Alicia Ault

MedSpa Bill Fails in California

A bill that could have shuttered a huge number of medical spas in California essentially expired after a failed floor vote in the state Senate and protracted negotiations over a competing bill in the Assembly. Introduced in February, AB 2398 made its way through the legislature with the support of the American Society for Dermatologic Surgery Association, the California Society of Dermatology and Dermatologic Surgery, and other groups. The bill would have revoked the licenses of any physician who practiced for a "business organization" that provided outpatient cosmetic procedures, because it would be considered a violation of the prohibition against the corporate practice of medicine. The California Medspa Management Association, the International Medical Spa Association (IMSA), and the Manufacturers of Equipment for Light-Based Aesthetics said the law would amount to restraint of trade and would "undermine a physician's right to make a living," according to a letter sent to Gov. Arnold Schwarzenegger by IMSA.

FDA Warns on Laser Brush

The Food and Drug Administration has warned Sunetics International Corp. of Las Vegas that it is illegally marketing its Laser Hair Brush and Laser Skin Brush. The company advertises the products as laser devices that can grow hair and treat skin conditions such as acne and dyspigmentation, according to the FDA. The devices have not received premarket approval, which is required for any product making a claim to affect a structure or function in the body, according to the agency's warning letter. Sunetics did submit an approval application in January of this year, but it is still being reviewed, the agency said.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions Inc. and the FDA have partnered to study genetic testing and the effect of genetics on prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and the quantifying of prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. "Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed," Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services, and also will receive $56 billion in uncompensated care while uninsured, according to a study in the journal Health Affairs. Government programs will pay about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35% (or $583 on average) out of pocket toward average annual medical costs of $1,686, the study said. In contrast, the annual medical costs of the privately insured average $3,915, with 17% (or $681 on average) paid out of pocket, according to the study.

Health Searches Level Off

The number of adults going online for health information has plateaued or declined, according to a Harris Interactive poll. According to the pollster, a total of 150 million people (66% of all adults and 81% of those who have online access) said they obtained health information from the Internet in 2008. That represents a slight drop from 2007, when the poll found that 160 million people reported obtaining health information online. The researchers noted that the slight differences from 2007 to 2008 are within the possible sampling error. But they pointed out that, as opposed to other years, it appears that there has been no increase in the total number of people with Internet access or in the number of people searching for health information—those the pollsters called "cybercondriacs"—which indicates that a plateau or even a slight decline was underway. Just under half of cybercondriacs said that they had discussed the information they obtained online with their doctors, and 49% had gone online to look for information as a result of discussions with their doctors, the survey found.

MedSpa Bill Fails in California

A bill that could have shuttered a huge number of medical spas in California essentially expired after a failed floor vote in the state Senate and protracted negotiations over a competing bill in the Assembly. Introduced in February, AB 2398 made its way through the legislature with the support of the American Society for Dermatologic Surgery Association, the California Society of Dermatology and Dermatologic Surgery, and other groups. The bill would have revoked the licenses of any physician who practiced for a "business organization" that provided outpatient cosmetic procedures, because it would be considered a violation of the prohibition against the corporate practice of medicine. The California Medspa Management Association, the International Medical Spa Association (IMSA), and the Manufacturers of Equipment for Light-Based Aesthetics said the law would amount to restraint of trade and would "undermine a physician's right to make a living," according to a letter sent to Gov. Arnold Schwarzenegger by IMSA.

FDA Warns on Laser Brush

The Food and Drug Administration has warned Sunetics International Corp. of Las Vegas that it is illegally marketing its Laser Hair Brush and Laser Skin Brush. The company advertises the products as laser devices that can grow hair and treat skin conditions such as acne and dyspigmentation, according to the FDA. The devices have not received premarket approval, which is required for any product making a claim to affect a structure or function in the body, according to the agency's warning letter. Sunetics did submit an approval application in January of this year, but it is still being reviewed, the agency said.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions Inc. and the FDA have partnered to study genetic testing and the effect of genetics on prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and the quantifying of prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. "Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed," Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services, and also will receive $56 billion in uncompensated care while uninsured, according to a study in the journal Health Affairs. Government programs will pay about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35% (or $583 on average) out of pocket toward average annual medical costs of $1,686, the study said. In contrast, the annual medical costs of the privately insured average $3,915, with 17% (or $681 on average) paid out of pocket, according to the study.

Health Searches Level Off

The number of adults going online for health information has plateaued or declined, according to a Harris Interactive poll. According to the pollster, a total of 150 million people (66% of all adults and 81% of those who have online access) said they obtained health information from the Internet in 2008. That represents a slight drop from 2007, when the poll found that 160 million people reported obtaining health information online. The researchers noted that the slight differences from 2007 to 2008 are within the possible sampling error. But they pointed out that, as opposed to other years, it appears that there has been no increase in the total number of people with Internet access or in the number of people searching for health information—those the pollsters called "cybercondriacs"—which indicates that a plateau or even a slight decline was underway. Just under half of cybercondriacs said that they had discussed the information they obtained online with their doctors, and 49% had gone online to look for information as a result of discussions with their doctors, the survey found.

