Alicia Ault

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but very needy, population.

It's a picture that's changed some—but not much—since a year ago.

Emergency departments, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. In mid-2006, according to claims information from Blue Cross and Blue Shield, only half had come back. The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by the Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006—to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care in the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is "going to give us a chance to expand upon what's been developing—multiple neighborhood clinics that are turning into medical homes," said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said. The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments. "We're trying to find those patients in the ER and get them into our system," she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take.

According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site. The city—along with LSU and Tulane—is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that—before Katrina—the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing. Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish. At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site "is above sea level and not located in a floodplain."

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

Mayor C. Ray Nagin is supporting a plan for a new medical center on a 37-acre parcel a few blocks from Charity Hospital. Jay Westcott/Elsevier Global Medical News

Federal Incentive Grants Offered to Draw Physicians to Louisiana

The state of Louisiana and city of New Orleans are struggling to lure physicians, dentists, mental health professionals, and nurses back to the city, or at least to convince those who did return to stay in the face of an onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area a health professional shortage area, eligible for federal grants to retain or recruit health professionals. This gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention; the money was originally earmarked at 70% for recruitment and 30% for retention.

Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds in mid-2006, there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients. The DHH determined that—based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan. The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009 when the grant cycle ends. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist—the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, "that's a dire need," said Ms. Strahan. Applicants—and there had been 300 as of press time—have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their packages of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology. Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

For more information on the program and to download an application, visit

www.pcrh.dhh.louisiana.gov

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but very needy, population.

It's a picture that's changed some—but not much—since a year ago.

Emergency departments, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. In mid-2006, according to claims information from Blue Cross and Blue Shield, only half had come back. The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by the Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006—to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care in the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is "going to give us a chance to expand upon what's been developing—multiple neighborhood clinics that are turning into medical homes," said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said. The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments. "We're trying to find those patients in the ER and get them into our system," she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take.

According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site. The city—along with LSU and Tulane—is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that—before Katrina—the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing. Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish. At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site "is above sea level and not located in a floodplain."

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

Mayor C. Ray Nagin is supporting a plan for a new medical center on a 37-acre parcel a few blocks from Charity Hospital. Jay Westcott/Elsevier Global Medical News

Federal Incentive Grants Offered to Draw Physicians to Louisiana

The state of Louisiana and city of New Orleans are struggling to lure physicians, dentists, mental health professionals, and nurses back to the city, or at least to convince those who did return to stay in the face of an onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area a health professional shortage area, eligible for federal grants to retain or recruit health professionals. This gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention; the money was originally earmarked at 70% for recruitment and 30% for retention.

Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds in mid-2006, there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients. The DHH determined that—based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan. The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009 when the grant cycle ends. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist—the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, "that's a dire need," said Ms. Strahan. Applicants—and there had been 300 as of press time—have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their packages of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology. Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

For more information on the program and to download an application, visit

www.pcrh.dhh.louisiana.gov

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but very needy, population.

It's a picture that's changed some—but not much—since a year ago.

Emergency departments, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. In mid-2006, according to claims information from Blue Cross and Blue Shield, only half had come back. The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by the Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006—to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care in the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is "going to give us a chance to expand upon what's been developing—multiple neighborhood clinics that are turning into medical homes," said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said. The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments. "We're trying to find those patients in the ER and get them into our system," she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take.

According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site. The city—along with LSU and Tulane—is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that—before Katrina—the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing. Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish. At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site "is above sea level and not located in a floodplain."

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

Mayor C. Ray Nagin is supporting a plan for a new medical center on a 37-acre parcel a few blocks from Charity Hospital. Jay Westcott/Elsevier Global Medical News

Federal Incentive Grants Offered to Draw Physicians to Louisiana

The state of Louisiana and city of New Orleans are struggling to lure physicians, dentists, mental health professionals, and nurses back to the city, or at least to convince those who did return to stay in the face of an onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area a health professional shortage area, eligible for federal grants to retain or recruit health professionals. This gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention; the money was originally earmarked at 70% for recruitment and 30% for retention.

Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds in mid-2006, there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients. The DHH determined that—based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan. The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009 when the grant cycle ends. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist—the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, "that's a dire need," said Ms. Strahan. Applicants—and there had been 300 as of press time—have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their packages of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology. Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

For more information on the program and to download an application, visit

www.pcrh.dhh.louisiana.gov

Solaraze Ads Run Afoul of FDA

The Food and Drug Administration has warned Doak Dermatologics that materials used by sales representatives and a journal ad for its Solaraze gel (diclofenac sodium) are promoting off-label and unapproved uses. In a letter sent to the company, the FDA's Division of Drug Marketing, Advertising, and Communications said that the materials are misleading because they "suggest that Solaraze Gel is approved for use in the treatment of AK (actinic keratoses) when used in combination with cryotherapy." The materials include a bar graph with data on patients treated with cryotherapy alone or cryotherapy followed by Solaraze; the sales aid included before and after pictures of patients treated with both therapies. Solaraze is approved only as a monotherapy. Doak also failed to submit the journal ad to the FDA when it was published, as is required.

AAD Alert on Mall Cosmetic Surgery

In response to the growing trend of cosmetic procedures' being performed in malls, at spas, and walk-in clinics, the American Academy of Dermatology has issued a consumer alert urging patients to use only board-certified physicians for cosmetic surgery. The growing availability of procedures that are being offered, both by nonphysicians and in more locations, may provide convenience, but "the limited training and supervision of the person performing the procedure, and the equipment available to handle complications or medical emergencies, can jeopardize the health and appearance of the patient," said Dr. Arielle N.B. Kauvar, of the department of dermatology at New York University, New York, in a statement issued by the academy. Dermatologists are seeing more patients who've had botched procedures, according to the AAD. A 2007 survey by the American Society for Dermatologic Surgery found that 56% of members who responded said they were seeing more patients with complications, such as burns, scarring, and skin discoloration, from procedures conducted by nonphysicians.

FDA, Defense Dept. to Share Data

The Department of Defense will share data and expertise with the FDA related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and to recognize the benefits of products, the two agencies said. The DoD will share general patient data such as prescriptions, laboratory results, and patient weight from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families. TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

Survey Shows Poor Sunscreen Use

Forty percent of people who responded to a recent survey said they never wear sunscreen. The lack of use was highest among men, 47% of whom said they never use sunscreen, compared with 34% of women. The mid-May telephone survey of 521 women and 483 men was conducted for iVillage and the Skin Cancer Foundation by GfK Roper Public Affairs and Media. Sixty percent of respondents said they at least occasionally use sunscreen, but only 11% use one with an SPF of 15 or higher every day. Reapplication of sunscreen is skimpy; 74% said they reapply every 4-6 hours and 28% said they reapply at least every 2 hours, as recommended.

FDA Updates Tanning Info

The Food and Drug Administration has updated its online information on tanning. The Web page, which formerly focused on indoor tanning, now contains information about ultraviolet radiation; the risks of both indoor and outdoor tanning; tanning pills and sunless tanning lotions; tips on sun protection; and how to choose a sunscreen. The site also has links to tanning information at the Centers for Disease Control and Prevention, the American Cancer Society, the American Academy of Dermatology, and other organizations. The site is at

www.fda.gov/cdrh/tanning

Publix to Offer Free Antibiotics

Publix Super Markets Inc. will offer seven oral antibiotics free of charge at its 684 pharmacy locations in Florida, Georgia, South Carolina, Alabama, and Tennessee, the Lakeland, Fla.-based chain said. The antibiotics included in the program—amoxicillin, sulfamethoxazole/trimethoprim (SMZ-TMP), cephalexin, ciprofloxacin penicillin VK, (excluding extended-release ciprofloxacin), ampicillin, and erythromycin (excluding Ery-Tab)–account for almost 50% of the generic pediatric prescriptions filled at Publix, the company said. New or current customers simply need a prescription, which will be filled regardless of the customer's insurance coverage. The chain will cover up to a 14-day supply, and there is no limit on the number of free prescriptions. However, Publix will no longer match the $4 price on generic prescriptions offered by rival chain Wal-Mart. A company spokesman told the St. Petersburg Times that Publix never had an official match, but that it did fill generics for $4 when asked to do so by customers.

Solaraze Ads Run Afoul of FDA

The Food and Drug Administration has warned Doak Dermatologics that materials used by sales representatives and a journal ad for its Solaraze gel (diclofenac sodium) are promoting off-label and unapproved uses. In a letter sent to the company, the FDA's Division of Drug Marketing, Advertising, and Communications said that the materials are misleading because they "suggest that Solaraze Gel is approved for use in the treatment of AK (actinic keratoses) when used in combination with cryotherapy." The materials include a bar graph with data on patients treated with cryotherapy alone or cryotherapy followed by Solaraze; the sales aid included before and after pictures of patients treated with both therapies. Solaraze is approved only as a monotherapy. Doak also failed to submit the journal ad to the FDA when it was published, as is required.

