Alicia Ault

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving β-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement last month that it would no longer collect data on how many acute MI patients receive β-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a β-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge β-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received β-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement. “At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided it would no longer collect this information. The organization decided to “evolve” the β-blocker measure by setting the bar higher, and began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking β-blockers 6 months after an MI. There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important—probably more important than whether patients were receiving β-blockers immediately after discharge.

Most post-MI care is done on an outpatient basis, said Dr. Dove, in an interview. Plus, “the data suggest that most people who are on a β-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, said Dr. Dove.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

“It's our obligation as we see the patient to reinforce why they need to take the medication,” said Dr. Dove.

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving β-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement last month that it would no longer collect data on how many acute MI patients receive β-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a β-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge β-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received β-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement. “At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided it would no longer collect this information. The organization decided to “evolve” the β-blocker measure by setting the bar higher, and began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking β-blockers 6 months after an MI. There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important—probably more important than whether patients were receiving β-blockers immediately after discharge.

Most post-MI care is done on an outpatient basis, said Dr. Dove, in an interview. Plus, “the data suggest that most people who are on a β-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, said Dr. Dove.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

“It's our obligation as we see the patient to reinforce why they need to take the medication,” said Dr. Dove.

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving β-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement last month that it would no longer collect data on how many acute MI patients receive β-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a β-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge β-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received β-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement. “At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided it would no longer collect this information. The organization decided to “evolve” the β-blocker measure by setting the bar higher, and began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking β-blockers 6 months after an MI. There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important—probably more important than whether patients were receiving β-blockers immediately after discharge.

Most post-MI care is done on an outpatient basis, said Dr. Dove, in an interview. Plus, “the data suggest that most people who are on a β-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, said Dr. Dove.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

“It's our obligation as we see the patient to reinforce why they need to take the medication,” said Dr. Dove.

Starting next year, federal health programs will cover any procedure done at an ambulatory surgery center, with few but defined exclusions, according to final regulations released by the Centers for Medicare and Medicaid Services.

The payment formula for such procedures, to be phased in over 4 years, was also set by the regulations.

Previously, CMS covered approximately 2,600 procedures when they were performed at an ASC; now, an additional 790 procedures will be eligible in 2008. According to Dr. Charles Mabry, chairman of the American College of Surgeons' health policy steering committee and a member of the general surgery coding and reimbursement committee, as new procedures receive CPT codes, they, too will be covered, unless they are specifically excluded.

CMS will not pay for a procedure if it meets the following exclusion criteria:

▸ It poses a significant safety risk to the beneficiary.

▸ It would result in the patient's requiring active monitoring or an overnight stay.

▸ It directly involves major blood vessels.

▸ It requires major or prolonged invasion of body cavities.

▸ It results in extensive blood loss.

▸ It is emergent or life threatening.

▸ It requires systemic thrombolysis.

▸ It can be reported only with an unlisted code.

The change means that more patients will likely be able to have procedures done in an ASC, said Dr. Mabry, who is also a shareholder in an ambulatory surgery center in Pine Bluff, Ark.

The question now: “Is the payment rate the right rate?” he said. (See box.)

CMS also decided to limit payment for procedures performed in an ASC that are done in a physician's office more than half the time. “CMS does not want to create inappropriate payment incentives for procedures to be performed in ASCs if the physician's office is the most efficient setting for providing high quality care,” according to the agency.

FASA, the advocacy arm of the Foundation for Ambulatory Surgery in America, objected to this proposal and also to CMS's list of exclusions, arguing that the agency should pay for any procedure that is not covered under the inpatient system.

Under the new rule, Medicare will make separate payments for ancillary services, such as radiology, and for some drugs and biologicals considered integral to a surgical procedure. The agency will also make adjustments for procedures that have high device costs (that is, when the cost of the device accounts for more than half the median cost of the procedure).

Those high device-cost procedures include placement of neurostimulators, pulse generators, or pacemakers.