MedSpa Bill Fails in California

A bill that could have shuttered a huge number of medical spas in California essentially expired after a failed floor vote in the state Senate and protracted negotiations over a competing bill in the Assembly. Introduced in February, AB 2398 made its way through the legislature with the support of the American Society for Dermatologic Surgery Association, the California Society of Dermatology and Dermatologic Surgery, and other groups. The bill would have revoked the licenses of any physician who practiced for a "business organization" that provided outpatient cosmetic procedures, because it would be considered a violation of the prohibition against the corporate practice of medicine. The California Medspa Management Association, the International Medical Spa Association (IMSA), and the Manufacturers of Equipment for Light-Based Aesthetics said the law would amount to restraint of trade and would "undermine a physician's right to make a living," according to a letter sent to Gov. Arnold Schwarzenegger by IMSA.

FDA Warns on Laser Brush

The Food and Drug Administration has warned Sunetics International Corp. of Las Vegas that it is illegally marketing its Laser Hair Brush and Laser Skin Brush. The company advertises the products as laser devices that can grow hair and treat skin conditions such as acne and dyspigmentation, according to the FDA. The devices have not received premarket approval, which is required for any product making a claim to affect a structure or function in the body, according to the agency's warning letter. Sunetics did submit an approval application in January of this year, but it is still being reviewed, the agency said.

PQRI Frustrating, But Not Costly

A total of 90% of physicians answering a Medical Group Management Association survey said that they had trouble accessing their confidential 2007 Physician Quality Reporting Initiative (PQRI) reports from the Centers for Medicare and Medicaid's secure Web site. Overall, 70% sought CMS help in getting the reports; of those, 11% rated the help as not satisfactory. The PQRI reports received average marks for clarity and slightly lower ratings for providing guidance on improving outcomes. Even so, 90% of the practices said they would participate in the 2008 PQRI program. Survey responses were taken from 295 practices who said they had reported on PQRI measures from July to December 2007. When asked why they participated, the largest weight was given to preparing for the future, when quality reporting is anticipated to play a bigger role in Medicare reimbursement. Overall, 61% of practices earned a bonus from 2007. Most practices said that participation had not led to the need for more staff or higher expenses.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions Inc. and the FDA have partnered to study genetic testing and the effect of genetics on prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and the quantifying of prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. "Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed," Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services, and also will receive $56 billion in uncompensated care while uninsured, according to a study in the journal Health Affairs. Government programs will pay about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35% (or $583 on average) out of pocket toward average annual medical costs of $1,686, the study said. In contrast, the annual medical costs of the privately insured average $3,915, with 17% (or $681 on average) paid out of pocket, according to the study.

Health Searches Level Off

The number of adults going online for health information has plateaued or declined, according to a Harris Interactive poll. According to the pollster, a total of 150 million people (66% of all adults and 81% of those who have online access) said they obtained health information from the Internet in 2008. That represents a slight drop from 2007, when the poll found that 160 million people reported obtaining health information online. The researchers noted that the slight differences from 2007 to 2008 are within the possible sampling error. But they pointed out that, as opposed to other years, it appears that there has been no increase in the total number of people with Internet access or in the number of people searching for health information—those the pollsters called "cybercondriacs"—which indicates that a plateau or even a slight decline was underway. Just under half of cybercondriacs said that they had discussed the information they obtained online with their doctors, and 49% had gone online to look for information as a result of discussions with their doctors, the survey found.

Leaders at the American Academy of Family Physicians and the American College of Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles that it says should guide the development of a medical home, a concept that was developed by the American Academy of Pediatrics, and has been championed by ACP, AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by a variety of payers, from Medicare and Medicaid to big employers such as IBM.

But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department (ED), including caring for the uninsured.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper, but it went on to describe several concerns.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But the hurdles to making it work are high, she said.

First, there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week.

And, there are no studies showing that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted.

“This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is how ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed, and yet still face the same daily struggles, the professional group maintains.

ACEP says that enhanced access should be demonstrated and that once a medical home is established, patients should be able to continue to be a part of that home, whether or not they change or lose their insurance.

Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also states that the value of the medical home concept should be proven before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at ACP, agreed, noting his commentary in JAMA in late August.

“Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834–5). “However, it is imperative to test the model in a credible and transparent way in different environments,” he added.

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, president of the AAFP, said in an interview that he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

“The entire health care system needs reforming, but if we wait we're going to be even farther behind,” he said. The medical home concept will not solve the problem of the uninsured, but it can help more people get good quality health care, Dr. King said.

Leaders at the American Academy of Family Physicians and the American College of Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles that it says should guide the development of a medical home, a concept that was developed by the American Academy of Pediatrics, and has been championed by ACP, AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by a variety of payers, from Medicare and Medicaid to big employers such as IBM.

But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department (ED), including caring for the uninsured.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper, but it went on to describe several concerns.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But the hurdles to making it work are high, she said.

First, there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week.

And, there are no studies showing that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted.

“This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is how ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed, and yet still face the same daily struggles, the professional group maintains.

ACEP says that enhanced access should be demonstrated and that once a medical home is established, patients should be able to continue to be a part of that home, whether or not they change or lose their insurance.

Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also states that the value of the medical home concept should be proven before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at ACP, agreed, noting his commentary in JAMA in late August.

“Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834–5). “However, it is imperative to test the model in a credible and transparent way in different environments,” he added.

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, president of the AAFP, said in an interview that he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

“The entire health care system needs reforming, but if we wait we're going to be even farther behind,” he said. The medical home concept will not solve the problem of the uninsured, but it can help more people get good quality health care, Dr. King said.

Leaders at the American Academy of Family Physicians and the American College of Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles that it says should guide the development of a medical home, a concept that was developed by the American Academy of Pediatrics, and has been championed by ACP, AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by a variety of payers, from Medicare and Medicaid to big employers such as IBM.

