Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels."

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. "Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue."

Eli Lilly, Merck Become First Pharmaceutical Companies to Disclose Physician Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company.

The physician payment registry will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act.

That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, by the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was "fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted."

Merck began disclosing the grants to patient organizations, professional societies, and others for "independent professional education initiatives," which includes continuing medical education, in October.

Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions.

The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

No Such Thing as a Safe Tan

Three papers published in the October issue of Pigment Cell and Melanoma Research contend that there's no evidence supporting the safety of tanning—especially indoor tanning—and they call on the tanning bed industry to cease promoting its services. Dr. David Fisher, president of the Society of Melanoma Research, and colleagues from Massachusetts General Hospital's dermatology department write that while genetic and other factors play a role in skin cancer risk, "the role of UV is incontrovertible, and efforts to confuse the public, particularly for purposes of economic gain by the indoor tanning industry, should be vigorously combated for the public health." Dr. Marianne Berwick of the University of New Mexico, Albuquerque, writes, "Epidemiologic data—incomplete and unsatisfactory—suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma." Finally, Dr. Dorothy Bennett of the University of London argues that recreational exposure to ultraviolet light should be discouraged because UV is a known mutagen.

Industry Groups Protest IVIG Cuts

The Biotechnology Industry Organization, the American Society of Clinical Oncology, the Association of Community Cancer Centers, and the Alliance for Plasma Therapies are urging the Centers for Medicare and Medicaid Services to preserve the preadministration fee currently paid for administering intravenous immune globulin (IVIG) therapy in hospital outpatient settings. The CMS proposed to eliminate the payment as part of its hospital outpatient prospective payment system rule for next year. The preadministration payment began in 2006 at a time when IVIG supplies were tight, driving up the price. The CMS says it's not clear that supply is still an issue, but manufacturers and patient organizations say there are still difficulties. "BIO does not believe that there is stability in the IVIG marketplace when over 40% of the providers cannot purchase IVIG at or below the Medicare payment rate," said the group in its comments. The CMS also said that it wants to cut the add-on fee because IVIG use has gone up markedly. BIO argued that increased use shows that the preadministration payment has helped providers acquire and administer the drug.

CMS Alters Overpayment Policy

CMS officials are changing the procedures for recovering certain overpayments made to physicians. The CMS will no longer seek payment from a physician for an overpayment while the physician is seeking a reconsideration of the overpayment determination by a qualified independent contractor. Under the new policy, which was mandated by the 2003 Medicare Modernization Act, the CMS can only seek to recoup the payment after a decision has been made on the reconsideration. The changes, which went into effect Sept. 29, will apply to all Part A and Part B claims for which a demand letter has been issued. However, a number of claims have been excluded, including Part A cost reports, hospice caps calculations, provider initiated adjustments, home health agency requests for anticipated payment, accelerated/advanced payments, and certain other claims adjustments. The changes do not affect the appeal process or the normal debt collection and referral process, according to the CMS.

HHS Privacy Efforts Lacking

The Health and Human Services department has taken some steps to safeguard patient privacy, but efforts in several areas are still lacking, according to a report from the Government Accountability Office. The report notes that although the HHS has made progress in developing a confidentiality, security, and privacy framework for health records, it has looked at some areas only in a narrow view. For example, the agency's efforts at harmonizing certification and standards mostly address technical issues such as data encryption and password protections, while the recommendations submitted by the HHS's advisory committees are primarily aimed at policy and legal issues. In response, the report noted that the "HHS agreed that more work remains to be done in the department's efforts to protect the privacy of electronic personal health information and stated that it is actively pursuing a two-phased process for assessing and prioritizing privacy-related initiatives intended to build public trust and confidence in health IT, particularly in electronic health information exchange."

Immigrants Must Get HPV Vaccine

Young women seeking to immigrate to the United States currently are required to be vaccinated against the human papillomavirus, under an amendment to the Immigration and Nationality Act. Under the 1996 amendment, individuals seeking immigrant visas must provide proof of vaccination for all vaccines recommended by the U.S. Advisory Committee for Immunization Practices. This list, which is updated periodically, now includes HPV vaccination for females aged 11–12 years, with catch-up vaccination among those aged 13–26 years. The addition of the HPV vaccine to the list of required vaccines for immigrants was automatic and required by statute, according to Centers for Disease Control and Prevention spokesman Curtis Allen, and was not part of ACIP deliberations when the committee originally recommended use of the HPV vaccine. According to a spokeswoman for Merck & Co., the HPV vaccine Gardasil costs approximately $290-$375 for the three-dose series. The company was not aware of the immigration policy and did not lobby for that provision, she added.