The adjustment is already in effect under CMS's hospital outpatient payment system.

The change means that more patients will likely beable to have procedures done in an ASC. DR. MABRY

Payment Proposals for 2008

In addition to setting the formula for how ambulatory surgery centers will be paid going forward, CMS has also issued proposals on how the formula will guide payments to ASCs in 2008, and on how much hospital outpatient departments will receive in 2008.

CMShas proposed that in 2008, ASCs would be paid at 65% of hospital outpatient rates, a slight increase over an earlier proposal of 62%.

Medicare and Medicaid expect to pay $3 billion in 2008 to about 4,600 participating ASCs, according to CMS.

In the proposed pay rates, orthopedic procedures would receive the greatest increases, whereas gastrointestinal procedures would be cut. An upper GI endoscopy with biopsy (CPT code 43239) would be cut by 13%, from $446 in 2007 to $387 in 2008. A small-bowel endoscopy with biopsy (CPT code 44361) would be cut by about 11%.

The agency also issued its proposal for hospital outpatient payments, which is partially driven by the desire to keep beneficiary copays at 20%. In 2008, the overall copay will be about 26%, but for most procedures, beneficiaries will be liable for only 20%.

Starting next year, federal health programs will cover any procedure done at an ambulatory surgery center, with few but defined exclusions, according to final regulations released by the Centers for Medicare and Medicaid Services.

The payment formula for such procedures, to be phased in over 4 years, was also set by the regulations.

Previously, CMS covered approximately 2,600 procedures when they were performed at an ASC; now, an additional 790 procedures will be eligible in 2008. According to Dr. Charles Mabry, chairman of the American College of Surgeons' health policy steering committee and a member of the general surgery coding and reimbursement committee, as new procedures receive CPT codes, they, too will be covered, unless they are specifically excluded.

CMS will not pay for a procedure if it meets the following exclusion criteria:

▸ It poses a significant safety risk to the beneficiary.

▸ It would result in the patient's requiring active monitoring or an overnight stay.

▸ It directly involves major blood vessels.

▸ It requires major or prolonged invasion of body cavities.

▸ It results in extensive blood loss.

▸ It is emergent or life threatening.

▸ It requires systemic thrombolysis.

▸ It can be reported only with an unlisted code.

The change means that more patients will likely be able to have procedures done in an ASC, said Dr. Mabry, who is also a shareholder in an ambulatory surgery center in Pine Bluff, Ark.

The question now: “Is the payment rate the right rate?” he said. (See box.)

CMS also decided to limit payment for procedures performed in an ASC that are done in a physician's office more than half the time. “CMS does not want to create inappropriate payment incentives for procedures to be performed in ASCs if the physician's office is the most efficient setting for providing high quality care,” according to the agency.

FASA, the advocacy arm of the Foundation for Ambulatory Surgery in America, objected to this proposal and also to CMS's list of exclusions, arguing that the agency should pay for any procedure that is not covered under the inpatient system.

Under the new rule, Medicare will make separate payments for ancillary services, such as radiology, and for some drugs and biologicals considered integral to a surgical procedure. The agency will also make adjustments for procedures that have high device costs (that is, when the cost of the device accounts for more than half the median cost of the procedure).

Those high device-cost procedures include placement of neurostimulators, pulse generators, or pacemakers.

The adjustment is already in effect under CMS's hospital outpatient payment system.

The change means that more patients will likely beable to have procedures done in an ASC. DR. MABRY

Payment Proposals for 2008

In addition to setting the formula for how ambulatory surgery centers will be paid going forward, CMS has also issued proposals on how the formula will guide payments to ASCs in 2008, and on how much hospital outpatient departments will receive in 2008.

CMShas proposed that in 2008, ASCs would be paid at 65% of hospital outpatient rates, a slight increase over an earlier proposal of 62%.

Medicare and Medicaid expect to pay $3 billion in 2008 to about 4,600 participating ASCs, according to CMS.