But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department (ED), including caring for the uninsured.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper, but it went on to describe several concerns.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But the hurdles to making it work are high, she said.

First, there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week.

And, there are no studies showing that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted.

“This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is how ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed, and yet still face the same daily struggles, the professional group maintains.

ACEP says that enhanced access should be demonstrated and that once a medical home is established, patients should be able to continue to be a part of that home, whether or not they change or lose their insurance.

Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also states that the value of the medical home concept should be proven before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at ACP, agreed, noting his commentary in JAMA in late August.

“Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834–5). “However, it is imperative to test the model in a credible and transparent way in different environments,” he added.

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, president of the AAFP, said in an interview that he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

“The entire health care system needs reforming, but if we wait we're going to be even farther behind,” he said. The medical home concept will not solve the problem of the uninsured, but it can help more people get good quality health care, Dr. King said.

Leaders at the American College of Physicians and the American Academy of Family Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles it says should guide the development of a medical home, a concept developed by the American Academy of Pediatrics and championed by the ACP, the AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by Medicare, Medicaid, and big employers such as IBM.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper. But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department, including caring for the uninsured.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week. And no studies show that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted. “This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is what ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed and yet still face the same daily struggles, the professional group maintains.

ACEP says enhanced access should be demonstrated and that once a medical home is established, patients should be able to remain a part of that home, whether or not they change or lose their insurance. Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also said the value of the medical home should be proved before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at the ACP, agreed, noting his commentary in JAMA in late August. “Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834-5). “However, it is imperative to test the model in a credible and transparent way in different environments.”

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, the ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, AAFP president, said he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

Leaders at the American College of Physicians and the American Academy of Family Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles it says should guide the development of a medical home, a concept developed by the American Academy of Pediatrics and championed by the ACP, the AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by Medicare, Medicaid, and big employers such as IBM.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper. But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department, including caring for the uninsured.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week. And no studies show that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted. “This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is what ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed and yet still face the same daily struggles, the professional group maintains.

ACEP says enhanced access should be demonstrated and that once a medical home is established, patients should be able to remain a part of that home, whether or not they change or lose their insurance. Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also said the value of the medical home should be proved before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at the ACP, agreed, noting his commentary in JAMA in late August. “Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834-5). “However, it is imperative to test the model in a credible and transparent way in different environments.”

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, the ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, AAFP president, said he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

Leaders at the American College of Physicians and the American Academy of Family Physicians say they welcome the American College of Emergency Physicians' recent statement supporting the concept of a patient-centered medical home, and hope to work with the group to address its concerns.

ACEP issued eight principles it says should guide the development of a medical home, a concept developed by the American Academy of Pediatrics and championed by the ACP, the AAFP, and the American Osteopathic Association. The idea of a medical home, where patients could receive consistent, coordinated care aided by electronic medical records, has been gaining attention from health policy makers.

The approach is the subject of demonstration projects around the country, with sponsorship by Medicare, Medicaid, and big employers such as IBM.

“ACEP agrees with the basic tenets of the patient-centered medical home model,” the organization said in its position paper. But ACEP says it is concerned that widespread implementation could exacerbate challenges in the emergency department, including caring for the uninsured.

“In an ideal world, the concepts in a patient-centered medical home are laudable,” Dr. Linda Lawrence, ACEP president, said in an interview. But there is a shortage of primary care physicians, and access to them cannot be guaranteed 24 hours a day, 7 days a week. And no studies show that a medical home will increase access to basic care or reduce the number of unnecessary visits to the ED, according to ACEP.

Many Americans continue to lack health insurance or have less-than-adequate coverage, Dr. Lawrence noted. “This could drive a greater divide in access to health care in America,” she said. “We have to be a bit skeptical that without overall change in the system, you're going to have more boutique medicine, and the rest are going to fall by the wayside.”

Inevitably, ACEP said, patients will still rely on the ED as their “medical home away from home,” which is what ACEP has dubbed the nation's emergency departments. If health care dollars are shifted to the medical home, EDs might end up being short-changed and yet still face the same daily struggles, the professional group maintains.

ACEP says enhanced access should be demonstrated and that once a medical home is established, patients should be able to remain a part of that home, whether or not they change or lose their insurance. Patients also should be able to switch medical homes when necessary, choose their own specialists, and access the emergency department when they determine it is appropriate.

More than a decade ago, emergency physicians fought to codify the notion that a “prudent layperson” could determine when it is necessary to seek emergency care. This came in the wake of frequent payment denials for emergency services by cost-conscious managed care organizations, Dr. Lawrence said. No one wants to repeat that battle, she said.

ACEP also said the value of the medical home should be proved before it is widely adopted.

Dr. Michael Barr, vice president for practice advocacy and improvement at the ACP, agreed, noting his commentary in JAMA in late August. “Data suggest that the model will deliver improved quality and reduced costs and prove attractive to patients and their families,” Dr. Barr wrote (JAMA 2008;300:834-5). “However, it is imperative to test the model in a credible and transparent way in different environments.”

In an interview, Dr. Barr agreed with Dr. Lawrence and her ACEP colleagues that the “medical home is not the answer to all the ills of the American health care system right now.” Like ACEP, the ACP has advocated for universal health coverage, he added.

But medical home supporters are not trying to limit patient choice, or to prevent patients from choosing the emergency department when necessary. “What the medical home would do if it works is hopefully reduce unnecessary or avoidable ED visits and at same time not limit appropriate ED referrals and use by patients,” Dr. Barr said.