AAD Alert on Mall Cosmetic Surgery

In response to the growing trend of cosmetic procedures' being performed in malls, at spas, and walk-in clinics, the American Academy of Dermatology has issued a consumer alert urging patients to use only board-certified physicians for cosmetic surgery. The growing availability of procedures that are being offered, both by nonphysicians and in more locations, may provide convenience, but "the limited training and supervision of the person performing the procedure, and the equipment available to handle complications or medical emergencies, can jeopardize the health and appearance of the patient," said Dr. Arielle N.B. Kauvar, of the department of dermatology at New York University, New York, in a statement issued by the academy. Dermatologists are seeing more patients who've had botched procedures, according to the AAD. A 2007 survey by the American Society for Dermatologic Surgery found that 56% of members who responded said they were seeing more patients with complications, such as burns, scarring, and skin discoloration, from procedures conducted by nonphysicians.

FDA, Defense Dept. to Share Data

The Department of Defense will share data and expertise with the FDA related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and to recognize the benefits of products, the two agencies said. The DoD will share general patient data such as prescriptions, laboratory results, and patient weight from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families. TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

Survey Shows Poor Sunscreen Use

Forty percent of people who responded to a recent survey said they never wear sunscreen. The lack of use was highest among men, 47% of whom said they never use sunscreen, compared with 34% of women. The mid-May telephone survey of 521 women and 483 men was conducted for iVillage and the Skin Cancer Foundation by GfK Roper Public Affairs and Media. Sixty percent of respondents said they at least occasionally use sunscreen, but only 11% use one with an SPF of 15 or higher every day. Reapplication of sunscreen is skimpy; 74% said they reapply every 4-6 hours and 28% said they reapply at least every 2 hours, as recommended.

FDA Updates Tanning Info

The Food and Drug Administration has updated its online information on tanning. The Web page, which formerly focused on indoor tanning, now contains information about ultraviolet radiation; the risks of both indoor and outdoor tanning; tanning pills and sunless tanning lotions; tips on sun protection; and how to choose a sunscreen. The site also has links to tanning information at the Centers for Disease Control and Prevention, the American Cancer Society, the American Academy of Dermatology, and other organizations. The site is at

www.fda.gov/cdrh/tanning

Publix to Offer Free Antibiotics

Publix Super Markets Inc. will offer seven oral antibiotics free of charge at its 684 pharmacy locations in Florida, Georgia, South Carolina, Alabama, and Tennessee, the Lakeland, Fla.-based chain said. The antibiotics included in the program—amoxicillin, sulfamethoxazole/trimethoprim (SMZ-TMP), cephalexin, ciprofloxacin penicillin VK, (excluding extended-release ciprofloxacin), ampicillin, and erythromycin (excluding Ery-Tab)–account for almost 50% of the generic pediatric prescriptions filled at Publix, the company said. New or current customers simply need a prescription, which will be filled regardless of the customer's insurance coverage. The chain will cover up to a 14-day supply, and there is no limit on the number of free prescriptions. However, Publix will no longer match the $4 price on generic prescriptions offered by rival chain Wal-Mart. A company spokesman told the St. Petersburg Times that Publix never had an official match, but that it did fill generics for $4 when asked to do so by customers.

Solaraze Ads Run Afoul of FDA

The Food and Drug Administration has warned Doak Dermatologics that materials used by sales representatives and a journal ad for its Solaraze gel (diclofenac sodium) are promoting off-label and unapproved uses. In a letter sent to the company, the FDA's Division of Drug Marketing, Advertising, and Communications said that the materials are misleading because they "suggest that Solaraze Gel is approved for use in the treatment of AK (actinic keratoses) when used in combination with cryotherapy." The materials include a bar graph with data on patients treated with cryotherapy alone or cryotherapy followed by Solaraze; the sales aid included before and after pictures of patients treated with both therapies. Solaraze is approved only as a monotherapy. Doak also failed to submit the journal ad to the FDA when it was published, as is required.