In the proposed pay rates, orthopedic procedures would receive the greatest increases, whereas gastrointestinal procedures would be cut. An upper GI endoscopy with biopsy (CPT code 43239) would be cut by 13%, from $446 in 2007 to $387 in 2008. A small-bowel endoscopy with biopsy (CPT code 44361) would be cut by about 11%.

The agency also issued its proposal for hospital outpatient payments, which is partially driven by the desire to keep beneficiary copays at 20%. In 2008, the overall copay will be about 26%, but for most procedures, beneficiaries will be liable for only 20%.

Starting next year, federal health programs will cover any procedure done at an ambulatory surgery center, with few but defined exclusions, according to final regulations released by the Centers for Medicare and Medicaid Services.

The payment formula for such procedures, to be phased in over 4 years, was also set by the regulations.

Previously, CMS covered approximately 2,600 procedures when they were performed at an ASC; now, an additional 790 procedures will be eligible in 2008. According to Dr. Charles Mabry, chairman of the American College of Surgeons' health policy steering committee and a member of the general surgery coding and reimbursement committee, as new procedures receive CPT codes, they, too will be covered, unless they are specifically excluded.

CMS will not pay for a procedure if it meets the following exclusion criteria:

▸ It poses a significant safety risk to the beneficiary.

▸ It would result in the patient's requiring active monitoring or an overnight stay.

▸ It directly involves major blood vessels.

▸ It requires major or prolonged invasion of body cavities.

▸ It results in extensive blood loss.

▸ It is emergent or life threatening.

▸ It requires systemic thrombolysis.

▸ It can be reported only with an unlisted code.

The change means that more patients will likely be able to have procedures done in an ASC, said Dr. Mabry, who is also a shareholder in an ambulatory surgery center in Pine Bluff, Ark.

The question now: “Is the payment rate the right rate?” he said. (See box.)

CMS also decided to limit payment for procedures performed in an ASC that are done in a physician's office more than half the time. “CMS does not want to create inappropriate payment incentives for procedures to be performed in ASCs if the physician's office is the most efficient setting for providing high quality care,” according to the agency.

FASA, the advocacy arm of the Foundation for Ambulatory Surgery in America, objected to this proposal and also to CMS's list of exclusions, arguing that the agency should pay for any procedure that is not covered under the inpatient system.

Under the new rule, Medicare will make separate payments for ancillary services, such as radiology, and for some drugs and biologicals considered integral to a surgical procedure. The agency will also make adjustments for procedures that have high device costs (that is, when the cost of the device accounts for more than half the median cost of the procedure).

Those high device-cost procedures include placement of neurostimulators, pulse generators, or pacemakers.

The adjustment is already in effect under CMS's hospital outpatient payment system.

The change means that more patients will likely beable to have procedures done in an ASC. DR. MABRY

Payment Proposals for 2008

In addition to setting the formula for how ambulatory surgery centers will be paid going forward, CMS has also issued proposals on how the formula will guide payments to ASCs in 2008, and on how much hospital outpatient departments will receive in 2008.

CMShas proposed that in 2008, ASCs would be paid at 65% of hospital outpatient rates, a slight increase over an earlier proposal of 62%.

Medicare and Medicaid expect to pay $3 billion in 2008 to about 4,600 participating ASCs, according to CMS.

In the proposed pay rates, orthopedic procedures would receive the greatest increases, whereas gastrointestinal procedures would be cut. An upper GI endoscopy with biopsy (CPT code 43239) would be cut by 13%, from $446 in 2007 to $387 in 2008. A small-bowel endoscopy with biopsy (CPT code 44361) would be cut by about 11%.

The agency also issued its proposal for hospital outpatient payments, which is partially driven by the desire to keep beneficiary copays at 20%. In 2008, the overall copay will be about 26%, but for most procedures, beneficiaries will be liable for only 20%.

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers.

The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary. The current warning—which was devised by the FDA—is very detailed and blunt, said Mr. Overstreet in an interview.