Dr. James King, AAFP president, said he's “pleased [ACEP] has thought about and evaluated the medical home.” Emergency physicians are seeing the 47 million uninsured, and “they need to get paid for that,” he said.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, Mr. Nichols said in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” Mr. Nichols said.

In a paper published in the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689-92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee, “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, Mr. Pollack said.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he said. But, “I don't think any of the proposals that have come out so far are going to be the proposals,” Mr. Pollack added.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Still Concerned About Health Care After All These Years

Harry and Louise, who became infamous in a 1993-1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion-dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The new ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

Harry and Louise were back at their kitchen table in a new ad promoting health care reform. Health Care First

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, Mr. Nichols said in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” Mr. Nichols said.

In a paper published in the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689-92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee, “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, Mr. Pollack said.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he said. But, “I don't think any of the proposals that have come out so far are going to be the proposals,” Mr. Pollack added.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Still Concerned About Health Care After All These Years

Harry and Louise, who became infamous in a 1993-1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion-dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The new ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

Harry and Louise were back at their kitchen table in a new ad promoting health care reform. Health Care First

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, Mr. Nichols said in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” Mr. Nichols said.

In a paper published in the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689-92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee, “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, Mr. Pollack said.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he said. But, “I don't think any of the proposals that have come out so far are going to be the proposals,” Mr. Pollack added.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Still Concerned About Health Care After All These Years

Harry and Louise, who became infamous in a 1993-1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion-dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The new ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

Harry and Louise were back at their kitchen table in a new ad promoting health care reform. Health Care First

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits. It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

The Brief Return of Harry and Louise

Harry and Louise, who became infamous in a 1993–1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was being bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits. It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

The Brief Return of Harry and Louise

Harry and Louise, who became infamous in a 1993–1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was being bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits. It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

The Brief Return of Harry and Louise

Harry and Louise, who became infamous in a 1993–1994 television ad lambasting the Clinton administration's health care reform plan, were dragged briefly out of mothballs to appear in a new commercial that urged Congress and the next president to make such reform the top domestic policy priority.

The effort was being bankrolled by five groups that by their own admission have “historically divergent views about health care reform”: the American Cancer Society's Cancer Action Network, the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

“We intend to transcend ideology and partisan politics,” said Families USA Executive Director Ron Pollack at a press conference. The multimillion dollar campaign aired nationally for 2 weeks during the Republican and Democratic conventions.

The ad featured Harry and Louise, back at their kitchen table. The characters were portrayed by the same two actors, now 14 years older. Harry noted that health care costs are going up again and that small businesses are being forced to drop their plans. Louise said that a friend just found out he has cancer and can't afford a plan. Harry remarked that “too many people are falling through the cracks.” Finally, Louise said that “whoever the next president is,” health care should be “at the top of his agenda,” and that he should bring everyone to the table and “make it happen.”

The campaign did not advocate any specific solution. The sponsors said their goal was to create momentum for change, and that they believed that, unlike 14 years ago, there is a consensus that reform is inevitable and necessary.

“The status quo is no longer acceptable,” said Rich Umbdenstock, AHA president and CEO.

“We simply can't be having this conversation 14 years from now,” added Sister Carol Keehan, CHA president and CEO.

The NFIB joined the effort because its membership said that “health care costs are their No. 1 concern,” said Todd Stottlemyer, president and CEO.

The five groups were joined at the briefing by Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP (back when it was known as the Health Insurance Association of America) launched Harry and Louise the first time, helping to defeat the Clinton reform plan.

But Ms. Ignani said times are different now: “Our commitment is to make sure no one falls through the cracks,” she said.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut.

Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, said Dr. Bishop.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, said Dr. Bishop. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians were eligible for the network, Aetna looked at the number of Aetna cases managed over a 3-year period; there was a 20-case minimum.

The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, said Dr. Bishop.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” said Dr. Bishop.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut.

Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, said Dr. Bishop.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, said Dr. Bishop. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians were eligible for the network, Aetna looked at the number of Aetna cases managed over a 3-year period; there was a 20-case minimum.

The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, said Dr. Bishop.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” said Dr. Bishop.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut.

Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, said Dr. Bishop.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, said Dr. Bishop. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians were eligible for the network, Aetna looked at the number of Aetna cases managed over a 3-year period; there was a 20-case minimum.

The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, said Dr. Bishop.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” said Dr. Bishop.

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, “While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area.”

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall. Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days. Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate—38%—was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York State Medicaid program came in for special criticism. It lagged in most of the key measures. The program had the highest DAR of any payer—for the second year running—coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category. According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, “While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area.”

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall. Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days. Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate—38%—was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York State Medicaid program came in for special criticism. It lagged in most of the key measures. The program had the highest DAR of any payer—for the second year running—coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category. According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, “While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area.”

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall. Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days. Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate—38%—was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York State Medicaid program came in for special criticism. It lagged in most of the key measures. The program had the highest DAR of any payer—for the second year running—coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category. According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

Experts serving on the Food and Drug Administration's advisory committees are now subject to new rules aimed at ensuring that they do not have conflicts of interest that could bias their decisions.

In early August, the FDA issued four final guidance documents and a draft guidance outlining how it plans to handle conflicts of interest among members of advisory committees, which review the safety and efficacy of drugs, medical devices, diagnostic tests, and other products and ingredients that the agency regulates.

In a separate move, the agency said that it plans to make it easier to find documents before and after advisory committee meetings by improving how it posts meeting information on its Web site.

