Alicia Ault

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

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; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

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; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

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; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com

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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com

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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com

WASHINGTON — Almost nothing has been done in the year since the Institute of Medicine called on Congress to help enact a comprehensive overhaul of the nation's emergency medicine system, two emergency physicians and a trauma surgeon told a U.S. House committee.

“I'm absolutely shocked that more hasn't been done to fix this in the last year,” Dr. William Schwab, chief of the division of trauma and surgical critical care at the University of Pennsylvania Medical Center in Philadelphia, testified at a House Committee on Oversight and Government Reform hearing.

Dr. Schwab was a member of the IOM's Committee on the Future of Emergency Care in the U.S. Health System, which issued its report in June 2006.

So far, the only congressional action has been the introduction of the Access to Emergency Medical Services Act (H.R. 882), which would increase payments to physicians through an emergency medicine-specific trust fund and create a commission to study potential solutions. A companion bill has been introduced in the Senate (S. 1003).

Dr. Schwab and his colleagues told House committee members that if anything, emergency departments have become more crowded and overburdened, and that it is becoming increasingly difficult to find specialists such as orthopedic surgeons or neurosurgeons who will accept on-call assignments.

Leaving his written testimony behind, Dr. Schwab told the committee members that a recent experience at his hospital more fully revealed the crisis. On one of his days off, a partner in his practice called and said he was needed to help attend to a department bursting at the seams from a multivehicle accident. Upon arrival, Dr. Schwab instead was diverted to a gunshot victim. He performed an emergency thoracotomy, and when he was done, he looked up and realized that the accident patients had been watching from just 40 feet away because the trauma bay was so crowded.

The burden is not limited to big-city facilities, said Dr. Schwab, noting that his brother-in-law, a transplant patient on dialysis who had become very ill, recently had been refused initial admittance through the ED at Rodney Strong Hospital in Rochester because of overcrowding. Eventually, he was seen.

Dr. Ramon Johnson, director of emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, Calif., agreed that the crisis did not respect demographic boundaries. “Even in my sleepy suburban community,” the emergency department is “understaffed, underfunded, overworked, and overcrowded,” said Dr. Johnson, who also related anecdotes in place of his written testimony. He spoke of having to scramble to find an open bed for a child who was brought in—blue and choking—by his mother. Staff removed a less-ill patient from a bed, which was quickly occupied by the choking child. Dr. Johnson then reached into the child's trachea to fish out the offending apricot pit. But he had a moment where he thought he'd have to tend to the child on the floor.

“We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment,” echoed Dr. Robert E. O'Connor, incoming chair of emergency medicine at the University of Virginia, Charlottesville.

At the hearing, the physicians were well received by Democrats and Republicans.

“The fact of the matter is that we have a crisis in emergency care, and it is nationwide,” said acting panel chairman Elijah Cummings (D-Md.). “This begs the question: With a national emergency and trauma care system as fragile as ours, how would we manage the very real threats of a terrorist bombing, a natural disaster, or an outbreak of pandemic flu? Where is the surge capacity?”

Rep. Tom Davis (R-Va.) also questioned whether many of the nation's emergency departments are ready to handle a surge from a multiple-casualty highway crash, much less a terrorist event. The crisis has many roots, said Rep. Davis. “Legal, financial, and demographic trends have converged to punish the success of hospital emergency departments transformed by federal law into the de facto primary care provider for millions of the under- and uninsured,” he said.

Several committee members asked whether the 2006 Pandemic and All Hazards Preparedness Act had benefited emergency care. The answer: a resounding no.

“I don't think we could track a dime to actual practice at the bedside,” said Dr. Schwab.

But he and the other physicians emphasized that just throwing more money at emergency medicine would not be a panacea. “There's no way a simple solution can fix this,” said Dr. Schwab.

Rep. Cummings and other committee members took the Department of Health and Human Services to task for not ensuring that more of the Pandemic law's money made it directly to hospitals.

Dr. Kevin Yeskey, director of the Office of Preparedness and Emergency Operations at HHS, defended the agency, saying that federal money had been distributed to states, not directly to hospitals. But, he agreed that there should be more accountability for how the almost $3 billion in funds has been and will be distributed.

'We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment.' DR. O'CONNOR

WASHINGTON — Almost nothing has been done in the year since the Institute of Medicine called on Congress to help enact a comprehensive overhaul of the nation's emergency medicine system, two emergency physicians and a trauma surgeon told a U.S. House committee.