“With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

At least 25 million Americans are indoor tanners, according to industry estimates. Medical groups want warnings to be updated and placed more prominently. ©Dragan Trifunovic/Fotolia.com

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers.

The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary. The current warning—which was devised by the FDA—is very detailed and blunt, said Mr. Overstreet in an interview.

“With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

At least 25 million Americans are indoor tanners, according to industry estimates. Medical groups want warnings to be updated and placed more prominently. ©Dragan Trifunovic/Fotolia.com

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers.

The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary. The current warning—which was devised by the FDA—is very detailed and blunt, said Mr. Overstreet in an interview.

“With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

At least 25 million Americans are indoor tanners, according to industry estimates. Medical groups want warnings to be updated and placed more prominently. ©Dragan Trifunovic/Fotolia.com

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving beta-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement that it would no longer collect data on how many acute MI patients receive beta-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a beta-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge beta-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received beta-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement.

“At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided to “evolve” the beta-blocker measure by setting the bar at a higher level, and it began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking beta-blockers 6 months after a myocardial infarction.

There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important. Most post-MI care is done on an outpatient basis, Dr. Dove said in an interview. Plus, “the data suggest that most people who are on a beta-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, Dr. Dove said.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving beta-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement that it would no longer collect data on how many acute MI patients receive beta-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a beta-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge beta-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received beta-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement.

“At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided to “evolve” the beta-blocker measure by setting the bar at a higher level, and it began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking beta-blockers 6 months after a myocardial infarction.

There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important. Most post-MI care is done on an outpatient basis, Dr. Dove said in an interview. Plus, “the data suggest that most people who are on a beta-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, Dr. Dove said.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

WASHINGTON — The National Committee for Quality Assurance will begin reporting in earnest next year on how many myocardial infarction patients are receiving beta-blockers 6 months after hospital discharge, as recommended by the American Heart Association and the American College of Cardiology.

This follows the organization's announcement that it would no longer collect data on how many acute MI patients receive beta-blockers within a week of hospital discharge.

First collected in 1996, that measure—an element of the Healthcare Effectiveness Data and Information Set (HEDIS)—was “retired” in May because so many patients are now meeting the benchmark, said NCQA president Margaret O'Kane at a briefing.

Ninety-eight percent of privately insured patients older than 35 years who had survived a heart attack were prescribed a beta-blocker upon discharge in 2006, according to the most recent NCQA State of Health Care Quality report.

Postdischarge beta-blockers were prescribed to 94% of Medicare managed care patients and 88% of Medicaid managed care patients in 2006.

When the measure was first reported, only “two-thirds of U.S. patients who survived acute myocardial infarction received beta-blockers; today, nearly all do,” according to Dr. Thomas H. Lee, cochair of the NCQA Committee on Performance Measurement.

“At least when it comes to this intervention, the U.S. health care system has become reliable” he said (N. Engl. J. Med. 2007;357:1175–7).

Thus, NCQA decided to “evolve” the beta-blocker measure by setting the bar at a higher level, and it began asking for the data in 2005, said Ms. O'Kane in an interview.

In the latest report, only 68% of Medicaid patients, 70% of Medicare patients, and 72% of privately insured patients were still taking beta-blockers 6 months after a myocardial infarction.

There's also a huge amount of variability among plans. Ms. O'Kane said she believes that putting more scrutiny on the 6-month measure is appropriate and will improve results.

Dr. James Dove, president of the American College of Cardiology, agreed that the 6-month measure was important. Most post-MI care is done on an outpatient basis, Dr. Dove said in an interview. Plus, “the data suggest that most people who are on a beta-blocker at 6 months got it at discharge,” he said, adding that the new measure will capture both the immediate postdischarge data and the picture at 6 months. Dr. Dove practices at Prairie Cardiovascular Consultants in Springfield, Ill.

It will be a challenge to both health plans and physicians to improve compliance rates, he said. Electronic health records could help; health plans could use the systems to send reminders, for instance, Dr. Dove said.