Guidance documents represent the agency's current thinking on a topic, but carry less weight than does a regulation. The FDA has no power to enforce guidance documents, which manufacturers and the agency generally use as rules of thumb.

The newest guidance documents will help ensure that the FDA “is getting the highest quality scientific advice, while at the same time preserving public trust in our decisions,” Randall Lutter, Ph.D., the FDA's deputy commissioner for policy, said in a teleconference briefing with reporters.

In the past, the agency has asked advisers to disclose potential conflicts of interest, but there was no monetary limit. Each potential conflict was weighed individually, and waivers were granted based on whether the adviser's expertise was considered necessary for a particular meeting.

With the new guidance, the agency sets a dollar limit on advisers' financial interests. If an adviser—or his or her spouse or minor child—has interests of at least $50,000 in an entity that would be directly or indirectly affected by the outcome of a particular meeting, the adviser would be barred from participating. Advisers with interests less than $50,000 will be allowed to participate and vote, unless they are found to have a significant conflict of interest.

An advocate who has been critical of the FDA's conflict of interest policy for advisers said that the $50,000 cap is too high.

“The FDA wants us to believe that an advisory committee member can receive $49,999 from a company and still make an unbiased decision. I don't buy it and the research doesn't support it,” said Diana Zuckerman, Ph.D., president of the National Research Center for Women and Families, an advocacy group in Washington.

She and another agency critic, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, both expressed concern that the new guidance would still allow advisers with conflicts to vote. Those advisers will be granted waivers if they are determined to provide essential expertise. This is not much of a change from current policy, according to Dr. Wolfe and Dr. Zuckerman.

“The FDA has consistently used a very low standard for granting waivers, and there is no evidence that this will change,” Dr. Zuckerman said.

But the FDA said that the Food and Drug Administration Amendments Act of 2007, which was signed into law last year, limits the number of waivers it is allowed to grant. The agency also has vowed to make the circumstances of the waivers public.

In another guidance, the agency said that it will require simultaneous voting by all committee members. Advisers at some meetings have begun using an electronic voting system to ensure that panel members don't influence the votes of those who succeed them in voting; the votes are conducted privately, and then broadcast immediately afterwards on a screen.

Dr. Wolfe said that when he has seen the voting system in action, “it worked well and served the stated purpose.”

He also praised the agency's proposed guidance to set out a more definitive policy on when a product should be referred to an advisory committee for review. The basis for referral “has been less than clear,” Dr. Wolfe said.

The FDA also is changing the administrative process for advisory committee meetings. The agency will formally notify a sponsoring company 55 days in advance that a meeting has been scheduled. Also, the FDA will post materials relating to the meeting on its Web site no later than 2 full days in advance of the meeting.

Experts serving on the Food and Drug Administration's advisory committees are now subject to new rules aimed at ensuring that they do not have conflicts of interest that could bias their decisions.

In early August, the FDA issued four final guidance documents and a draft guidance outlining how it plans to handle conflicts of interest among members of advisory committees, which review the safety and efficacy of drugs, medical devices, diagnostic tests, and other products and ingredients that the agency regulates.

In a separate move, the agency said that it plans to make it easier to find documents before and after advisory committee meetings by improving how it posts meeting information on its Web site.

Guidance documents represent the agency's current thinking on a topic, but carry less weight than does a regulation. The FDA has no power to enforce guidance documents, which manufacturers and the agency generally use as rules of thumb.

The newest guidance documents will help ensure that the FDA “is getting the highest quality scientific advice, while at the same time preserving public trust in our decisions,” Randall Lutter, Ph.D., the FDA's deputy commissioner for policy, said in a teleconference briefing with reporters.

In the past, the agency has asked advisers to disclose potential conflicts of interest, but there was no monetary limit. Each potential conflict was weighed individually, and waivers were granted based on whether the adviser's expertise was considered necessary for a particular meeting.

With the new guidance, the agency sets a dollar limit on advisers' financial interests. If an adviser—or his or her spouse or minor child—has interests of at least $50,000 in an entity that would be directly or indirectly affected by the outcome of a particular meeting, the adviser would be barred from participating. Advisers with interests less than $50,000 will be allowed to participate and vote, unless they are found to have a significant conflict of interest.

An advocate who has been critical of the FDA's conflict of interest policy for advisers said that the $50,000 cap is too high.

“The FDA wants us to believe that an advisory committee member can receive $49,999 from a company and still make an unbiased decision. I don't buy it and the research doesn't support it,” said Diana Zuckerman, Ph.D., president of the National Research Center for Women and Families, an advocacy group in Washington.

She and another agency critic, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, both expressed concern that the new guidance would still allow advisers with conflicts to vote. Those advisers will be granted waivers if they are determined to provide essential expertise. This is not much of a change from current policy, according to Dr. Wolfe and Dr. Zuckerman.

“The FDA has consistently used a very low standard for granting waivers, and there is no evidence that this will change,” Dr. Zuckerman said.

But the FDA said that the Food and Drug Administration Amendments Act of 2007, which was signed into law last year, limits the number of waivers it is allowed to grant. The agency also has vowed to make the circumstances of the waivers public.

In another guidance, the agency said that it will require simultaneous voting by all committee members. Advisers at some meetings have begun using an electronic voting system to ensure that panel members don't influence the votes of those who succeed them in voting; the votes are conducted privately, and then broadcast immediately afterwards on a screen.

Dr. Wolfe said that when he has seen the voting system in action, “it worked well and served the stated purpose.”