AAD Alert on Mall Cosmetic Surgery

In response to the growing trend of cosmetic procedures' being performed in malls, at spas, and walk-in clinics, the American Academy of Dermatology has issued a consumer alert urging patients to use only board-certified physicians for cosmetic surgery. The growing availability of procedures that are being offered, both by nonphysicians and in more locations, may provide convenience, but "the limited training and supervision of the person performing the procedure, and the equipment available to handle complications or medical emergencies, can jeopardize the health and appearance of the patient," said Dr. Arielle N.B. Kauvar, of the department of dermatology at New York University, New York, in a statement issued by the academy. Dermatologists are seeing more patients who've had botched procedures, according to the AAD. A 2007 survey by the American Society for Dermatologic Surgery found that 56% of members who responded said they were seeing more patients with complications, such as burns, scarring, and skin discoloration, from procedures conducted by nonphysicians.

FDA, Defense Dept. to Share Data

The Department of Defense will share data and expertise with the FDA related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and to recognize the benefits of products, the two agencies said. The DoD will share general patient data such as prescriptions, laboratory results, and patient weight from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families. TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

Survey Shows Poor Sunscreen Use

Forty percent of people who responded to a recent survey said they never wear sunscreen. The lack of use was highest among men, 47% of whom said they never use sunscreen, compared with 34% of women. The mid-May telephone survey of 521 women and 483 men was conducted for iVillage and the Skin Cancer Foundation by GfK Roper Public Affairs and Media. Sixty percent of respondents said they at least occasionally use sunscreen, but only 11% use one with an SPF of 15 or higher every day. Reapplication of sunscreen is skimpy; 74% said they reapply every 4-6 hours and 28% said they reapply at least every 2 hours, as recommended.

FDA Updates Tanning Info

The Food and Drug Administration has updated its online information on tanning. The Web page, which formerly focused on indoor tanning, now contains information about ultraviolet radiation; the risks of both indoor and outdoor tanning; tanning pills and sunless tanning lotions; tips on sun protection; and how to choose a sunscreen. The site also has links to tanning information at the Centers for Disease Control and Prevention, the American Cancer Society, the American Academy of Dermatology, and other organizations. The site is at

www.fda.gov/cdrh/tanning

Publix to Offer Free Antibiotics

Publix Super Markets Inc. will offer seven oral antibiotics free of charge at its 684 pharmacy locations in Florida, Georgia, South Carolina, Alabama, and Tennessee, the Lakeland, Fla.-based chain said. The antibiotics included in the program—amoxicillin, sulfamethoxazole/trimethoprim (SMZ-TMP), cephalexin, ciprofloxacin penicillin VK, (excluding extended-release ciprofloxacin), ampicillin, and erythromycin (excluding Ery-Tab)–account for almost 50% of the generic pediatric prescriptions filled at Publix, the company said. New or current customers simply need a prescription, which will be filled regardless of the customer's insurance coverage. The chain will cover up to a 14-day supply, and there is no limit on the number of free prescriptions. However, Publix will no longer match the $4 price on generic prescriptions offered by rival chain Wal-Mart. A company spokesman told the St. Petersburg Times that Publix never had an official match, but that it did fill generics for $4 when asked to do so by customers.

Building on the success of its Hospital Quality Improvement Demonstration, Premier Inc. is launching a new initiative to pay hospitals that perform at the top of a scale measuring improvements in mortality, the percentage of patients receiving appropriate care, efficiency, harm avoidance, and patient satisfaction.

Premier introduced the QUEST (Quality, Efficiency, Safety, and Transparency) initiative in late July and said it was recruiting hospitals to participate through the end of September. In a briefing with reporters, Premier president and CEO Richard A. Norling said that 60 hospitals had expressed interest so far, but he declined to name them.

Premier is an alliance owned by 1,700 nonprofit hospitals. Premier's purchasing network also serves 46,500 health care entities. The alliance's previous project–HQID–was a joint effort with the Centers for Medicare & Medicaid Services that began in 2003 and concludes in November.

QUEST will initially focus on hospitals' risk-adjusted mortality ratio, and on how well they deliver appropriate care, measured by the percentage of patients who receive perfect care according to evidence-based guidelines. Hospitals will also be measured on the severity adjusted cost per discharge, a reflection of efficiency.

In the second year, QUEST hospitals will have to show how well they prevent health care-related infections and adverse drug events, and how well they serve patients, measured through CMS Hospital Consumer Assessment of Healthcare Providers and Systems. QUEST participants are also expected to share best practices.

The hospitals that show the most improvement from baseline will receive an incentive payment, most likely in year 3. Premier has provided seed money for the incentives, said Susan DeVore, the alliance's chief operating officer. The company is in discussions with the Blue Cross Blue Shield Association to provide more funds.