Patient compliance, however, is one of the biggest hurdles. Patients might not take medications for a variety of reasons—cost, forgetfulness, fears about side effects, or because they feel better, he said.

Depression No. 2 in Disability Days

Major depression accounts for the second-largest number of days lost to disability in the United States–387 million days per year at the population level, second only to back and neck pain, at 1.2 billion days–according to a study by Harvard University and National Institute of Mental Health researchers. The study was published in the October 2007 issue of the Archives of General Psychiatry. The researchers analyzed data from the National Comorbidity Survey Replication, a nationwide survey of 9,282 adults. Overall, half the adult population reported one or more physical or mental conditions that kept them from fully functioning. Individuals averaged 32 days of disability a year. Disability was lowest among students, who reported 17.9 individual days, and highest among the unemployed and disabled, at 121.4 days. The authors said their results “confirm those of several other studies in suggesting that individual-level effects of mental conditions are as large as those of most chronic physical conditions.”

Teens' Daily Substance Use High

A snapshot of adolescents across America on any given day finds that 1.2 million smoked, 631,000 drank alcohol, and 586,000 used marijuana, according to a Substance Abuse and Mental Health Services Administration report. Another 50,000 used inhalants, 27,000 used hallucinogens, 13,000 used cocaine, and 3,800 used heroin. “A Day in the Life of American Adolescents: Substance Use Facts” draws data from SAMHSA's National Survey on Drug Use and Health, Treatment Episode Data Set and the National Survey of Substance Abuse Treatment Services. The report also finds that 76,000 adolescents were in outpatient treatment on an average day in 2005 and that 10,000 or more were in nonhospital residential treatment. “By breaking the data down and analyzing it on a day-to-day basis, we gain a fresh perspective on how deeply substance abuse pervades the lives of many young people and their families,” said SAMHSA Administrator Terry Cline, in a statement.

Nicotine Linked to Other Teen Ills

The nicotine in tobacco products poses a significant danger of structural and chemical changes in developing brains that can make teens more vulnerable to alcohol and other drug addiction, as well as to mental illness, according to a new white paper from Columbia University. The paper, commissioned by former top federal health officials, found that teens who smoke are 9 times likelier to meet the medical criteria for past year alcohol abuse or dependence and 13 times likelier to meet the medical criteria for abuse and dependence on an illegal drug than teens who don't smoke. The analysis also found that among teens 12-17 years, twice as many smokers as nonsmokers suffered from symptoms of depression in the last year, and smoking at a young age is related to panic attacks, general anxiety disorders, and posttraumatic stress disorder.

Lilly Warned on Cymbalta

A promotional brochure mailed to physicians on Cymbalta (duloxetine) delayed-release capsules overstates the drug's efficacy and “omits some of the most serious and important risk information associated with its use,” said the Food and Drug Administration in a late September warning letter sent to the drug's maker, Eli Lilly & Co. The agency questioned the references used to support the efficacy claims, and also said that even though the brochure included information from the boxed warning, it did not include contraindications in uncontrolled narrow-angle glaucoma and with monoamine oxidase inhibitors.

Change Proposed in Detox Rule

The Drug Enforcement Administration is proposing to allow group practices to prescribe drug addiction treatments to 30 or more patients. Each qualifying practitioner in a group could offer maintenance or detoxification treatment to 30 patients at one time. In some instances, qualifying physicians would be able to treat up to 100 patients at once. The proposed rule was published in the Sept. 20 Federal Register. Comments on the rule are due by Nov. 19.

Eating Disorders in Adolescents

Factors such as teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence, a study in the American Journal of Preventive Medicine found. About 40% of overweight girls and 20% of overweight boys in the study engaged in either binge eating, extreme weight control, or both. The findings “suggest a need for decreasing weight-related pressures within an adolescent's social environment, decreasing weight concerns, and decreasing unhealthy weight control practices while promoting healthier alternatives,” the study's authors concluded.