He also praised the agency's proposed guidance to set out a more definitive policy on when a product should be referred to an advisory committee for review. The basis for referral “has been less than clear,” Dr. Wolfe said.

The FDA also is changing the administrative process for advisory committee meetings. The agency will formally notify a sponsoring company 55 days in advance that a meeting has been scheduled. Also, the FDA will post materials relating to the meeting on its Web site no later than 2 full days in advance of the meeting.

Experts serving on the Food and Drug Administration's advisory committees are now subject to new rules aimed at ensuring that they do not have conflicts of interest that could bias their decisions.

In early August, the FDA issued four final guidance documents and a draft guidance outlining how it plans to handle conflicts of interest among members of advisory committees, which review the safety and efficacy of drugs, medical devices, diagnostic tests, and other products and ingredients that the agency regulates.

In a separate move, the agency said that it plans to make it easier to find documents before and after advisory committee meetings by improving how it posts meeting information on its Web site.

Guidance documents represent the agency's current thinking on a topic, but carry less weight than does a regulation. The FDA has no power to enforce guidance documents, which manufacturers and the agency generally use as rules of thumb.

The newest guidance documents will help ensure that the FDA “is getting the highest quality scientific advice, while at the same time preserving public trust in our decisions,” Randall Lutter, Ph.D., the FDA's deputy commissioner for policy, said in a teleconference briefing with reporters.

In the past, the agency has asked advisers to disclose potential conflicts of interest, but there was no monetary limit. Each potential conflict was weighed individually, and waivers were granted based on whether the adviser's expertise was considered necessary for a particular meeting.

With the new guidance, the agency sets a dollar limit on advisers' financial interests. If an adviser—or his or her spouse or minor child—has interests of at least $50,000 in an entity that would be directly or indirectly affected by the outcome of a particular meeting, the adviser would be barred from participating. Advisers with interests less than $50,000 will be allowed to participate and vote, unless they are found to have a significant conflict of interest.

An advocate who has been critical of the FDA's conflict of interest policy for advisers said that the $50,000 cap is too high.

“The FDA wants us to believe that an advisory committee member can receive $49,999 from a company and still make an unbiased decision. I don't buy it and the research doesn't support it,” said Diana Zuckerman, Ph.D., president of the National Research Center for Women and Families, an advocacy group in Washington.

She and another agency critic, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, both expressed concern that the new guidance would still allow advisers with conflicts to vote. Those advisers will be granted waivers if they are determined to provide essential expertise. This is not much of a change from current policy, according to Dr. Wolfe and Dr. Zuckerman.

“The FDA has consistently used a very low standard for granting waivers, and there is no evidence that this will change,” Dr. Zuckerman said.

But the FDA said that the Food and Drug Administration Amendments Act of 2007, which was signed into law last year, limits the number of waivers it is allowed to grant. The agency also has vowed to make the circumstances of the waivers public.

In another guidance, the agency said that it will require simultaneous voting by all committee members. Advisers at some meetings have begun using an electronic voting system to ensure that panel members don't influence the votes of those who succeed them in voting; the votes are conducted privately, and then broadcast immediately afterwards on a screen.

Dr. Wolfe said that when he has seen the voting system in action, “it worked well and served the stated purpose.”

He also praised the agency's proposed guidance to set out a more definitive policy on when a product should be referred to an advisory committee for review. The basis for referral “has been less than clear,” Dr. Wolfe said.

The FDA also is changing the administrative process for advisory committee meetings. The agency will formally notify a sponsoring company 55 days in advance that a meeting has been scheduled. Also, the FDA will post materials relating to the meeting on its Web site no later than 2 full days in advance of the meeting.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation.

“The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June.

Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, said Mr. Pollack.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he commented.

But, “I don't think any of the proposals that have come out so far are going to be the proposals,” added Mr. Pollack.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation.

“The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June.

Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, said Mr. Pollack.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he commented.

But, “I don't think any of the proposals that have come out so far are going to be the proposals,” added Mr. Pollack.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.

Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.

Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.

For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.

But the differences between the two elections are striking in a positive way, said Mr. Nichols, in an interview.

First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.

Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.

Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”

Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.

The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” said Mr. Nichols.

In a paper published in the May/June 2008 issue of the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation.

“The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689–92).

The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.

It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.

Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles.”

Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”

Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June.

Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.

Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.

Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.

The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, said Mr. Pollack.

“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he commented.

But, “I don't think any of the proposals that have come out so far are going to be the proposals,” added Mr. Pollack.

Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, “and that's what we should look at most seriously,” he said.

Statin Use Soars

Americans spent $20 billion on statin medications in 2005. This was a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, a total of 16 million people said they had purchased at least one statin. By 2005, almost twice as many people (30 million) had purchased a statin. Outpatient prescriptions of statins zoomed from 90 million to 174 million Each of the individuals who took a statin saw expenditures increase in this period from $484 per year to $661 annually. The AHRQ did not determine in its analysis how much of that expenditure was covered by insurers and how much of it was out-of-pocket cost to the individual patients. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details the health services that are used by civilian, noninstitutionalized Americans.