QUEST results will be made public at some point, though in aggregate only.

“Transparency has arrived and should be considered a good thing for providers,” said Dr. Ken Davis, chief medical officer of North Mississippi Health Services, at the briefing. The Tupelo, Miss.-based hospital is a member of Premier and will be a QUEST participant, he said.

Building on the success of its Hospital Quality Improvement Demonstration, Premier Inc. is launching a new initiative to pay hospitals that perform at the top of a scale measuring improvements in mortality, the percentage of patients receiving appropriate care, efficiency, harm avoidance, and patient satisfaction.

Premier introduced the QUEST (Quality, Efficiency, Safety, and Transparency) initiative in late July and said it was recruiting hospitals to participate through the end of September. In a briefing with reporters, Premier president and CEO Richard A. Norling said that 60 hospitals had expressed interest so far, but he declined to name them.

Premier is an alliance owned by 1,700 nonprofit hospitals. Premier's purchasing network also serves 46,500 health care entities. The alliance's previous project–HQID–was a joint effort with the Centers for Medicare & Medicaid Services that began in 2003 and concludes in November.

QUEST will initially focus on hospitals' risk-adjusted mortality ratio, and on how well they deliver appropriate care, measured by the percentage of patients who receive perfect care according to evidence-based guidelines. Hospitals will also be measured on the severity adjusted cost per discharge, a reflection of efficiency.

In the second year, QUEST hospitals will have to show how well they prevent health care-related infections and adverse drug events, and how well they serve patients, measured through CMS Hospital Consumer Assessment of Healthcare Providers and Systems. QUEST participants are also expected to share best practices.

The hospitals that show the most improvement from baseline will receive an incentive payment, most likely in year 3. Premier has provided seed money for the incentives, said Susan DeVore, the alliance's chief operating officer. The company is in discussions with the Blue Cross Blue Shield Association to provide more funds.

QUEST results will be made public at some point, though in aggregate only.

“Transparency has arrived and should be considered a good thing for providers,” said Dr. Ken Davis, chief medical officer of North Mississippi Health Services, at the briefing. The Tupelo, Miss.-based hospital is a member of Premier and will be a QUEST participant, he said.

Building on the success of its Hospital Quality Improvement Demonstration, Premier Inc. is launching a new initiative to pay hospitals that perform at the top of a scale measuring improvements in mortality, the percentage of patients receiving appropriate care, efficiency, harm avoidance, and patient satisfaction.

Premier introduced the QUEST (Quality, Efficiency, Safety, and Transparency) initiative in late July and said it was recruiting hospitals to participate through the end of September. In a briefing with reporters, Premier president and CEO Richard A. Norling said that 60 hospitals had expressed interest so far, but he declined to name them.

Premier is an alliance owned by 1,700 nonprofit hospitals. Premier's purchasing network also serves 46,500 health care entities. The alliance's previous project–HQID–was a joint effort with the Centers for Medicare & Medicaid Services that began in 2003 and concludes in November.

QUEST will initially focus on hospitals' risk-adjusted mortality ratio, and on how well they deliver appropriate care, measured by the percentage of patients who receive perfect care according to evidence-based guidelines. Hospitals will also be measured on the severity adjusted cost per discharge, a reflection of efficiency.

In the second year, QUEST hospitals will have to show how well they prevent health care-related infections and adverse drug events, and how well they serve patients, measured through CMS Hospital Consumer Assessment of Healthcare Providers and Systems. QUEST participants are also expected to share best practices.

The hospitals that show the most improvement from baseline will receive an incentive payment, most likely in year 3. Premier has provided seed money for the incentives, said Susan DeVore, the alliance's chief operating officer. The company is in discussions with the Blue Cross Blue Shield Association to provide more funds.

QUEST results will be made public at some point, though in aggregate only.

“Transparency has arrived and should be considered a good thing for providers,” said Dr. Ken Davis, chief medical officer of North Mississippi Health Services, at the briefing. The Tupelo, Miss.-based hospital is a member of Premier and will be a QUEST participant, he said.

www.pcrh.dhh.louisiana.gov

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but just as medically needy, population.

It's a picture that's changed some–but not much–since a year ago.

Emergency rooms, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. By mid-2006, according to claims information from Blue Cross and Blue Shield, only half of them had come back.

The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006–to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive about $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care around the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House, in an interview. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is “going to give us a chance to expand upon what's been developing–multiple neighborhood clinics that are turning into medical homes,” said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said.

The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments.

“We're trying to find those patients in the ER and get them into our system,” she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take. According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site.

The city–along with LSU and Tulane–is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that–before Katrina–the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing.

Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish.

At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site “is above sea level and not located in a flood plain.”

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

And some stalwarts have not given up on reopening Charity. Last year, the state legislature approved a study by an independent team of investigators to see if the first three floors could be refurbished while a new medical campus is put together.

EDs Feel Ripple Effect

The lack of inpatient beds and mental health care, and the shortage of primary care sites are felt most acutely in the area's emergency departments.

Two years ago, the now-shuttered Charity Hospital received 120,000 to 200,000 ED visits a year. Granted, there are fewer people in the city now, but there are more now who come in the door sicker or in need of basic care, said Dr. Jim Aiken of the emergency medicine department at LSU.

“We do a lot of renewing prescriptions and checking blood pressures,” and other primary care types of interventions, he said in an interview.

The Interim Hospital sees about 3,500 patients a month. Although things have improved in the last year, the ED is admitting more patients than before the storm, and “we struggle every day with surge capacity,” said Dr. Aiken.

Diversion is not uncommon, but the hospitals in the area now at least have a new communications module that lets them track online what's happening at other facilities in the area.

The lack of adequate mental health care, combined with poststorm stress and anxiety, is having the biggest impact on the ED, said Dr. Aiken. It is not unusual for the hospital to be holding 15 psychiatric patients at its 31-bed ED, he said.

Charity also housed a crisis intervention unit where the police could take the mentally ill. With that unit gone, those with psychiatric needs have been spread out around the city.

Before Katrina, there were 578 psychiatric and detox beds in and around New Orleans; that number is now at 236, with only a small portion of them actually in downtown New Orleans, according to Dr. Cerise.

The deteriorated mental health system is “probably in my mind the most critical health care issue in this state since the storm,” said Dr. Aiken.

Even the LSU system in Baton Rouge has been affected, said Dr. William “Beau” Clark, president of the Louisiana chapter of the American College of Emergency Physicians.

Emergency rooms in that city have absorbed some of New Orleans' outflow, including psychiatric patients who end up boarding in Baton Rouge, he said.

A new medical center is planned on a 37-acre parcel a few blocks from Charity Hospital, said Mayor C. Ray Nagin. Jay Westcott/Elsevier Global Medical News

Grants Offered for Primary Care Help

The state of Louisiana and city of New Orleans are struggling to lure physicians–especially primary care doctors–dentists, mental health professionals, and nurses back to the city or at least to convince those who did come back to stay in the face of a new and bigger onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area–encompassing Orleans, Jefferson, Plaquemines, and St. Bernard parishes–a health-professional shortage area.

The region became eligible for federal grants to offer incentives to retain or recruit health professionals and gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention. The first chunk, $15 million, was received in March 2007; 70% of the funds were earmarked for recruitment and 30% for retention.

In mid-June, the state agency received another $35 million. Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds–in mid-2006–there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients.

The DHH determined that–based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan.

The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009, when the grant cycle ends, she said. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist–the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, “that's a dire need,” said Ms. Strahan.

Applicants–and there were 300 as of press time–have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their own package of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology.

Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

So far, there have been at least 125 awards, including 62 primary care positions (including mid-level providers), 16 dentists, 42 mental health professionals, and 5 pharmacists.

www.pcrh.dhh.louisiana.gov

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but just as medically needy, population.

It's a picture that's changed some–but not much–since a year ago.

Emergency rooms, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. By mid-2006, according to claims information from Blue Cross and Blue Shield, only half of them had come back.

The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006–to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive about $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care around the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House, in an interview. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is “going to give us a chance to expand upon what's been developing–multiple neighborhood clinics that are turning into medical homes,” said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said.

The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments.

“We're trying to find those patients in the ER and get them into our system,” she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take. According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site.

The city–along with LSU and Tulane–is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that–before Katrina–the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing.

Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish.

At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site “is above sea level and not located in a flood plain.”

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

And some stalwarts have not given up on reopening Charity. Last year, the state legislature approved a study by an independent team of investigators to see if the first three floors could be refurbished while a new medical campus is put together.

EDs Feel Ripple Effect

The lack of inpatient beds and mental health care, and the shortage of primary care sites are felt most acutely in the area's emergency departments.

Two years ago, the now-shuttered Charity Hospital received 120,000 to 200,000 ED visits a year. Granted, there are fewer people in the city now, but there are more now who come in the door sicker or in need of basic care, said Dr. Jim Aiken of the emergency medicine department at LSU.