Social Programs Eat Federal Funds

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

www.census.gov

Depression No. 2 in Disability Days

Major depression accounts for the second-largest number of days lost to disability in the United States–387 million days per year at the population level, second only to back and neck pain, at 1.2 billion days–according to a study by Harvard University and National Institute of Mental Health researchers. The study was published in the October 2007 issue of the Archives of General Psychiatry. The researchers analyzed data from the National Comorbidity Survey Replication, a nationwide survey of 9,282 adults. Overall, half the adult population reported one or more physical or mental conditions that kept them from fully functioning. Individuals averaged 32 days of disability a year. Disability was lowest among students, who reported 17.9 individual days, and highest among the unemployed and disabled, at 121.4 days. The authors said their results “confirm those of several other studies in suggesting that individual-level effects of mental conditions are as large as those of most chronic physical conditions.”

Teens' Daily Substance Use High

A snapshot of adolescents across America on any given day finds that 1.2 million smoked, 631,000 drank alcohol, and 586,000 used marijuana, according to a Substance Abuse and Mental Health Services Administration report. Another 50,000 used inhalants, 27,000 used hallucinogens, 13,000 used cocaine, and 3,800 used heroin. “A Day in the Life of American Adolescents: Substance Use Facts” draws data from SAMHSA's National Survey on Drug Use and Health, Treatment Episode Data Set and the National Survey of Substance Abuse Treatment Services. The report also finds that 76,000 adolescents were in outpatient treatment on an average day in 2005 and that 10,000 or more were in nonhospital residential treatment. “By breaking the data down and analyzing it on a day-to-day basis, we gain a fresh perspective on how deeply substance abuse pervades the lives of many young people and their families,” said SAMHSA Administrator Terry Cline, in a statement.

Nicotine Linked to Other Teen Ills

The nicotine in tobacco products poses a significant danger of structural and chemical changes in developing brains that can make teens more vulnerable to alcohol and other drug addiction, as well as to mental illness, according to a new white paper from Columbia University. The paper, commissioned by former top federal health officials, found that teens who smoke are 9 times likelier to meet the medical criteria for past year alcohol abuse or dependence and 13 times likelier to meet the medical criteria for abuse and dependence on an illegal drug than teens who don't smoke. The analysis also found that among teens 12-17 years, twice as many smokers as nonsmokers suffered from symptoms of depression in the last year, and smoking at a young age is related to panic attacks, general anxiety disorders, and posttraumatic stress disorder.

Lilly Warned on Cymbalta

A promotional brochure mailed to physicians on Cymbalta (duloxetine) delayed-release capsules overstates the drug's efficacy and “omits some of the most serious and important risk information associated with its use,” said the Food and Drug Administration in a late September warning letter sent to the drug's maker, Eli Lilly & Co. The agency questioned the references used to support the efficacy claims, and also said that even though the brochure included information from the boxed warning, it did not include contraindications in uncontrolled narrow-angle glaucoma and with monoamine oxidase inhibitors.

Change Proposed in Detox Rule

The Drug Enforcement Administration is proposing to allow group practices to prescribe drug addiction treatments to 30 or more patients. Each qualifying practitioner in a group could offer maintenance or detoxification treatment to 30 patients at one time. In some instances, qualifying physicians would be able to treat up to 100 patients at once. The proposed rule was published in the Sept. 20 Federal Register. Comments on the rule are due by Nov. 19.

Eating Disorders in Adolescents

Factors such as teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence, a study in the American Journal of Preventive Medicine found. About 40% of overweight girls and 20% of overweight boys in the study engaged in either binge eating, extreme weight control, or both. The findings “suggest a need for decreasing weight-related pressures within an adolescent's social environment, decreasing weight concerns, and decreasing unhealthy weight control practices while promoting healthier alternatives,” the study's authors concluded.