“I'm absolutely shocked that more hasn't been done to fix this in the last year,” Dr. William Schwab, chief of the division of trauma and surgical critical care at the University of Pennsylvania Medical Center in Philadelphia, testified at a House Committee on Oversight and Government Reform hearing.

Dr. Schwab was a member of the IOM's Committee on the Future of Emergency Care in the U.S. Health System, which issued its report in June 2006.

So far, the only congressional action has been the introduction of the Access to Emergency Medical Services Act (H.R. 882), which would increase payments to physicians through an emergency medicine-specific trust fund and create a commission to study potential solutions. A companion bill has been introduced in the Senate (S. 1003).

Dr. Schwab and his colleagues told House committee members that if anything, emergency departments have become more crowded and overburdened, and that it is becoming increasingly difficult to find specialists such as orthopedic surgeons or neurosurgeons who will accept on-call assignments.

Leaving his written testimony behind, Dr. Schwab told the committee members that a recent experience at his hospital more fully revealed the crisis. On one of his days off, a partner in his practice called and said he was needed to help attend to a department bursting at the seams from a multivehicle accident. Upon arrival, Dr. Schwab instead was diverted to a gunshot victim. He performed an emergency thoracotomy, and when he was done, he looked up and realized that the accident patients had been watching from just 40 feet away because the trauma bay was so crowded.

The burden is not limited to big-city facilities, said Dr. Schwab, noting that his brother-in-law, a transplant patient on dialysis who had become very ill, recently had been refused initial admittance through the ED at Rodney Strong Hospital in Rochester because of overcrowding. Eventually, he was seen.

Dr. Ramon Johnson, director of emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, Calif., agreed that the crisis did not respect demographic boundaries. “Even in my sleepy suburban community,” the emergency department is “understaffed, underfunded, overworked, and overcrowded,” said Dr. Johnson, who also related anecdotes in place of his written testimony. He spoke of having to scramble to find an open bed for a child who was brought in—blue and choking—by his mother. Staff removed a less-ill patient from a bed, which was quickly occupied by the choking child. Dr. Johnson then reached into the child's trachea to fish out the offending apricot pit. But he had a moment where he thought he'd have to tend to the child on the floor.

“We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment,” echoed Dr. Robert E. O'Connor, incoming chair of emergency medicine at the University of Virginia, Charlottesville.

At the hearing, the physicians were well received by Democrats and Republicans.

“The fact of the matter is that we have a crisis in emergency care, and it is nationwide,” said acting panel chairman Elijah Cummings (D-Md.). “This begs the question: With a national emergency and trauma care system as fragile as ours, how would we manage the very real threats of a terrorist bombing, a natural disaster, or an outbreak of pandemic flu? Where is the surge capacity?”

Rep. Tom Davis (R-Va.) also questioned whether many of the nation's emergency departments are ready to handle a surge from a multiple-casualty highway crash, much less a terrorist event. The crisis has many roots, said Rep. Davis. “Legal, financial, and demographic trends have converged to punish the success of hospital emergency departments transformed by federal law into the de facto primary care provider for millions of the under- and uninsured,” he said.

Several committee members asked whether the 2006 Pandemic and All Hazards Preparedness Act had benefited emergency care. The answer: a resounding no.

“I don't think we could track a dime to actual practice at the bedside,” said Dr. Schwab.

But he and the other physicians emphasized that just throwing more money at emergency medicine would not be a panacea. “There's no way a simple solution can fix this,” said Dr. Schwab.

Rep. Cummings and other committee members took the Department of Health and Human Services to task for not ensuring that more of the Pandemic law's money made it directly to hospitals.

Dr. Kevin Yeskey, director of the Office of Preparedness and Emergency Operations at HHS, defended the agency, saying that federal money had been distributed to states, not directly to hospitals. But, he agreed that there should be more accountability for how the almost $3 billion in funds has been and will be distributed.

'We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment.' DR. O'CONNOR

WASHINGTON — Almost nothing has been done in the year since the Institute of Medicine called on Congress to help enact a comprehensive overhaul of the nation's emergency medicine system, two emergency physicians and a trauma surgeon told a U.S. House committee.

“I'm absolutely shocked that more hasn't been done to fix this in the last year,” Dr. William Schwab, chief of the division of trauma and surgical critical care at the University of Pennsylvania Medical Center in Philadelphia, testified at a House Committee on Oversight and Government Reform hearing.

Dr. Schwab was a member of the IOM's Committee on the Future of Emergency Care in the U.S. Health System, which issued its report in June 2006.

So far, the only congressional action has been the introduction of the Access to Emergency Medical Services Act (H.R. 882), which would increase payments to physicians through an emergency medicine-specific trust fund and create a commission to study potential solutions. A companion bill has been introduced in the Senate (S. 1003).

Dr. Schwab and his colleagues told House committee members that if anything, emergency departments have become more crowded and overburdened, and that it is becoming increasingly difficult to find specialists such as orthopedic surgeons or neurosurgeons who will accept on-call assignments.

Leaving his written testimony behind, Dr. Schwab told the committee members that a recent experience at his hospital more fully revealed the crisis. On one of his days off, a partner in his practice called and said he was needed to help attend to a department bursting at the seams from a multivehicle accident. Upon arrival, Dr. Schwab instead was diverted to a gunshot victim. He performed an emergency thoracotomy, and when he was done, he looked up and realized that the accident patients had been watching from just 40 feet away because the trauma bay was so crowded.

The burden is not limited to big-city facilities, said Dr. Schwab, noting that his brother-in-law, a transplant patient on dialysis who had become very ill, recently had been refused initial admittance through the ED at Rodney Strong Hospital in Rochester because of overcrowding. Eventually, he was seen.

Dr. Ramon Johnson, director of emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, Calif., agreed that the crisis did not respect demographic boundaries. “Even in my sleepy suburban community,” the emergency department is “understaffed, underfunded, overworked, and overcrowded,” said Dr. Johnson, who also related anecdotes in place of his written testimony. He spoke of having to scramble to find an open bed for a child who was brought in—blue and choking—by his mother. Staff removed a less-ill patient from a bed, which was quickly occupied by the choking child. Dr. Johnson then reached into the child's trachea to fish out the offending apricot pit. But he had a moment where he thought he'd have to tend to the child on the floor.

“We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment,” echoed Dr. Robert E. O'Connor, incoming chair of emergency medicine at the University of Virginia, Charlottesville.

At the hearing, the physicians were well received by Democrats and Republicans.

“The fact of the matter is that we have a crisis in emergency care, and it is nationwide,” said acting panel chairman Elijah Cummings (D-Md.). “This begs the question: With a national emergency and trauma care system as fragile as ours, how would we manage the very real threats of a terrorist bombing, a natural disaster, or an outbreak of pandemic flu? Where is the surge capacity?”

Rep. Tom Davis (R-Va.) also questioned whether many of the nation's emergency departments are ready to handle a surge from a multiple-casualty highway crash, much less a terrorist event. The crisis has many roots, said Rep. Davis. “Legal, financial, and demographic trends have converged to punish the success of hospital emergency departments transformed by federal law into the de facto primary care provider for millions of the under- and uninsured,” he said.

Several committee members asked whether the 2006 Pandemic and All Hazards Preparedness Act had benefited emergency care. The answer: a resounding no.

“I don't think we could track a dime to actual practice at the bedside,” said Dr. Schwab.

But he and the other physicians emphasized that just throwing more money at emergency medicine would not be a panacea. “There's no way a simple solution can fix this,” said Dr. Schwab.

Rep. Cummings and other committee members took the Department of Health and Human Services to task for not ensuring that more of the Pandemic law's money made it directly to hospitals.

Dr. Kevin Yeskey, director of the Office of Preparedness and Emergency Operations at HHS, defended the agency, saying that federal money had been distributed to states, not directly to hospitals. But, he agreed that there should be more accountability for how the almost $3 billion in funds has been and will be distributed.

'We have state-of-the-art technology, and yet we're practicing in a non-state-of-the-art environment.' DR. O'CONNOR

WASHINGTON — Patients who are sicker, who are taking warfarin, and whose polyps are removed by snare with cautery are at higher risk for complications following screening or surveillance colonoscopy, according to an analysis presented at the annual Digestive Disease Week.

Overall, the incidence of serious complications after screening was 2.2 of every 1,000 exams, and it was 1.7/1,000 for potential related events, according to Dr. Cynthia Ko of the University of Washington, Seattle.

Dr. Ko and her colleagues prospectivelyassessed colonoscopies performed on 18,271 patients aged 40 years and older who were referred for average risk screening, surveillance of prior polyps or cancer, a family history of polyps or cancer, or follow-up after another diagnostic procedure, such as a positive result on a fecal occult blood test.

Patients were excluded if they had a history of recent gastrointestinal bleeding or of inflammatory bowel disease, or had an incomplete colonoscopy because of poor bowel preparation.

The researchers identified the study patients through the Clinical Outcomes Research Initiative, a database maintained by the Oregon Health and Science University, Portland.

Complication rates for surveillance and screening aren't well defined, Dr. Ko said. In the Washington study, patients were queried at 7 and 30 days after colonoscopy about new symptoms, physician visits, hospitalizations, and unplanned surgeries.

Related events included colon perforation, GI bleeding, diverticulitis, and postpolypectomy syndrome. Potentially related complications included cardiac and neurologic events.

The 18,271 patients came from 19 sites and received colonoscopies from 89 endoscopists. Related complication rates were 1.3/1,000 for GI bleeding requiring hospitalization, 0.8/1,000 for GI bleeding requiring transfusion, 0.9/1,000 for diverticulitis, 0.3/1,000 for diverticulitis requiring hospitalization, 0.1/1,000 for postpolypectomy syndrome, and 0.2/1,000 for perforation.

The authors also calculated an overall complication rate of 2.2/1,000, which included GI bleeding with transfusion, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome. The serious complication rate was 1.4/1,000; serious complications included GI bleeding with hospitalization, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome.

Potentially related events included angina or myocardial infarction (0.6/1,000), stroke or transient ischemic attack (0.4/1,000), and other events, including hospitalization for intravenous catheter site infections, abdominal pain, arrythmia, gallstones, kidney stones, and drug reactions (0.7/1,000).

Complications were higher for patients undergoing a surveillance or follow-up exam, and for those who were older. There were no complications among the 40- to 49-year-olds, compared with 4.4/1,000 among patients aged 80 and older.

There was a threefold increase in complications in patients who were American Society of Anesthesiologists class III, compared with class I or II patients; a fivefold increase in patients who took warfarin, compared with those who used aspirin or NSAIDs; and a fivefold increase for a polyp removed with cautery. If more than one polyp was removed, there was a 13-fold increase in complications, Dr. Ko said.

The study was supported by the National Institutes of Health and the Centers for Disease Control and Prevention.

WASHINGTON — Patients who are sicker, who are taking warfarin, and whose polyps are removed by snare with cautery are at higher risk for complications following screening or surveillance colonoscopy, according to an analysis presented at the annual Digestive Disease Week.

Overall, the incidence of serious complications after screening was 2.2 of every 1,000 exams, and it was 1.7/1,000 for potential related events, according to Dr. Cynthia Ko of the University of Washington, Seattle.

Dr. Ko and her colleagues prospectivelyassessed colonoscopies performed on 18,271 patients aged 40 years and older who were referred for average risk screening, surveillance of prior polyps or cancer, a family history of polyps or cancer, or follow-up after another diagnostic procedure, such as a positive result on a fecal occult blood test.

Patients were excluded if they had a history of recent gastrointestinal bleeding or of inflammatory bowel disease, or had an incomplete colonoscopy because of poor bowel preparation.

The researchers identified the study patients through the Clinical Outcomes Research Initiative, a database maintained by the Oregon Health and Science University, Portland.

Complication rates for surveillance and screening aren't well defined, Dr. Ko said. In the Washington study, patients were queried at 7 and 30 days after colonoscopy about new symptoms, physician visits, hospitalizations, and unplanned surgeries.

Related events included colon perforation, GI bleeding, diverticulitis, and postpolypectomy syndrome. Potentially related complications included cardiac and neurologic events.

The 18,271 patients came from 19 sites and received colonoscopies from 89 endoscopists. Related complication rates were 1.3/1,000 for GI bleeding requiring hospitalization, 0.8/1,000 for GI bleeding requiring transfusion, 0.9/1,000 for diverticulitis, 0.3/1,000 for diverticulitis requiring hospitalization, 0.1/1,000 for postpolypectomy syndrome, and 0.2/1,000 for perforation.

The authors also calculated an overall complication rate of 2.2/1,000, which included GI bleeding with transfusion, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome. The serious complication rate was 1.4/1,000; serious complications included GI bleeding with hospitalization, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome.

Potentially related events included angina or myocardial infarction (0.6/1,000), stroke or transient ischemic attack (0.4/1,000), and other events, including hospitalization for intravenous catheter site infections, abdominal pain, arrythmia, gallstones, kidney stones, and drug reactions (0.7/1,000).

Complications were higher for patients undergoing a surveillance or follow-up exam, and for those who were older. There were no complications among the 40- to 49-year-olds, compared with 4.4/1,000 among patients aged 80 and older.

There was a threefold increase in complications in patients who were American Society of Anesthesiologists class III, compared with class I or II patients; a fivefold increase in patients who took warfarin, compared with those who used aspirin or NSAIDs; and a fivefold increase for a polyp removed with cautery. If more than one polyp was removed, there was a 13-fold increase in complications, Dr. Ko said.

The study was supported by the National Institutes of Health and the Centers for Disease Control and Prevention.

WASHINGTON — Patients who are sicker, who are taking warfarin, and whose polyps are removed by snare with cautery are at higher risk for complications following screening or surveillance colonoscopy, according to an analysis presented at the annual Digestive Disease Week.

Overall, the incidence of serious complications after screening was 2.2 of every 1,000 exams, and it was 1.7/1,000 for potential related events, according to Dr. Cynthia Ko of the University of Washington, Seattle.

Dr. Ko and her colleagues prospectivelyassessed colonoscopies performed on 18,271 patients aged 40 years and older who were referred for average risk screening, surveillance of prior polyps or cancer, a family history of polyps or cancer, or follow-up after another diagnostic procedure, such as a positive result on a fecal occult blood test.

Patients were excluded if they had a history of recent gastrointestinal bleeding or of inflammatory bowel disease, or had an incomplete colonoscopy because of poor bowel preparation.

The researchers identified the study patients through the Clinical Outcomes Research Initiative, a database maintained by the Oregon Health and Science University, Portland.

Complication rates for surveillance and screening aren't well defined, Dr. Ko said. In the Washington study, patients were queried at 7 and 30 days after colonoscopy about new symptoms, physician visits, hospitalizations, and unplanned surgeries.

Related events included colon perforation, GI bleeding, diverticulitis, and postpolypectomy syndrome. Potentially related complications included cardiac and neurologic events.

The 18,271 patients came from 19 sites and received colonoscopies from 89 endoscopists. Related complication rates were 1.3/1,000 for GI bleeding requiring hospitalization, 0.8/1,000 for GI bleeding requiring transfusion, 0.9/1,000 for diverticulitis, 0.3/1,000 for diverticulitis requiring hospitalization, 0.1/1,000 for postpolypectomy syndrome, and 0.2/1,000 for perforation.

The authors also calculated an overall complication rate of 2.2/1,000, which included GI bleeding with transfusion, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome. The serious complication rate was 1.4/1,000; serious complications included GI bleeding with hospitalization, diverticulitis with hospitalization, perforation, or postpolypectomy syndrome.

Potentially related events included angina or myocardial infarction (0.6/1,000), stroke or transient ischemic attack (0.4/1,000), and other events, including hospitalization for intravenous catheter site infections, abdominal pain, arrythmia, gallstones, kidney stones, and drug reactions (0.7/1,000).

Complications were higher for patients undergoing a surveillance or follow-up exam, and for those who were older. There were no complications among the 40- to 49-year-olds, compared with 4.4/1,000 among patients aged 80 and older.

There was a threefold increase in complications in patients who were American Society of Anesthesiologists class III, compared with class I or II patients; a fivefold increase in patients who took warfarin, compared with those who used aspirin or NSAIDs; and a fivefold increase for a polyp removed with cautery. If more than one polyp was removed, there was a 13-fold increase in complications, Dr. Ko said.

The study was supported by the National Institutes of Health and the Centers for Disease Control and Prevention.

Patients should avoid injection treatments to dissolve fat—known as mesotherapy or lipolysis—as they are neither safe nor effective, according to a warning from the American Society for Aesthetic Plastic Surgery.

An ASAPS spokeswoman said the organization issued the warning in the wake of concerns expressed by its membership at the annual meeting.

“The bottom line for patients is this: Don't allow yourself to be injected with an unknown and untested substance,” Dr. Foad Nahai, president of ASAPS, said in the statement.

Mesotherapy is not approved by the Food and Drug Administration. First practiced in France in the 1950s, the procedure involves multiple injections into the mesoderm of vitamins, plant extracts, minerals, homeopathic preparations, or traditional pharmaceuticals, depending on the condition targeted.

Practitioners claim there are few side effects, mainly burning, swelling and minor irritation.

But dermatologists note that there have been reports of serious infections and severely localized inflammation with mesotherapy.

“The bottom line is, long on hype, short on science,” said Dr. Richard G. Glogau, a dermatologist in private practice in San Francisco.

Dr. Robert A. Weiss of Johns Hopkins University, Baltimore, agreed on the potential dangers, and added, “I certainly warn my patients that it's unproven and could lead to the area possibly looking worse.”

The Aesthetic Surgery Education and Research Foundation is seeking Food and Drug Administration approval for a pilot study of lipolysis. In the 20-patient, 46-week placebo-controlled, double-blinded trial, patients will receive sham injections or injections of phosphatidylcholine/sodium deoxycholate, the most popular drug combination for lipolysis, Dr. Alan Gold, ASERF president, said in an interview. Evaluations will include histochemical and biochemical data and tissue scans. If the pilot is promising, the ASERF will conduct a multicenter trial, he said.

Patients should avoid injection treatments to dissolve fat—known as mesotherapy or lipolysis—as they are neither safe nor effective, according to a warning from the American Society for Aesthetic Plastic Surgery.

An ASAPS spokeswoman said the organization issued the warning in the wake of concerns expressed by its membership at the annual meeting.

“The bottom line for patients is this: Don't allow yourself to be injected with an unknown and untested substance,” Dr. Foad Nahai, president of ASAPS, said in the statement.

Mesotherapy is not approved by the Food and Drug Administration. First practiced in France in the 1950s, the procedure involves multiple injections into the mesoderm of vitamins, plant extracts, minerals, homeopathic preparations, or traditional pharmaceuticals, depending on the condition targeted.

Practitioners claim there are few side effects, mainly burning, swelling and minor irritation.

But dermatologists note that there have been reports of serious infections and severely localized inflammation with mesotherapy.

“The bottom line is, long on hype, short on science,” said Dr. Richard G. Glogau, a dermatologist in private practice in San Francisco.

Dr. Robert A. Weiss of Johns Hopkins University, Baltimore, agreed on the potential dangers, and added, “I certainly warn my patients that it's unproven and could lead to the area possibly looking worse.”

The Aesthetic Surgery Education and Research Foundation is seeking Food and Drug Administration approval for a pilot study of lipolysis. In the 20-patient, 46-week placebo-controlled, double-blinded trial, patients will receive sham injections or injections of phosphatidylcholine/sodium deoxycholate, the most popular drug combination for lipolysis, Dr. Alan Gold, ASERF president, said in an interview. Evaluations will include histochemical and biochemical data and tissue scans. If the pilot is promising, the ASERF will conduct a multicenter trial, he said.

Patients should avoid injection treatments to dissolve fat—known as mesotherapy or lipolysis—as they are neither safe nor effective, according to a warning from the American Society for Aesthetic Plastic Surgery.

An ASAPS spokeswoman said the organization issued the warning in the wake of concerns expressed by its membership at the annual meeting.

“The bottom line for patients is this: Don't allow yourself to be injected with an unknown and untested substance,” Dr. Foad Nahai, president of ASAPS, said in the statement.

Mesotherapy is not approved by the Food and Drug Administration. First practiced in France in the 1950s, the procedure involves multiple injections into the mesoderm of vitamins, plant extracts, minerals, homeopathic preparations, or traditional pharmaceuticals, depending on the condition targeted.

Practitioners claim there are few side effects, mainly burning, swelling and minor irritation.

But dermatologists note that there have been reports of serious infections and severely localized inflammation with mesotherapy.

“The bottom line is, long on hype, short on science,” said Dr. Richard G. Glogau, a dermatologist in private practice in San Francisco.

Dr. Robert A. Weiss of Johns Hopkins University, Baltimore, agreed on the potential dangers, and added, “I certainly warn my patients that it's unproven and could lead to the area possibly looking worse.”

The Aesthetic Surgery Education and Research Foundation is seeking Food and Drug Administration approval for a pilot study of lipolysis. In the 20-patient, 46-week placebo-controlled, double-blinded trial, patients will receive sham injections or injections of phosphatidylcholine/sodium deoxycholate, the most popular drug combination for lipolysis, Dr. Alan Gold, ASERF president, said in an interview. Evaluations will include histochemical and biochemical data and tissue scans. If the pilot is promising, the ASERF will conduct a multicenter trial, he said.

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, near the bottom of the list were state Medicaid programs.

The performance rankings were compiled for the second year in a row by AthenaHealth, a company based in Watertown, Mass., that collects about $2 billion a year on behalf of 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 as well as 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 of 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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, who is 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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The performance rankings are posted at www.athenapayerview.com

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, near the bottom of the list were state Medicaid programs.

The performance rankings were compiled for the second year in a row by AthenaHealth, a company based in Watertown, Mass., that collects about $2 billion a year on behalf of 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 as well as 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 of 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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, who is 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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The performance rankings are posted at www.athenapayerview.com

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, near the bottom of the list were state Medicaid programs.

The performance rankings were compiled for the second year in a row by AthenaHealth, a company based in Watertown, Mass., that collects about $2 billion a year on behalf of 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 as well as 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 of 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. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“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, who is 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, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The performance rankings are posted at www.athenapayerview.com

Under the Medicare final inpatient payment rule for fiscal 2008, many procedures to implant medical devices would see substantial payment increases, a development that has physicians and surgeons cautiously applauding.

A year ago, when the Centers for Medicare and Medicaid Services unveiled its inpatient payment proposal for fiscal 2007, it was met with dire predictions that access to crucial technologies would be diminished.

Interested parties argued that the agency's reliance on outdated cost data would end up chopping reimbursement for some procedures by as much as 30%.

The deep cuts disappeared in the final rule, however, and more recent data were used to calculate 2007 payments. For next fiscal year, CMS is still using a cost-based method, but with updated data, and is proposing to adjust payments based on illness severity with a new set of Medicare Severity diagnosis-related groups (MS-DRGs). Those 745 new DRGs—which have three levels of severity—replace the 538 current DRGs, which have only two levels.

As a result, payments for some procedures will rise if the rule is adopted.

To prevent hospitals from upcoding, CMS proposed about a 2% reduction in overall payments.

The bottom line: Hospitals will receive a 3.3% payment increase. To receive the full increase, hospitals must report to CMS on 27 quality measures, 6 more than last year. Some of the new measures are:

▸ Whether venous thromboembolism (VTE) prophylaxis was ordered for a surgery patient.

▸ Whether VTE prophylaxis was given within 24 hours before or after surgery.

▸ Whether antibiotics were given prophylactically for surgery patients.

▸ 30-day mortality for AMI patients.

▸ 30-day mortality for heart failure patients.

Under the proposed rule, hospitals will also now have a way to account for the receipt of free replacement devices sent by manufacturers after a recall. In the past, Medicare has paid for the devices because there was no way to cull them from the DRG for the replacement procedure. The new accounting method will also require hospitals to keep closer track of how often recalled devices are replaced.

In addition, hospitals will have to report secondary diagnoses present when patients are admitted. This is to fuel an effort to stop paying for conditions that develop in the hospital as a result of poor quality care, such as surgical infections. Beginning in fiscal 2009, CMS will not pay for some of these conditions under a higher DRG rate unless they were present at admission.

AdvaMed, a trade group for the medical device industry, said it was generally happy with the proposed final rule.

“The MS-DRGs maintain improvements to the patient classification system that have been made over the last few years to acknowledge rapid advancements in medical technology while improving the ability of the system to more precisely reflect the costs of more severely ill patients,” said AdvaMed President and CEO Stephen J. Ubl in a statement.

In a briefing with reporters, Mr. Ubl said that CMS's proposal still creates “charge compression,” by which the cost of low-technology devices is overstated and high technology, understated. The organization is also uncertain how hospitals will compensate when payments are reduced in some areas—a concern echoed by a spokesman for one surgeons' group and by the Heart Rhythm Society.

“On the face of it, it does make sense to pay hospitals more for patients who are sicker,” added Amy Melnick, vice president of health policy for HRS. The group is pleased with what it has seen so far, but is still reading through the proposal to analyze its potential impact, said Ms. Melnick.

CMS will publish a final rule before Oct. 1.

Under the Medicare final inpatient payment rule for fiscal 2008, many procedures to implant medical devices would see substantial payment increases, a development that has physicians and surgeons cautiously applauding.

A year ago, when the Centers for Medicare and Medicaid Services unveiled its inpatient payment proposal for fiscal 2007, it was met with dire predictions that access to crucial technologies would be diminished.

Interested parties argued that the agency's reliance on outdated cost data would end up chopping reimbursement for some procedures by as much as 30%.

The deep cuts disappeared in the final rule, however, and more recent data were used to calculate 2007 payments. For next fiscal year, CMS is still using a cost-based method, but with updated data, and is proposing to adjust payments based on illness severity with a new set of Medicare Severity diagnosis-related groups (MS-DRGs). Those 745 new DRGs—which have three levels of severity—replace the 538 current DRGs, which have only two levels.

As a result, payments for some procedures will rise if the rule is adopted.

To prevent hospitals from upcoding, CMS proposed about a 2% reduction in overall payments.

The bottom line: Hospitals will receive a 3.3% payment increase. To receive the full increase, hospitals must report to CMS on 27 quality measures, 6 more than last year. Some of the new measures are:

▸ Whether venous thromboembolism (VTE) prophylaxis was ordered for a surgery patient.

▸ Whether VTE prophylaxis was given within 24 hours before or after surgery.

▸ Whether antibiotics were given prophylactically for surgery patients.

▸ 30-day mortality for AMI patients.

▸ 30-day mortality for heart failure patients.

Under the proposed rule, hospitals will also now have a way to account for the receipt of free replacement devices sent by manufacturers after a recall. In the past, Medicare has paid for the devices because there was no way to cull them from the DRG for the replacement procedure. The new accounting method will also require hospitals to keep closer track of how often recalled devices are replaced.

In addition, hospitals will have to report secondary diagnoses present when patients are admitted. This is to fuel an effort to stop paying for conditions that develop in the hospital as a result of poor quality care, such as surgical infections. Beginning in fiscal 2009, CMS will not pay for some of these conditions under a higher DRG rate unless they were present at admission.

AdvaMed, a trade group for the medical device industry, said it was generally happy with the proposed final rule.

“The MS-DRGs maintain improvements to the patient classification system that have been made over the last few years to acknowledge rapid advancements in medical technology while improving the ability of the system to more precisely reflect the costs of more severely ill patients,” said AdvaMed President and CEO Stephen J. Ubl in a statement.

In a briefing with reporters, Mr. Ubl said that CMS's proposal still creates “charge compression,” by which the cost of low-technology devices is overstated and high technology, understated. The organization is also uncertain how hospitals will compensate when payments are reduced in some areas—a concern echoed by a spokesman for one surgeons' group and by the Heart Rhythm Society.

“On the face of it, it does make sense to pay hospitals more for patients who are sicker,” added Amy Melnick, vice president of health policy for HRS. The group is pleased with what it has seen so far, but is still reading through the proposal to analyze its potential impact, said Ms. Melnick.

CMS will publish a final rule before Oct. 1.

Under the Medicare final inpatient payment rule for fiscal 2008, many procedures to implant medical devices would see substantial payment increases, a development that has physicians and surgeons cautiously applauding.

A year ago, when the Centers for Medicare and Medicaid Services unveiled its inpatient payment proposal for fiscal 2007, it was met with dire predictions that access to crucial technologies would be diminished.

Interested parties argued that the agency's reliance on outdated cost data would end up chopping reimbursement for some procedures by as much as 30%.

The deep cuts disappeared in the final rule, however, and more recent data were used to calculate 2007 payments. For next fiscal year, CMS is still using a cost-based method, but with updated data, and is proposing to adjust payments based on illness severity with a new set of Medicare Severity diagnosis-related groups (MS-DRGs). Those 745 new DRGs—which have three levels of severity—replace the 538 current DRGs, which have only two levels.

As a result, payments for some procedures will rise if the rule is adopted.

To prevent hospitals from upcoding, CMS proposed about a 2% reduction in overall payments.

The bottom line: Hospitals will receive a 3.3% payment increase. To receive the full increase, hospitals must report to CMS on 27 quality measures, 6 more than last year. Some of the new measures are:

▸ Whether venous thromboembolism (VTE) prophylaxis was ordered for a surgery patient.

▸ Whether VTE prophylaxis was given within 24 hours before or after surgery.

▸ Whether antibiotics were given prophylactically for surgery patients.

▸ 30-day mortality for AMI patients.

▸ 30-day mortality for heart failure patients.

Under the proposed rule, hospitals will also now have a way to account for the receipt of free replacement devices sent by manufacturers after a recall. In the past, Medicare has paid for the devices because there was no way to cull them from the DRG for the replacement procedure. The new accounting method will also require hospitals to keep closer track of how often recalled devices are replaced.

In addition, hospitals will have to report secondary diagnoses present when patients are admitted. This is to fuel an effort to stop paying for conditions that develop in the hospital as a result of poor quality care, such as surgical infections. Beginning in fiscal 2009, CMS will not pay for some of these conditions under a higher DRG rate unless they were present at admission.

AdvaMed, a trade group for the medical device industry, said it was generally happy with the proposed final rule.

“The MS-DRGs maintain improvements to the patient classification system that have been made over the last few years to acknowledge rapid advancements in medical technology while improving the ability of the system to more precisely reflect the costs of more severely ill patients,” said AdvaMed President and CEO Stephen J. Ubl in a statement.

In a briefing with reporters, Mr. Ubl said that CMS's proposal still creates “charge compression,” by which the cost of low-technology devices is overstated and high technology, understated. The organization is also uncertain how hospitals will compensate when payments are reduced in some areas—a concern echoed by a spokesman for one surgeons' group and by the Heart Rhythm Society.

“On the face of it, it does make sense to pay hospitals more for patients who are sicker,” added Amy Melnick, vice president of health policy for HRS. The group is pleased with what it has seen so far, but is still reading through the proposal to analyze its potential impact, said Ms. Melnick.

CMS will publish a final rule before Oct. 1.