“We do a lot of renewing prescriptions and checking blood pressures,” and other primary care types of interventions, he said in an interview.

The Interim Hospital sees about 3,500 patients a month. Although things have improved in the last year, the ED is admitting more patients than before the storm, and “we struggle every day with surge capacity,” said Dr. Aiken.

Diversion is not uncommon, but the hospitals in the area now at least have a new communications module that lets them track online what's happening at other facilities in the area.

The lack of adequate mental health care, combined with poststorm stress and anxiety, is having the biggest impact on the ED, said Dr. Aiken. It is not unusual for the hospital to be holding 15 psychiatric patients at its 31-bed ED, he said.

Charity also housed a crisis intervention unit where the police could take the mentally ill. With that unit gone, those with psychiatric needs have been spread out around the city.

Before Katrina, there were 578 psychiatric and detox beds in and around New Orleans; that number is now at 236, with only a small portion of them actually in downtown New Orleans, according to Dr. Cerise.

The deteriorated mental health system is “probably in my mind the most critical health care issue in this state since the storm,” said Dr. Aiken.

Even the LSU system in Baton Rouge has been affected, said Dr. William “Beau” Clark, president of the Louisiana chapter of the American College of Emergency Physicians.

Emergency rooms in that city have absorbed some of New Orleans' outflow, including psychiatric patients who end up boarding in Baton Rouge, he said.

A new medical center is planned on a 37-acre parcel a few blocks from Charity Hospital, said Mayor C. Ray Nagin. Jay Westcott/Elsevier Global Medical News

Grants Offered for Primary Care Help

The state of Louisiana and city of New Orleans are struggling to lure physicians–especially primary care doctors–dentists, mental health professionals, and nurses back to the city or at least to convince those who did come back to stay in the face of a new and bigger onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area–encompassing Orleans, Jefferson, Plaquemines, and St. Bernard parishes–a health-professional shortage area.

The region became eligible for federal grants to offer incentives to retain or recruit health professionals and gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention. The first chunk, $15 million, was received in March 2007; 70% of the funds were earmarked for recruitment and 30% for retention.

In mid-June, the state agency received another $35 million. Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds–in mid-2006–there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients.

The DHH determined that–based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan.

The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009, when the grant cycle ends, she said. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist–the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, “that's a dire need,” said Ms. Strahan.

Applicants–and there were 300 as of press time–have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their own package of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology.

Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

So far, there have been at least 125 awards, including 62 primary care positions (including mid-level providers), 16 dentists, 42 mental health professionals, and 5 pharmacists.

www.pcrh.dhh.louisiana.gov

Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but just as medically needy, population.

It's a picture that's changed some–but not much–since a year ago.

Emergency rooms, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.

It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).

It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. By mid-2006, according to claims information from Blue Cross and Blue Shield, only half of them had come back.

The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.

The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006–to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.

Primary Clinics to Be Medical Homes

According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.

The sites will receive about $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care around the area.

The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House, in an interview. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).

The money is “going to give us a chance to expand upon what's been developing–multiple neighborhood clinics that are turning into medical homes,” said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.

All PATH clinics have agreed to uphold and advance the principles of a medical home, she said.

The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.

Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments.

“We're trying to find those patients in the ER and get them into our system,” she said.

Inpatient Capacity Still Down

Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.

Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).

The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.

LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take. According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site.

The city–along with LSU and Tulane–is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that–before Katrina–the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing.

Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish.

At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site “is above sea level and not located in a flood plain.”

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

And some stalwarts have not given up on reopening Charity. Last year, the state legislature approved a study by an independent team of investigators to see if the first three floors could be refurbished while a new medical campus is put together.

EDs Feel Ripple Effect

The lack of inpatient beds and mental health care, and the shortage of primary care sites are felt most acutely in the area's emergency departments.

Two years ago, the now-shuttered Charity Hospital received 120,000 to 200,000 ED visits a year. Granted, there are fewer people in the city now, but there are more now who come in the door sicker or in need of basic care, said Dr. Jim Aiken of the emergency medicine department at LSU.

“We do a lot of renewing prescriptions and checking blood pressures,” and other primary care types of interventions, he said in an interview.

The Interim Hospital sees about 3,500 patients a month. Although things have improved in the last year, the ED is admitting more patients than before the storm, and “we struggle every day with surge capacity,” said Dr. Aiken.

Diversion is not uncommon, but the hospitals in the area now at least have a new communications module that lets them track online what's happening at other facilities in the area.

The lack of adequate mental health care, combined with poststorm stress and anxiety, is having the biggest impact on the ED, said Dr. Aiken. It is not unusual for the hospital to be holding 15 psychiatric patients at its 31-bed ED, he said.

Charity also housed a crisis intervention unit where the police could take the mentally ill. With that unit gone, those with psychiatric needs have been spread out around the city.

Before Katrina, there were 578 psychiatric and detox beds in and around New Orleans; that number is now at 236, with only a small portion of them actually in downtown New Orleans, according to Dr. Cerise.

The deteriorated mental health system is “probably in my mind the most critical health care issue in this state since the storm,” said Dr. Aiken.

Even the LSU system in Baton Rouge has been affected, said Dr. William “Beau” Clark, president of the Louisiana chapter of the American College of Emergency Physicians.

Emergency rooms in that city have absorbed some of New Orleans' outflow, including psychiatric patients who end up boarding in Baton Rouge, he said.

A new medical center is planned on a 37-acre parcel a few blocks from Charity Hospital, said Mayor C. Ray Nagin. Jay Westcott/Elsevier Global Medical News

Grants Offered for Primary Care Help

The state of Louisiana and city of New Orleans are struggling to lure physicians–especially primary care doctors–dentists, mental health professionals, and nurses back to the city or at least to convince those who did come back to stay in the face of a new and bigger onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area–encompassing Orleans, Jefferson, Plaquemines, and St. Bernard parishes–a health-professional shortage area.

The region became eligible for federal grants to offer incentives to retain or recruit health professionals and gave rise to the Greater New Orleans Health Service Corps.

The Louisiana Department of Health and Hospitals, which is overseeing the Corps, has received $50 million to spend on recruitment and retention. The first chunk, $15 million, was received in March 2007; 70% of the funds were earmarked for recruitment and 30% for retention.

In mid-June, the state agency received another $35 million. Realizing how difficult it is keep physicians in the city, the state received permission to adjust the split, said Gayla Strahan, a program administrator for the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Now, half goes for recruitment and half for retention.

When the state applied for federal health shortage funds–in mid-2006–there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists at that time took Medicaid or uninsured patients.

The DHH determined that–based on the region's population at that time (about 700,000) and the Medicaid enrollment (about 135,000)–there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals, such as psychologists, licensed clinical social workers, and marriage and family therapists.

The department also will seek to retain and recruit faculty at the area's medical, nursing and allied health schools, said Ms. Strahan.

The goal is to retain 50 primary care physicians and recruit 48 new ones by September 2009, when the grant cycle ends, she said. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 new appointments, including 24 at the medical schools.

The Service Corps also has earmarked a little over $2 million to retain 5 specialists and bring in 15 new ones. The bar is a little higher for a specialist–the applicant has to show there is a dire need. For instance, if there's only one cardiologist who agrees to accept Medicaid patients, “that's a dire need,” said Ms. Strahan.

Applicants–and there were 300 as of press time–have to accept Medicare, Medicaid, and the uninsured; must work at least 32 hours a week in clinical practice; and have to be licensed in Louisiana or at least agree to become licensed before starting work. Once accepted, participants have a 3-year obligation.

Physicians, psychiatrists, and dentists can tailor their own package of incentives up to $110,000, which is paid in one lump sum at the beginning of the 3 years. They can use it toward salary, to repay loans, for malpractice premiums, and/or to buy health information technology.

Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive $10,000 to $40,000, depending on the discipline.

So far, there have been at least 125 awards, including 62 primary care positions (including mid-level providers), 16 dentists, 42 mental health professionals, and 5 pharmacists.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer. But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; half were male, 59% were white, and 41% were African American. Of these patients, 29% were normal weight (BMI of 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%. There was no difference in screening behavior in any of the overweight or obese patients, compared with normal-weight patients. Gender also had no impact on screening behavior. Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer. But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; half were male, 59% were white, and 41% were African American. Of these patients, 29% were normal weight (BMI of 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%. There was no difference in screening behavior in any of the overweight or obese patients, compared with normal-weight patients. Gender also had no impact on screening behavior. Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer. But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; half were male, 59% were white, and 41% were African American. Of these patients, 29% were normal weight (BMI of 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%. There was no difference in screening behavior in any of the overweight or obese patients, compared with normal-weight patients. Gender also had no impact on screening behavior. Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.