Speedier Device Reviews

The Food and Drug Administration reports that it is reviewing medical devices more quickly than it has in the past, but it is not by much. And they reported that the number of submissions directed to the agency has declined both for breakthrough devices—called premarket approval (PMA) applications—and for those devices that are substantially equivalent to those already on the market—known as 510(k) applications. The agency's Office of Device Evaluation received a total of 31 PMAs in fiscal 2007, compared with 66 submissions in fiscal 1997. In fiscal 2007 there were a total of 3,192 510(k) submissions, compared with 5,049 in fiscal 1997. Of the 2007 submissions, 2,640 were approved. The number of supplemental PMA applications, however, has been increasing. A supplemental PMA usually seeks an additional indication or use for the same device. The average time it took to review original and supplemental PMA applications by the FDA has declined somewhat since the agency began charging the device companies a fee for review in 2002—dropping from 292 days in that fiscal year to 283 days in fiscal 2006. The FDA has not reported fiscal 2007 data yet because many of those products were still under review at the time the report was being compiled.

Dems Seek to Restore Device Suits

Democrats in the House of Representatives were not happy when the U.S. Supreme Court ruled in February that device makers are immune from state lawsuits brought by patients who allege that they were harmed by a product that was approved by the FDA under the pre-market approval process. House Democrats have introduced a bill, the Medical Device Safety Act of 2008 (H.R. 6381), in order to reverse that decision. The charge is being led by Reps. Frank Pallone (D-N.J.) and Henry Waxman (D-Calif.), and the bill now has 64 cosponsors. A companion bill is expected to come from Sens. Edward Kennedy (D-Mass.) and Patrick Leahy (D-Vt.), but had not been introduced at press time. The Supreme Court ruling in Reigel v. Medtronic Inc. “ignores both congressional intent and 30 years of experience in which FDA regulation and tort liability played complementary roles in protecting consumers from device risks,” according to a joint statement from Reps. Pallone and Waxman. The device industry trade group AdvaMed criticized the “patchwork approach” that has been in existence thanks to the allowance for state suits and said that H.R. 6381 “will not improve patient safety but will result in needless delays in patient access to essential medical technologies, more lawsuits, and ultimately higher health care costs.”

Feds Scrutinize Generic Maker

India's Ranbaxy Inc., which is one of the top 10 generic drug makers in the world, is now being investigated by various arms of the U.S. federal government for allegedly introducing “adulterated or misbranded products” into the United States market. In addition, the company's auditor, Parexel Consulting, has come under federal scrutiny for violations. According to a subpoena for documents that was filed in the U.S. District Court for the District of Maryland by the Department of Justice and the U.S. Attorney's Office in Maryland, Ranbaxy Inc. allegedly submitted false information to the U.S. Food and Drug Administration regarding sterility and bioequivalence, covered up good manufacturing practice violations, and defrauded Medicare. Reps. John Dingell (D-Mich.) and Bart Stupak (D-Mich.) said that they would formally investigate the Ranbaxy situation. “If these allegations are true, Ranbaxy has imperiled the safety of Americans in a manner similar to the generic drug scandal we uncovered 20 years ago,” said Rep. Dingell. “I would like to know whether FDA officials knew about these allegations and what, if any, action was taken.”

Medicare Issues PQRI Payments

Physicians who successfully reported their quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments last month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had already paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health care professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and would be receiving bonus checks, according to the CMS. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, the CMS.reported. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri

Statin Use Soars

Americans spent $20 billion on statin medications in 2005. This was a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, a total of 16 million people said they had purchased at least one statin. By 2005, almost twice as many people (30 million) had purchased a statin. Outpatient prescriptions of statins zoomed from 90 million to 174 million Each of the individuals who took a statin saw expenditures increase in this period from $484 per year to $661 annually. The AHRQ did not determine in its analysis how much of that expenditure was covered by insurers and how much of it was out-of-pocket cost to the individual patients. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details the health services that are used by civilian, noninstitutionalized Americans.

Speedier Device Reviews

The Food and Drug Administration reports that it is reviewing medical devices more quickly than it has in the past, but it is not by much. And they reported that the number of submissions directed to the agency has declined both for breakthrough devices—called premarket approval (PMA) applications—and for those devices that are substantially equivalent to those already on the market—known as 510(k) applications. The agency's Office of Device Evaluation received a total of 31 PMAs in fiscal 2007, compared with 66 submissions in fiscal 1997. In fiscal 2007 there were a total of 3,192 510(k) submissions, compared with 5,049 in fiscal 1997. Of the 2007 submissions, 2,640 were approved. The number of supplemental PMA applications, however, has been increasing. A supplemental PMA usually seeks an additional indication or use for the same device. The average time it took to review original and supplemental PMA applications by the FDA has declined somewhat since the agency began charging the device companies a fee for review in 2002—dropping from 292 days in that fiscal year to 283 days in fiscal 2006. The FDA has not reported fiscal 2007 data yet because many of those products were still under review at the time the report was being compiled.

Dems Seek to Restore Device Suits

Democrats in the House of Representatives were not happy when the U.S. Supreme Court ruled in February that device makers are immune from state lawsuits brought by patients who allege that they were harmed by a product that was approved by the FDA under the pre-market approval process. House Democrats have introduced a bill, the Medical Device Safety Act of 2008 (H.R. 6381), in order to reverse that decision. The charge is being led by Reps. Frank Pallone (D-N.J.) and Henry Waxman (D-Calif.), and the bill now has 64 cosponsors. A companion bill is expected to come from Sens. Edward Kennedy (D-Mass.) and Patrick Leahy (D-Vt.), but had not been introduced at press time. The Supreme Court ruling in Reigel v. Medtronic Inc. “ignores both congressional intent and 30 years of experience in which FDA regulation and tort liability played complementary roles in protecting consumers from device risks,” according to a joint statement from Reps. Pallone and Waxman. The device industry trade group AdvaMed criticized the “patchwork approach” that has been in existence thanks to the allowance for state suits and said that H.R. 6381 “will not improve patient safety but will result in needless delays in patient access to essential medical technologies, more lawsuits, and ultimately higher health care costs.”