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box below.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use. In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, which was released in October, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

The National Institute on Drug Abuse is developing a resource guide for primary care physicians that will eventually be posted on the agency's Web site, said Dr. Wilson Compton of the NIDA. Some online training is already available at www.mdalcoholtraining.org

The curriculum is sponsored by the National Institute on Alcohol Abuse and Alcoholism and Boston University. Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.

WASHINGTON – Hispanics may place significant stress on the health care system in the future, as they are projected to be the largest segment of the population by 2050 but are less likely to have a usual source of care and have less knowledge about chronic disease, according to new data from the Pew Hispanic Center and the U.S. Census Bureau.

The Hispanic population will triple from 2008 to 2050, rising from 47 million today to 133 million in 4 decades. By 2050, Hispanics will make up 30% (131 million) of the nation's total population of an estimated 439 million, according to the Census Bureau.

And, as the nation ages overall, the number of Hispanics who are aged 65 years and older also will rise. By 2050, 88 million people will be older than 65 years old, according to the Census Bureau.

Currently, there are some 45 million Hispanics in the United States, 30 million of whom are adults, according a new report by the Pew Hispanic Center, “Hispanics and Health Care in the United States: Access, Information and Knowledge.” The Pew Hispanic Center, in conjunction with the Robert Wood Johnson Foundation, conducted a national telephone survey in mid to late 2007. Overall, about 4,000 Hispanic individuals completed the survey.

Survey data showed that Hispanics generally tend to be young and healthy, but have a high prevalence of obesity and a predisposition to diabetes, indicating a potential future crisis, said Susan Minushkin, deputy director of the Pew Hispanic Center, in a briefing with reporters. The Centers for Disease Control and Prevention has estimated that 10% of Hispanics have diabetes, 20% have hypertension, 40% are overweight, and 27% are obese, she said.

Therefore, it is worrisome that 27% of Hispanics–about 8 million adults–lacked a usual health care provider, Ms. Minushkin said. Only 62% of Hispanics without a usual provider had a blood pressure check in the last 2 years, compared with 86% of those who have a provider, the Pew Center found. Only 67% of those lacking a usual provider had a blood sugar test in the last 2 years, compared with 90% of those with a provider.

Diabetes knowledge was inconsistent, even among those diagnosed with the disease, the Pew Center found. Of diagnosed diabetics, 27% answered at least three of eight questions about the disease incorrectly, for instance. Overall, Hispanic women were more likely to give correct answers, as were middle-aged Hispanics of both sexes. Immigrants had the least amount of knowledge.

Those who did not have a usual health care provider were more likely to be young (aged 18–29 years), to lack a high school diploma, and to be uninsured. They also were more likely to be predominantly Spanish-speaking and to be foreign-born but not yet legal permanent residents. However, 45% of those who did not have a usual provider had health insurance.

The primary reason–given by 41% of respondents–for not having a usual health care provider was that they were seldom or never sick. Another 13% said they treat themselves or don't use a physician, 11% said the cost of care was prohibitive, 2% said they didn't know where to go for care, and 1% said they couldn't find a provider who spoke their language.

Though 78% rated the quality of their care as good or excellent, some 25% said the care they received was poor, which they blamed on their ethnicity or their English-speaking skills or accent.

More than two-thirds of respondents (71%) said they received information about health from a physician or other medical professional, but 83% said they received it from the media. “I can't comment on whether the information they are getting is good or bad,” said Ms. Minushkin, adding that the Pew Center did not ask what types of media were being cited.

But, she added, “those who do get information from the media make changes in their behavior.” About 40%–64% said the information affected decisions on how to treat an illness, led them to ask a physician a new question, or changed the way they thought about diet or exercise.

The National Hispanic Medical Association has joined the call for the establishment of medical homes that would provide patient-centered, coordinated care, Dr. Elena Rios, president and CEO of the NHMA, said at the briefing.