Social Programs Eat Federal Funds

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

www.census.gov

Depression No. 2 in Disability Days

Major depression accounts for the second-largest number of days lost to disability in the United States–387 million days per year at the population level, second only to back and neck pain, at 1.2 billion days–according to a study by Harvard University and National Institute of Mental Health researchers. The study was published in the October 2007 issue of the Archives of General Psychiatry. The researchers analyzed data from the National Comorbidity Survey Replication, a nationwide survey of 9,282 adults. Overall, half the adult population reported one or more physical or mental conditions that kept them from fully functioning. Individuals averaged 32 days of disability a year. Disability was lowest among students, who reported 17.9 individual days, and highest among the unemployed and disabled, at 121.4 days. The authors said their results “confirm those of several other studies in suggesting that individual-level effects of mental conditions are as large as those of most chronic physical conditions.”

Teens' Daily Substance Use High

A snapshot of adolescents across America on any given day finds that 1.2 million smoked, 631,000 drank alcohol, and 586,000 used marijuana, according to a Substance Abuse and Mental Health Services Administration report. Another 50,000 used inhalants, 27,000 used hallucinogens, 13,000 used cocaine, and 3,800 used heroin. “A Day in the Life of American Adolescents: Substance Use Facts” draws data from SAMHSA's National Survey on Drug Use and Health, Treatment Episode Data Set and the National Survey of Substance Abuse Treatment Services. The report also finds that 76,000 adolescents were in outpatient treatment on an average day in 2005 and that 10,000 or more were in nonhospital residential treatment. “By breaking the data down and analyzing it on a day-to-day basis, we gain a fresh perspective on how deeply substance abuse pervades the lives of many young people and their families,” said SAMHSA Administrator Terry Cline, in a statement.

Nicotine Linked to Other Teen Ills

The nicotine in tobacco products poses a significant danger of structural and chemical changes in developing brains that can make teens more vulnerable to alcohol and other drug addiction, as well as to mental illness, according to a new white paper from Columbia University. The paper, commissioned by former top federal health officials, found that teens who smoke are 9 times likelier to meet the medical criteria for past year alcohol abuse or dependence and 13 times likelier to meet the medical criteria for abuse and dependence on an illegal drug than teens who don't smoke. The analysis also found that among teens 12-17 years, twice as many smokers as nonsmokers suffered from symptoms of depression in the last year, and smoking at a young age is related to panic attacks, general anxiety disorders, and posttraumatic stress disorder.

Lilly Warned on Cymbalta

A promotional brochure mailed to physicians on Cymbalta (duloxetine) delayed-release capsules overstates the drug's efficacy and “omits some of the most serious and important risk information associated with its use,” said the Food and Drug Administration in a late September warning letter sent to the drug's maker, Eli Lilly & Co. The agency questioned the references used to support the efficacy claims, and also said that even though the brochure included information from the boxed warning, it did not include contraindications in uncontrolled narrow-angle glaucoma and with monoamine oxidase inhibitors.

Change Proposed in Detox Rule

The Drug Enforcement Administration is proposing to allow group practices to prescribe drug addiction treatments to 30 or more patients. Each qualifying practitioner in a group could offer maintenance or detoxification treatment to 30 patients at one time. In some instances, qualifying physicians would be able to treat up to 100 patients at once. The proposed rule was published in the Sept. 20 Federal Register. Comments on the rule are due by Nov. 19.

Eating Disorders in Adolescents

Factors such as teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence, a study in the American Journal of Preventive Medicine found. About 40% of overweight girls and 20% of overweight boys in the study engaged in either binge eating, extreme weight control, or both. The findings “suggest a need for decreasing weight-related pressures within an adolescent's social environment, decreasing weight concerns, and decreasing unhealthy weight control practices while promoting healthier alternatives,” the study's authors concluded.

Social Programs Eat Federal Funds

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

www.census.gov

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money,” the White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money,” the White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money,” the White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," according to a statement from the White House.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," according to a statement from the White House.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," according to a statement from the White House.

About 6 million children are currently enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.