Feds Scrutinize Generic Maker

India's Ranbaxy Inc., which is one of the top 10 generic drug makers in the world, is now being investigated by various arms of the U.S. federal government for allegedly introducing “adulterated or misbranded products” into the United States market. In addition, the company's auditor, Parexel Consulting, has come under federal scrutiny for violations. According to a subpoena for documents that was filed in the U.S. District Court for the District of Maryland by the Department of Justice and the U.S. Attorney's Office in Maryland, Ranbaxy Inc. allegedly submitted false information to the U.S. Food and Drug Administration regarding sterility and bioequivalence, covered up good manufacturing practice violations, and defrauded Medicare. Reps. John Dingell (D-Mich.) and Bart Stupak (D-Mich.) said that they would formally investigate the Ranbaxy situation. “If these allegations are true, Ranbaxy has imperiled the safety of Americans in a manner similar to the generic drug scandal we uncovered 20 years ago,” said Rep. Dingell. “I would like to know whether FDA officials knew about these allegations and what, if any, action was taken.”

Medicare Issues PQRI Payments

Physicians who successfully reported their quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments last month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had already paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health care professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and would be receiving bonus checks, according to the CMS. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, the CMS.reported. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri

Statin Use Soars

Americans spent $20 billion on statin medications in 2005. This was a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, a total of 16 million people said they had purchased at least one statin. By 2005, almost twice as many people (30 million) had purchased a statin. Outpatient prescriptions of statins zoomed from 90 million to 174 million Each of the individuals who took a statin saw expenditures increase in this period from $484 per year to $661 annually. The AHRQ did not determine in its analysis how much of that expenditure was covered by insurers and how much of it was out-of-pocket cost to the individual patients. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details the health services that are used by civilian, noninstitutionalized Americans.

Speedier Device Reviews

The Food and Drug Administration reports that it is reviewing medical devices more quickly than it has in the past, but it is not by much. And they reported that the number of submissions directed to the agency has declined both for breakthrough devices—called premarket approval (PMA) applications—and for those devices that are substantially equivalent to those already on the market—known as 510(k) applications. The agency's Office of Device Evaluation received a total of 31 PMAs in fiscal 2007, compared with 66 submissions in fiscal 1997. In fiscal 2007 there were a total of 3,192 510(k) submissions, compared with 5,049 in fiscal 1997. Of the 2007 submissions, 2,640 were approved. The number of supplemental PMA applications, however, has been increasing. A supplemental PMA usually seeks an additional indication or use for the same device. The average time it took to review original and supplemental PMA applications by the FDA has declined somewhat since the agency began charging the device companies a fee for review in 2002—dropping from 292 days in that fiscal year to 283 days in fiscal 2006. The FDA has not reported fiscal 2007 data yet because many of those products were still under review at the time the report was being compiled.

Dems Seek to Restore Device Suits

Democrats in the House of Representatives were not happy when the U.S. Supreme Court ruled in February that device makers are immune from state lawsuits brought by patients who allege that they were harmed by a product that was approved by the FDA under the pre-market approval process. House Democrats have introduced a bill, the Medical Device Safety Act of 2008 (H.R. 6381), in order to reverse that decision. The charge is being led by Reps. Frank Pallone (D-N.J.) and Henry Waxman (D-Calif.), and the bill now has 64 cosponsors. A companion bill is expected to come from Sens. Edward Kennedy (D-Mass.) and Patrick Leahy (D-Vt.), but had not been introduced at press time. The Supreme Court ruling in Reigel v. Medtronic Inc. “ignores both congressional intent and 30 years of experience in which FDA regulation and tort liability played complementary roles in protecting consumers from device risks,” according to a joint statement from Reps. Pallone and Waxman. The device industry trade group AdvaMed criticized the “patchwork approach” that has been in existence thanks to the allowance for state suits and said that H.R. 6381 “will not improve patient safety but will result in needless delays in patient access to essential medical technologies, more lawsuits, and ultimately higher health care costs.”

Feds Scrutinize Generic Maker

India's Ranbaxy Inc., which is one of the top 10 generic drug makers in the world, is now being investigated by various arms of the U.S. federal government for allegedly introducing “adulterated or misbranded products” into the United States market. In addition, the company's auditor, Parexel Consulting, has come under federal scrutiny for violations. According to a subpoena for documents that was filed in the U.S. District Court for the District of Maryland by the Department of Justice and the U.S. Attorney's Office in Maryland, Ranbaxy Inc. allegedly submitted false information to the U.S. Food and Drug Administration regarding sterility and bioequivalence, covered up good manufacturing practice violations, and defrauded Medicare. Reps. John Dingell (D-Mich.) and Bart Stupak (D-Mich.) said that they would formally investigate the Ranbaxy situation. “If these allegations are true, Ranbaxy has imperiled the safety of Americans in a manner similar to the generic drug scandal we uncovered 20 years ago,” said Rep. Dingell. “I would like to know whether FDA officials knew about these allegations and what, if any, action was taken.”

Medicare Issues PQRI Payments

Physicians who successfully reported their quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments last month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had already paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health care professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and would be receiving bonus checks, according to the CMS. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, the CMS.reported. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri