Alicia Ault

In anticipation of the huge health insurance expansion coming in 2 years under the Affordable Care Act, federal officials are opening a one-stop shop for those applying for coverage through a health insurance exchange, Medicaid, or the Children’s Health Insurance Program.

The rule establishing the web-based system was issued March 16 but does not take effect until Jan. 1, 2014. The idea is to give states time to set up the new systems, according to Cindy Mann, CMS deputy administrator and director of the Center for Medicaid and CHIP Services.

Ms. Mann said the final rule sets up a process for low-income Americans to apply online for insurance using a single application process. The government – either through the state exchange or state Medicaid/CHIP agencies – will determine whether they are eligible and in which program they will be enrolled.

Rather than submitting lengthy paperwork to support an application, the agencies will use data provided by the Internal Revenue Service, Social Security Administration, state unemployment agencies, and other government databases to determine a "modified gross income" to verify eligibility. The process will be repeated once a year.

Disabled individuals and those needing long-term care coverage through Medicaid will go through a slightly different process requiring more verification, said Ms. Mann.

In some cases, potential enrollees may know within hours whether they are eligible for benefits.

Currently, the Medicaid and CHIP enrollment processes are largely done through the mail, although California, Utah, and Oklahoma are experimenting with online applications, said Ms. Mann. But it can take days or weeks for someone to determine if they are eligible for a program now, she said.

The rule lays the groundwork for an expansion of Medicaid benefits under the ACA. The law guarantees for the first-time coverage to low-income (up to 133% of the federal poverty level) adults without children. Effectively, the expansion will be up to 138% of the poverty level, as the law requires that 5% of income be disregarded for eligibility purposes, Ms. Mann said.

The expansion goes into effect in 2014 when the health insurance exchanges are due to start operating. Under the ACA, the federal government is set to pay 100% of the cost of the Medicaid expansion for 3 years, ending in 2016, and a minimum of 90% permanently thereafter.

Even so, Medicaid expansion is one aspects of the ACA being challenged in the Supreme Court on March 28. Twenty-six states have said that the expansion amounts to coercion by the federal government. If states don’t participate, they stand to lose all of their Medicaid funding.

In anticipation of the huge health insurance expansion coming in 2 years under the Affordable Care Act, federal officials are opening a one-stop shop for those applying for coverage through a health insurance exchange, Medicaid, or the Children’s Health Insurance Program.

The rule establishing the web-based system was issued March 16 but does not take effect until Jan. 1, 2014. The idea is to give states time to set up the new systems, according to Cindy Mann, CMS deputy administrator and director of the Center for Medicaid and CHIP Services.

Ms. Mann said the final rule sets up a process for low-income Americans to apply online for insurance using a single application process. The government – either through the state exchange or state Medicaid/CHIP agencies – will determine whether they are eligible and in which program they will be enrolled.

Rather than submitting lengthy paperwork to support an application, the agencies will use data provided by the Internal Revenue Service, Social Security Administration, state unemployment agencies, and other government databases to determine a "modified gross income" to verify eligibility. The process will be repeated once a year.

Disabled individuals and those needing long-term care coverage through Medicaid will go through a slightly different process requiring more verification, said Ms. Mann.

In some cases, potential enrollees may know within hours whether they are eligible for benefits.

Currently, the Medicaid and CHIP enrollment processes are largely done through the mail, although California, Utah, and Oklahoma are experimenting with online applications, said Ms. Mann. But it can take days or weeks for someone to determine if they are eligible for a program now, she said.

The rule lays the groundwork for an expansion of Medicaid benefits under the ACA. The law guarantees for the first-time coverage to low-income (up to 133% of the federal poverty level) adults without children. Effectively, the expansion will be up to 138% of the poverty level, as the law requires that 5% of income be disregarded for eligibility purposes, Ms. Mann said.

The expansion goes into effect in 2014 when the health insurance exchanges are due to start operating. Under the ACA, the federal government is set to pay 100% of the cost of the Medicaid expansion for 3 years, ending in 2016, and a minimum of 90% permanently thereafter.

Even so, Medicaid expansion is one aspects of the ACA being challenged in the Supreme Court on March 28. Twenty-six states have said that the expansion amounts to coercion by the federal government. If states don’t participate, they stand to lose all of their Medicaid funding.

In anticipation of the huge health insurance expansion coming in 2 years under the Affordable Care Act, federal officials are opening a one-stop shop for those applying for coverage through a health insurance exchange, Medicaid, or the Children’s Health Insurance Program.

The rule establishing the web-based system was issued March 16 but does not take effect until Jan. 1, 2014. The idea is to give states time to set up the new systems, according to Cindy Mann, CMS deputy administrator and director of the Center for Medicaid and CHIP Services.

Ms. Mann said the final rule sets up a process for low-income Americans to apply online for insurance using a single application process. The government – either through the state exchange or state Medicaid/CHIP agencies – will determine whether they are eligible and in which program they will be enrolled.

Rather than submitting lengthy paperwork to support an application, the agencies will use data provided by the Internal Revenue Service, Social Security Administration, state unemployment agencies, and other government databases to determine a "modified gross income" to verify eligibility. The process will be repeated once a year.

Disabled individuals and those needing long-term care coverage through Medicaid will go through a slightly different process requiring more verification, said Ms. Mann.

In some cases, potential enrollees may know within hours whether they are eligible for benefits.

Currently, the Medicaid and CHIP enrollment processes are largely done through the mail, although California, Utah, and Oklahoma are experimenting with online applications, said Ms. Mann. But it can take days or weeks for someone to determine if they are eligible for a program now, she said.

The rule lays the groundwork for an expansion of Medicaid benefits under the ACA. The law guarantees for the first-time coverage to low-income (up to 133% of the federal poverty level) adults without children. Effectively, the expansion will be up to 138% of the poverty level, as the law requires that 5% of income be disregarded for eligibility purposes, Ms. Mann said.

The expansion goes into effect in 2014 when the health insurance exchanges are due to start operating. Under the ACA, the federal government is set to pay 100% of the cost of the Medicaid expansion for 3 years, ending in 2016, and a minimum of 90% permanently thereafter.

Even so, Medicaid expansion is one aspects of the ACA being challenged in the Supreme Court on March 28. Twenty-six states have said that the expansion amounts to coercion by the federal government. If states don’t participate, they stand to lose all of their Medicaid funding.

A new UnitedHealthcare study finds that few Americans have undergone genetic testing, but that, increasingly, physicians say they will be using the diagnostics in their practices.

Overall national spending on genetic testing was about $5 billion in 2010, which is only 8% of spending on clinical lab services, according to UnitedHealthcare’s study. Spending should rise to $15 billion to 20 billion by 2021, said the insurer, which studied genetic testing using its own data and an analysis of Medicare and Medicaid fee-for-service data, as well as by conducting surveys of patients and physicians.

The insurer estimates that there are 1,000-1,300 tests available for 2,500 conditions, and that several new tests are being developed each month. UnitedHealthcare said it spent $500 million on testing for its members in 2010 (40% on testing for infectious diseases, 16% for cancer, and the rest for other conditions including inherited disorders).

Testing use per person was highest in UnitedHealthcare’s Medicaid population, followed by its commercially insured and then its Medicare populations. Cancer diagnostics, however, were used at a higher rate in the Medicare population, reflecting "greater risk and incidence of cancer in senior populations."

Molecular and genetic testing increased by 14% per year from 2008 to 2010.

Two surveys that were commissioned by UnitedHealthcare and conducted by Harris Interactive in January and February found that Americans have a positive view of genetic testing, with 71% saying they were familiar with testing, but only 6% saying they’d had such a test. In all, 3% were unsure whether they’d been tested. About half said that they were "knowledgeable" about "genetic science." The vast majority said that the number of tests available and the amount of testing conducted will increase in 5 years.

UnitedHealthcare reported that 63% of physicians said that testing helped them to diagnose undetected conditions. Overall, 75% of physicians said that testing could benefit patients in their practices, but only 4% of their patients had been tested. They expected that figure to rise to 14% of patients in 5 years.

Three-quarters of physicians said they were "somewhat knowledgeable" about genetic science; 7% said they are "very knowledgeable," and 16% said they were "not knowledgeable."

Meanwhile, they said that 72% of their patients are "somewhat able" to understand results. Physicians thought that 7% were "not at all able to understand" genetic test results.

Some 59% of doctors said that they are concerned about the cost of genetic tests for their patients, whereas only 21% said they worried about their own reimbursement. In all, 56% said they expected genetic testing to increase overall health spending, compared with 19% who said it would cut costs. The majority said that testing would improve care.

A new UnitedHealthcare study finds that few Americans have undergone genetic testing, but that, increasingly, physicians say they will be using the diagnostics in their practices.

Overall national spending on genetic testing was about $5 billion in 2010, which is only 8% of spending on clinical lab services, according to UnitedHealthcare’s study. Spending should rise to $15 billion to 20 billion by 2021, said the insurer, which studied genetic testing using its own data and an analysis of Medicare and Medicaid fee-for-service data, as well as by conducting surveys of patients and physicians.

The insurer estimates that there are 1,000-1,300 tests available for 2,500 conditions, and that several new tests are being developed each month. UnitedHealthcare said it spent $500 million on testing for its members in 2010 (40% on testing for infectious diseases, 16% for cancer, and the rest for other conditions including inherited disorders).

Testing use per person was highest in UnitedHealthcare’s Medicaid population, followed by its commercially insured and then its Medicare populations. Cancer diagnostics, however, were used at a higher rate in the Medicare population, reflecting "greater risk and incidence of cancer in senior populations."

Molecular and genetic testing increased by 14% per year from 2008 to 2010.

Two surveys that were commissioned by UnitedHealthcare and conducted by Harris Interactive in January and February found that Americans have a positive view of genetic testing, with 71% saying they were familiar with testing, but only 6% saying they’d had such a test. In all, 3% were unsure whether they’d been tested. About half said that they were "knowledgeable" about "genetic science." The vast majority said that the number of tests available and the amount of testing conducted will increase in 5 years.

UnitedHealthcare reported that 63% of physicians said that testing helped them to diagnose undetected conditions. Overall, 75% of physicians said that testing could benefit patients in their practices, but only 4% of their patients had been tested. They expected that figure to rise to 14% of patients in 5 years.

Three-quarters of physicians said they were "somewhat knowledgeable" about genetic science; 7% said they are "very knowledgeable," and 16% said they were "not knowledgeable."

Meanwhile, they said that 72% of their patients are "somewhat able" to understand results. Physicians thought that 7% were "not at all able to understand" genetic test results.

Some 59% of doctors said that they are concerned about the cost of genetic tests for their patients, whereas only 21% said they worried about their own reimbursement. In all, 56% said they expected genetic testing to increase overall health spending, compared with 19% who said it would cut costs. The majority said that testing would improve care.

A new UnitedHealthcare study finds that few Americans have undergone genetic testing, but that, increasingly, physicians say they will be using the diagnostics in their practices.

Overall national spending on genetic testing was about $5 billion in 2010, which is only 8% of spending on clinical lab services, according to UnitedHealthcare’s study. Spending should rise to $15 billion to 20 billion by 2021, said the insurer, which studied genetic testing using its own data and an analysis of Medicare and Medicaid fee-for-service data, as well as by conducting surveys of patients and physicians.

The insurer estimates that there are 1,000-1,300 tests available for 2,500 conditions, and that several new tests are being developed each month. UnitedHealthcare said it spent $500 million on testing for its members in 2010 (40% on testing for infectious diseases, 16% for cancer, and the rest for other conditions including inherited disorders).

Testing use per person was highest in UnitedHealthcare’s Medicaid population, followed by its commercially insured and then its Medicare populations. Cancer diagnostics, however, were used at a higher rate in the Medicare population, reflecting "greater risk and incidence of cancer in senior populations."

Molecular and genetic testing increased by 14% per year from 2008 to 2010.

Two surveys that were commissioned by UnitedHealthcare and conducted by Harris Interactive in January and February found that Americans have a positive view of genetic testing, with 71% saying they were familiar with testing, but only 6% saying they’d had such a test. In all, 3% were unsure whether they’d been tested. About half said that they were "knowledgeable" about "genetic science." The vast majority said that the number of tests available and the amount of testing conducted will increase in 5 years.

UnitedHealthcare reported that 63% of physicians said that testing helped them to diagnose undetected conditions. Overall, 75% of physicians said that testing could benefit patients in their practices, but only 4% of their patients had been tested. They expected that figure to rise to 14% of patients in 5 years.

Three-quarters of physicians said they were "somewhat knowledgeable" about genetic science; 7% said they are "very knowledgeable," and 16% said they were "not knowledgeable."

Meanwhile, they said that 72% of their patients are "somewhat able" to understand results. Physicians thought that 7% were "not at all able to understand" genetic test results.

Some 59% of doctors said that they are concerned about the cost of genetic tests for their patients, whereas only 21% said they worried about their own reimbursement. In all, 56% said they expected genetic testing to increase overall health spending, compared with 19% who said it would cut costs. The majority said that testing would improve care.

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials announced earlier this year.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010.

But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said. The agency documented a shrinkage in use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010. The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending.

Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This is because few provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected. ☐

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials announced earlier this year.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010.

But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said. The agency documented a shrinkage in use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010. The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending.

Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This is because few provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected. ☐

WASHINGTON – The historically low growth in health spending in 2009 continued through 2010, driven largely by the recession, Centers for Medicare and Medicaid officials announced earlier this year.

U.S. health spending grew 3.9% in 2010, to a total of $2.6 trillion or $8,402 per person. That was a 0.1% rise from 2009, which was already at an all-time low growth rate.

As the nation’s economy slumped throughout 2009 and 2010, consumers cut back on elective surgical procedures, emergency room visits, physician office visits, and prescription drug use, according to the officials.

"Even though the recession officially ended in 2009, its impact on the health sector appears to have continued into 2010," said Anne Martin, an economist with the CMS.

Employers shifted the costs of insurance and care to employees, which drove up out-of-pocket spending in 2010.

But consumers overall spent only 1.8% more out-of-pocket in 2010 than they had in 2009, which was a slow rate of growth when compared with historical patterns, Ms. Martin said.

Consumers reacted to cost-shifting by choosing health insurance plans with lower premiums and higher deductibles, and by reducing, where they could, use of personal health care services. Medical prices and the U.S. population remained relatively stable before, during, and after the recession, and yet, personal health spending fell, indicating a willful pullback.

"The slower growth in personal health care spending was mainly driven by the slowdown in the use and intensity of health care goods and services," Ms. Martin said. The agency documented a shrinkage in use of hospital care and physician services as compared with historical levels.

Hospital spending grew only 5% to $814 billion in 2010, compared to 6% in 2009. There was a decline in median inpatient admissions, and slower growth in emergency department visits, outpatient visits, and outpatient surgeries.

Overall spending on physicians and clinical services – totaling $515 billion in 2010 – accounted for 20% of total health spending. As consumers went to the doctor less frequently, fewer prescriptions were written. And, many of those dispensed were for less expensive generic drugs. These and other factors led to the slowest rate of growth in prescription drug spending ever recorded – a 1% increase from 2009 to $259 billion. The data were published in the journal Health Affairs (2012 [doi: 10.1377/hlthaff.2011.1135]).

Growth in spending on physician and clinical services also was historically low, growing 2.5% in 2010 as compared with 3.3% in 2009, said Ms. Martin.

Meanwhile, as employers and private insurers reduced the amount they spent on health care, the federal government’s share of health spending rose – to 29% or a total of $742 billion in 2010. The rise in federal spending also was attributed to federal subsidies to state Medicaid programs. Medicaid was about 15% of the nation’s health bill in 2010, at $401 billion.

In 2009, the federal government spent 22% more than in 2008; in 2010, spending rose by almost 9%. That compares to a 10% decrease in spending by states and localities in 2008, and a 4% increase in 2010.

Medicare saw an increase in enrollment, both in Medicare Advantage managed care program and traditional fee-for-service Medicare. The increase in traditional enrollment reversed a several-year pattern of decline. Overall, Medicare spending increased 5% in 2010 to $524 billion, but per-enrollee spending did not rise as quickly as it had in 2009.

This is because there was a big reduction in payments for certain types of home health services, but also because of low use of physician services. Small increases in physician fees in 2009 and 2010 also kept a lid on Medicare spending.

Those increases were instituted by Congress in response to cuts that would otherwise have been required by Medicare’s Sustainable Growth Rate formula.

The Affordable Care Act had a negligible impact on overall spending, perhaps accounting for less than 0.1% of the slowdown, according to the CMS economists. This is because few provisions were in effect in 2010, and some, such as coverage for patients with preexisting conditions, did not enroll as many people as had been expected. ☐

The Society of General Internal Medicine is convening a panel of experts to help map out strategies for reining-in health care spending, as well as optimizing physician payment reform and patient outcomes, the organization announced on March 5.

The 13-member National Commission on Physician Payment Reform aims to issue their recommendations by early 2013. The group will have former Senator and cardiac surgeon Bill Frist as its honorary chair and Dr. Steven Schroeder, former president of the Robert Wood Johnson Foundation, as its chairman.

The effort is being funded by the Robert Wood Johnson Foundation, the California Healthcare Foundation, and the Sergei S. Zlinkoff Fund for Medical Education and Research.

"This country is grappling with how to control escalating medical costs and how to expand coverage at a time when we are seeing more elderly accessing care and putting strain on the federal budget," Dr. Schroeder said in a statement. "Being able to provide the best care possible, as well as the best health outcomes, while getting better value for our money, is one of the biggest challenges facing us this century."

The fee-for-service system is a key cost driver under the current system, said Dr. Schroeder. The commission will also examine efforts to tie quality to payment, and new payment structures being implemented as part of the Affordable Care Act.

The recommendations will be issued under the auspices of the SGIM, an organization established by the Robert Wood Johnson Foundation to promote innovation in general internal medicine. But, said Dr. Schroeder in an interview, "this is not going to be a house organ piece. Hopefully, it will be salient to all people interested in how doctors will get paid."

The panel includes physicians, insurers, and others with a stake in physician payment: Dr. Judy Ann Bigby, secretary of the Executive Office of Health and Human Services in Massachusetts; Dr. Troyen A. Brennan, executive vice president and chief medical officer at CVS Caremark; Suzanne Delbanco, executive director of Catalyst for Payment Reform; Dr. Thomas Gallagher, a bioethicist at University of Washington, Seattle; Dr. Jerry Kennett, an interventional cardiologist who is also president of the Missouri State Medical Association; Dr. Rich Kravitz, an internist and vice chair of research at University of California, Davis; Dr. Lisa Latts, vice president for public health policy at WellPoint Inc.; Dr. Kavita Patel, managing director for clinical transformation and delivery at the Brookings Institution’s Engelberg Center for Health Care Reform; Meredith Rosenthal, an economist at the Harvard School of Public Health; Dr. Michael Wagner, chief medical officer at Tufts Medical Center; and Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians (ACP).

Many physicians view Medicare’s Sustainable Growth Rate formula as a primary problem in physician payment. The SGR issue will provide context, but will not be a focus of the commission’s work, said Dr. Schroeder.

"Fixing the SGR is trying to get rid of the immediate problem, but it’s not developing the future solution of where health care payment needs to go," agreed Dr. Weinberger in an interview.

Dr. Schroeder also said that the commission will not be duplicating the work of other groups, such as the Medicare Payment Advisory Commission. The SGIM commission will have a much broader focus, Dr. Schroeder said.

The commission will likely meet in person only once, in the fall, he said. Most of the commission’s work up to that point will be background research. The full panel will grapple with the findings and make its recommendations after the meeting, said Dr. Schroeder.

The Society of General Internal Medicine is convening a panel of experts to help map out strategies for reining-in health care spending, as well as optimizing physician payment reform and patient outcomes, the organization announced on March 5.

The 13-member National Commission on Physician Payment Reform aims to issue their recommendations by early 2013. The group will have former Senator and cardiac surgeon Bill Frist as its honorary chair and Dr. Steven Schroeder, former president of the Robert Wood Johnson Foundation, as its chairman.

The effort is being funded by the Robert Wood Johnson Foundation, the California Healthcare Foundation, and the Sergei S. Zlinkoff Fund for Medical Education and Research.

"This country is grappling with how to control escalating medical costs and how to expand coverage at a time when we are seeing more elderly accessing care and putting strain on the federal budget," Dr. Schroeder said in a statement. "Being able to provide the best care possible, as well as the best health outcomes, while getting better value for our money, is one of the biggest challenges facing us this century."

The fee-for-service system is a key cost driver under the current system, said Dr. Schroeder. The commission will also examine efforts to tie quality to payment, and new payment structures being implemented as part of the Affordable Care Act.

The recommendations will be issued under the auspices of the SGIM, an organization established by the Robert Wood Johnson Foundation to promote innovation in general internal medicine. But, said Dr. Schroeder in an interview, "this is not going to be a house organ piece. Hopefully, it will be salient to all people interested in how doctors will get paid."

The panel includes physicians, insurers, and others with a stake in physician payment: Dr. Judy Ann Bigby, secretary of the Executive Office of Health and Human Services in Massachusetts; Dr. Troyen A. Brennan, executive vice president and chief medical officer at CVS Caremark; Suzanne Delbanco, executive director of Catalyst for Payment Reform; Dr. Thomas Gallagher, a bioethicist at University of Washington, Seattle; Dr. Jerry Kennett, an interventional cardiologist who is also president of the Missouri State Medical Association; Dr. Rich Kravitz, an internist and vice chair of research at University of California, Davis; Dr. Lisa Latts, vice president for public health policy at WellPoint Inc.; Dr. Kavita Patel, managing director for clinical transformation and delivery at the Brookings Institution’s Engelberg Center for Health Care Reform; Meredith Rosenthal, an economist at the Harvard School of Public Health; Dr. Michael Wagner, chief medical officer at Tufts Medical Center; and Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians (ACP).

Many physicians view Medicare’s Sustainable Growth Rate formula as a primary problem in physician payment. The SGR issue will provide context, but will not be a focus of the commission’s work, said Dr. Schroeder.

"Fixing the SGR is trying to get rid of the immediate problem, but it’s not developing the future solution of where health care payment needs to go," agreed Dr. Weinberger in an interview.

Dr. Schroeder also said that the commission will not be duplicating the work of other groups, such as the Medicare Payment Advisory Commission. The SGIM commission will have a much broader focus, Dr. Schroeder said.

The commission will likely meet in person only once, in the fall, he said. Most of the commission’s work up to that point will be background research. The full panel will grapple with the findings and make its recommendations after the meeting, said Dr. Schroeder.

The Society of General Internal Medicine is convening a panel of experts to help map out strategies for reining-in health care spending, as well as optimizing physician payment reform and patient outcomes, the organization announced on March 5.

The 13-member National Commission on Physician Payment Reform aims to issue their recommendations by early 2013. The group will have former Senator and cardiac surgeon Bill Frist as its honorary chair and Dr. Steven Schroeder, former president of the Robert Wood Johnson Foundation, as its chairman.

The effort is being funded by the Robert Wood Johnson Foundation, the California Healthcare Foundation, and the Sergei S. Zlinkoff Fund for Medical Education and Research.

"This country is grappling with how to control escalating medical costs and how to expand coverage at a time when we are seeing more elderly accessing care and putting strain on the federal budget," Dr. Schroeder said in a statement. "Being able to provide the best care possible, as well as the best health outcomes, while getting better value for our money, is one of the biggest challenges facing us this century."

The fee-for-service system is a key cost driver under the current system, said Dr. Schroeder. The commission will also examine efforts to tie quality to payment, and new payment structures being implemented as part of the Affordable Care Act.

The recommendations will be issued under the auspices of the SGIM, an organization established by the Robert Wood Johnson Foundation to promote innovation in general internal medicine. But, said Dr. Schroeder in an interview, "this is not going to be a house organ piece. Hopefully, it will be salient to all people interested in how doctors will get paid."

The panel includes physicians, insurers, and others with a stake in physician payment: Dr. Judy Ann Bigby, secretary of the Executive Office of Health and Human Services in Massachusetts; Dr. Troyen A. Brennan, executive vice president and chief medical officer at CVS Caremark; Suzanne Delbanco, executive director of Catalyst for Payment Reform; Dr. Thomas Gallagher, a bioethicist at University of Washington, Seattle; Dr. Jerry Kennett, an interventional cardiologist who is also president of the Missouri State Medical Association; Dr. Rich Kravitz, an internist and vice chair of research at University of California, Davis; Dr. Lisa Latts, vice president for public health policy at WellPoint Inc.; Dr. Kavita Patel, managing director for clinical transformation and delivery at the Brookings Institution’s Engelberg Center for Health Care Reform; Meredith Rosenthal, an economist at the Harvard School of Public Health; Dr. Michael Wagner, chief medical officer at Tufts Medical Center; and Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians (ACP).

Many physicians view Medicare’s Sustainable Growth Rate formula as a primary problem in physician payment. The SGR issue will provide context, but will not be a focus of the commission’s work, said Dr. Schroeder.

"Fixing the SGR is trying to get rid of the immediate problem, but it’s not developing the future solution of where health care payment needs to go," agreed Dr. Weinberger in an interview.

Dr. Schroeder also said that the commission will not be duplicating the work of other groups, such as the Medicare Payment Advisory Commission. The SGIM commission will have a much broader focus, Dr. Schroeder said.

The commission will likely meet in person only once, in the fall, he said. Most of the commission’s work up to that point will be background research. The full panel will grapple with the findings and make its recommendations after the meeting, said Dr. Schroeder.

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

“I think maybe we have the chance to turn the world upside down just a bit,” said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. “Maybe we can invert the traditional power structure,” he said, adding that the research that gets funded by PCORI will have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. “We didn't want to say, 'Well, you know, the people with atrial fibrillation, they're more important than the people who got Parkinson's,'” said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many speakers said PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. “Rather than politicians talking about rationing, they need to be talking about how to make the system rational,” he said, noting that there is overconsumption, underconsumption, and disparate levels of care.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. “The problem for PCORI is getting people actually to believe the scientific findings you actually come up with,” he said.

Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America's Health Insurance Plans. The insurers believe “that the initial focus of PCORI's agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations,” said Dr. Baskin.

Hitting those high-profile areas is especially important, because “if there's not some early successes, people won't believe in this process,” he said.

PCORI accepted public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

“We have the chance to turn the world upside down just a bit,” said PCORI member Dr. Harlan Krumholz.

Source Alicia Ault/IMNG Medical Me

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

“I think maybe we have the chance to turn the world upside down just a bit,” said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. “Maybe we can invert the traditional power structure,” he said, adding that the research that gets funded by PCORI will have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. “We didn't want to say, 'Well, you know, the people with atrial fibrillation, they're more important than the people who got Parkinson's,'” said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many speakers said PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. “Rather than politicians talking about rationing, they need to be talking about how to make the system rational,” he said, noting that there is overconsumption, underconsumption, and disparate levels of care.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. “The problem for PCORI is getting people actually to believe the scientific findings you actually come up with,” he said.

Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America's Health Insurance Plans. The insurers believe “that the initial focus of PCORI's agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations,” said Dr. Baskin.

Hitting those high-profile areas is especially important, because “if there's not some early successes, people won't believe in this process,” he said.

PCORI accepted public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

“We have the chance to turn the world upside down just a bit,” said PCORI member Dr. Harlan Krumholz.

Source Alicia Ault/IMNG Medical Me

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

“I think maybe we have the chance to turn the world upside down just a bit,” said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. “Maybe we can invert the traditional power structure,” he said, adding that the research that gets funded by PCORI will have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. “We didn't want to say, 'Well, you know, the people with atrial fibrillation, they're more important than the people who got Parkinson's,'” said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many speakers said PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. “Rather than politicians talking about rationing, they need to be talking about how to make the system rational,” he said, noting that there is overconsumption, underconsumption, and disparate levels of care.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. “The problem for PCORI is getting people actually to believe the scientific findings you actually come up with,” he said.

Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America's Health Insurance Plans. The insurers believe “that the initial focus of PCORI's agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations,” said Dr. Baskin.

Hitting those high-profile areas is especially important, because “if there's not some early successes, people won't believe in this process,” he said.

PCORI accepted public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

“We have the chance to turn the world upside down just a bit,” said PCORI member Dr. Harlan Krumholz.

Source Alicia Ault/IMNG Medical Me

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said Feb. 27.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

"We want to know whether in your opinion we’ve got the national priorities and the research agenda right," said Dr. Joe Selby, PCORI executive director.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

Alicia Ault/Elsevier Global Medical News

"I think maybe we have the chance to turn the world upside down just a bit," said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. "Maybe we can invert the traditional power structure," he said, adding that the research that gets funded by PCORI will be projects that have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. "We didn’t want to say, ‘Well, you know, the people with atrial fibrillation, they’re more important than the people who got Parkinson’s,’ " said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many of the speakers said that PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. "Rather than politicians talking about rationing, they need to be talking about how to make the system rational," he said, noting that there is overconsumption, underconsumption, and disparate levels of care in the United States.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. "The problem for PCORI is getting people actually to believe the scientific findings you actually come up with," he said.

Alicia Ault/Elseiver Global Medical News

Dr. Ardis Dee Hoven, a member of the American Medical Association Board of Trustees, and Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America’s Health Insurance Plans. The insurers believe "that the initial focus of PCORI’s agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations," said Dr. Baskin.

Hitting those high-profile areas is especially important, because "if there’s not some early successes, people won’t believe in this process," he said.

"PCORI must address the prevention, management, and treatment of preventable diseases," which are "a major cost driver," said Dr. Hoven, noting that the AMA supported a priority focus on cardiovascular disease, diabetes care, and nutrition. In wellness, nutrition, and obesity there are a wide range of treatments, "but little clarity about what may work," said Dr. Hoven. Also, to be useful, evidence-based guidelines need to be made available to physicians in their offices, on a real-time basis, she said.

Alicia Ault/Elsevier Global Medical News

Dr. Glen Stream, president of the American Academy of Family Physicians, agreed with Dr. Hoven that information has to be at a physician’s fingertips at the point of care. The AAFP urged PCORI to "initially focus on conditions we see every day in our practices and for which evidence provides solid conclusions." Knowledge is not being well applied and is not well understood, said Dr. Stream. "We have a lot of low-hanging fruit we can take advantage of in that area."

He noted that although PCORI will not directly consider cost issues, the AAFP believes that through its efforts it "will bend the cost curve by identifying those cost-effective interventions and evidence-based interventions."

PCORI is accepting public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said Feb. 27.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

"We want to know whether in your opinion we’ve got the national priorities and the research agenda right," said Dr. Joe Selby, PCORI executive director.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

Alicia Ault/Elsevier Global Medical News

"I think maybe we have the chance to turn the world upside down just a bit," said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. "Maybe we can invert the traditional power structure," he said, adding that the research that gets funded by PCORI will be projects that have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. "We didn’t want to say, ‘Well, you know, the people with atrial fibrillation, they’re more important than the people who got Parkinson’s,’ " said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many of the speakers said that PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. "Rather than politicians talking about rationing, they need to be talking about how to make the system rational," he said, noting that there is overconsumption, underconsumption, and disparate levels of care in the United States.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. "The problem for PCORI is getting people actually to believe the scientific findings you actually come up with," he said.

Alicia Ault/Elseiver Global Medical News

Dr. Ardis Dee Hoven, a member of the American Medical Association Board of Trustees, and Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America’s Health Insurance Plans. The insurers believe "that the initial focus of PCORI’s agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations," said Dr. Baskin.

Hitting those high-profile areas is especially important, because "if there’s not some early successes, people won’t believe in this process," he said.

"PCORI must address the prevention, management, and treatment of preventable diseases," which are "a major cost driver," said Dr. Hoven, noting that the AMA supported a priority focus on cardiovascular disease, diabetes care, and nutrition. In wellness, nutrition, and obesity there are a wide range of treatments, "but little clarity about what may work," said Dr. Hoven. Also, to be useful, evidence-based guidelines need to be made available to physicians in their offices, on a real-time basis, she said.

Alicia Ault/Elsevier Global Medical News

Dr. Glen Stream, president of the American Academy of Family Physicians, agreed with Dr. Hoven that information has to be at a physician’s fingertips at the point of care. The AAFP urged PCORI to "initially focus on conditions we see every day in our practices and for which evidence provides solid conclusions." Knowledge is not being well applied and is not well understood, said Dr. Stream. "We have a lot of low-hanging fruit we can take advantage of in that area."

He noted that although PCORI will not directly consider cost issues, the AAFP believes that through its efforts it "will bend the cost curve by identifying those cost-effective interventions and evidence-based interventions."

PCORI is accepting public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

WASHINGTON – The Patient-Centered Outcomes Research Institute is on track to release its initial research agenda by mid-April, officials from the organization said Feb. 27.

At its first public meeting, PCORI, created by the Affordable Care Act, sought the input of insurers, physicians, nurses, and patients on a draft agenda released in late January.

"We want to know whether in your opinion we’ve got the national priorities and the research agenda right," said Dr. Joe Selby, PCORI executive director.

The organization is charged with funding research that will help patients, physicians, and caregivers make better-informed decisions. The focus will be on coming up with evidence-based practices that allow individuals to more closely tailor decisions to their personal needs.

Alicia Ault/Elsevier Global Medical News

"I think maybe we have the chance to turn the world upside down just a bit," said Dr. Harlan Krumholz, a member of the PCORI Board of Governors. "Maybe we can invert the traditional power structure," he said, adding that the research that gets funded by PCORI will be projects that have patients at the absolute center.

The draft research agenda had very broad priorities – there were no condition-specific requests for proposal. "We didn’t want to say, ‘Well, you know, the people with atrial fibrillation, they’re more important than the people who got Parkinson’s,’ " said Dr. Krumholz, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Many of the speakers said that PCORI had a difficult road ahead. Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that much of medicine was based on emotion and habit, rather than evidence. "Rather than politicians talking about rationing, they need to be talking about how to make the system rational," he said, noting that there is overconsumption, underconsumption, and disparate levels of care in the United States.

But the biggest issue is the lack of faith in, and understanding of, science – not just among patients but among physicians too, Dr. Brawley said. "The problem for PCORI is getting people actually to believe the scientific findings you actually come up with," he said.

Alicia Ault/Elseiver Global Medical News

Dr. Ardis Dee Hoven, a member of the American Medical Association Board of Trustees, and Dr. Andrew Baskin, national medical director for quality and provider performance measurement at Aetna, agreed with Dr. Brawley that there needed to be some rationalization of treatment. Dr. Baskin spoke on behalf of America’s Health Insurance Plans. The insurers believe "that the initial focus of PCORI’s agenda should really be on looking at gaps in evidence, which tend to be in high-volume, high-cost, perhaps even high-risk situations," said Dr. Baskin.

Hitting those high-profile areas is especially important, because "if there’s not some early successes, people won’t believe in this process," he said.

"PCORI must address the prevention, management, and treatment of preventable diseases," which are "a major cost driver," said Dr. Hoven, noting that the AMA supported a priority focus on cardiovascular disease, diabetes care, and nutrition. In wellness, nutrition, and obesity there are a wide range of treatments, "but little clarity about what may work," said Dr. Hoven. Also, to be useful, evidence-based guidelines need to be made available to physicians in their offices, on a real-time basis, she said.

Alicia Ault/Elsevier Global Medical News

Dr. Glen Stream, president of the American Academy of Family Physicians, agreed with Dr. Hoven that information has to be at a physician’s fingertips at the point of care. The AAFP urged PCORI to "initially focus on conditions we see every day in our practices and for which evidence provides solid conclusions." Knowledge is not being well applied and is not well understood, said Dr. Stream. "We have a lot of low-hanging fruit we can take advantage of in that area."

He noted that although PCORI will not directly consider cost issues, the AAFP believes that through its efforts it "will bend the cost curve by identifying those cost-effective interventions and evidence-based interventions."

PCORI is accepting public comments on its research agenda and priorities through March 15. The group will publish a report summarizing the input, and then the Board of Governors will approve the changes at another public meeting in April.

About 50,000 Americans who previously were uninsured are now covered under a program created by the Affordable Care Act, according to a report issued Feb. 23 by the Health and Human Services department.

The Pre-Existing Condition Insurance Plan (PCIP) initially was not well subscribed, and even now, has enrollment well below what the Obama Administration had predicted when health reform was passed in March 2010.

Enrollment was lower than expected for a number of months, but then took off in August 2011. Since then applications to the program have averaged about 8,000 per month, according to Steve Larsen, Deputy Administrator at the Centers for Medicare and Medicaid Services and Director of the Center for Consumer Information and Insurance Oversight.

CMS has been working with states, health care providers, federal agencies such as the Social Security Administration, and insurers to publicize the program’s existence, Mr. Larsen said. Some insurers have agreed to refer people to the PCIP who have been denied coverage. "The enrollment rates we’ve seen shows that over time there’s a greater rate as word gets out."

The program is open to anyone who has been uninsured for at least 6 months, has a pre-existing condition or has been denied health coverage because of a health condition, and is a U.S. citizen or legal resident.

Enrollees pay premiums that are similar to those paid by healthy people in the individual insurance market. They may pay more based on age, geographic area, and tobacco use. Out-of-pocket expenses are limited by law each year; in 2010 and 2011, this amount was $5,950; in 2012, it is $6,050.

Twenty-seven states run their own plans, and 23 states and the District of Columbia have plans operated by the federal government.

The Affordable Care Act appropriated $5 billion to pay out claims. So far, the program has spent $600 million, Mr. Larsen said. When asked whether the remaining funds would be enough to cover claims through 2014 – when enrollees will be transitioned to the state health exchanges – Mr. Larsen did not give a direct answer, but said that the program was managing so far.

Costs for enrollees have been higher than anticipated, possibly because of deferred health care prior to their enrollment, he said. They had more than 1.5 times as many claims, office visits, emergency room visits, and procedures as enrollees in the Federal Employees Health Benefits plan, and more than five times as many hospital admissions. The pre-existing plan enrollees were 3.5 times more likely to have claims of more than $10,000.

More than three-quarters (78%) of the costs for enrollees in the federal PCIP were for four conditions: cancer (27% of total); circulatory system conditions such as coronary artery disease (19%); rehabilitative care and aftercare, such as postsurgical care and certain forms of radiation and chemotherapy (18%); and degenerative joint diseases, such as osteoarthritis (14%). Extrapolating the known numbers of people with these conditions in the federally run plans, the report estimates that the PCIP program served nearly 1,900 people with cancer and 4,700 with heart disease in 2011. Other prevalent conditions included organ failures requiring a transplant, and hemophilia.

The largest proportion of PCIP enrollees are over age 55 years. The report said that these enrollees are likely "retired or no longer working, do not have access to employer-sponsored health insurance, and have not yet reached the age when they can enroll in Medicare."

About 50,000 Americans who previously were uninsured are now covered under a program created by the Affordable Care Act, according to a report issued Feb. 23 by the Health and Human Services department.

The Pre-Existing Condition Insurance Plan (PCIP) initially was not well subscribed, and even now, has enrollment well below what the Obama Administration had predicted when health reform was passed in March 2010.

Enrollment was lower than expected for a number of months, but then took off in August 2011. Since then applications to the program have averaged about 8,000 per month, according to Steve Larsen, Deputy Administrator at the Centers for Medicare and Medicaid Services and Director of the Center for Consumer Information and Insurance Oversight.

CMS has been working with states, health care providers, federal agencies such as the Social Security Administration, and insurers to publicize the program’s existence, Mr. Larsen said. Some insurers have agreed to refer people to the PCIP who have been denied coverage. "The enrollment rates we’ve seen shows that over time there’s a greater rate as word gets out."

The program is open to anyone who has been uninsured for at least 6 months, has a pre-existing condition or has been denied health coverage because of a health condition, and is a U.S. citizen or legal resident.

Enrollees pay premiums that are similar to those paid by healthy people in the individual insurance market. They may pay more based on age, geographic area, and tobacco use. Out-of-pocket expenses are limited by law each year; in 2010 and 2011, this amount was $5,950; in 2012, it is $6,050.

Twenty-seven states run their own plans, and 23 states and the District of Columbia have plans operated by the federal government.

The Affordable Care Act appropriated $5 billion to pay out claims. So far, the program has spent $600 million, Mr. Larsen said. When asked whether the remaining funds would be enough to cover claims through 2014 – when enrollees will be transitioned to the state health exchanges – Mr. Larsen did not give a direct answer, but said that the program was managing so far.

Costs for enrollees have been higher than anticipated, possibly because of deferred health care prior to their enrollment, he said. They had more than 1.5 times as many claims, office visits, emergency room visits, and procedures as enrollees in the Federal Employees Health Benefits plan, and more than five times as many hospital admissions. The pre-existing plan enrollees were 3.5 times more likely to have claims of more than $10,000.

More than three-quarters (78%) of the costs for enrollees in the federal PCIP were for four conditions: cancer (27% of total); circulatory system conditions such as coronary artery disease (19%); rehabilitative care and aftercare, such as postsurgical care and certain forms of radiation and chemotherapy (18%); and degenerative joint diseases, such as osteoarthritis (14%). Extrapolating the known numbers of people with these conditions in the federally run plans, the report estimates that the PCIP program served nearly 1,900 people with cancer and 4,700 with heart disease in 2011. Other prevalent conditions included organ failures requiring a transplant, and hemophilia.

The largest proportion of PCIP enrollees are over age 55 years. The report said that these enrollees are likely "retired or no longer working, do not have access to employer-sponsored health insurance, and have not yet reached the age when they can enroll in Medicare."

About 50,000 Americans who previously were uninsured are now covered under a program created by the Affordable Care Act, according to a report issued Feb. 23 by the Health and Human Services department.

The Pre-Existing Condition Insurance Plan (PCIP) initially was not well subscribed, and even now, has enrollment well below what the Obama Administration had predicted when health reform was passed in March 2010.

Enrollment was lower than expected for a number of months, but then took off in August 2011. Since then applications to the program have averaged about 8,000 per month, according to Steve Larsen, Deputy Administrator at the Centers for Medicare and Medicaid Services and Director of the Center for Consumer Information and Insurance Oversight.

CMS has been working with states, health care providers, federal agencies such as the Social Security Administration, and insurers to publicize the program’s existence, Mr. Larsen said. Some insurers have agreed to refer people to the PCIP who have been denied coverage. "The enrollment rates we’ve seen shows that over time there’s a greater rate as word gets out."

The program is open to anyone who has been uninsured for at least 6 months, has a pre-existing condition or has been denied health coverage because of a health condition, and is a U.S. citizen or legal resident.

Enrollees pay premiums that are similar to those paid by healthy people in the individual insurance market. They may pay more based on age, geographic area, and tobacco use. Out-of-pocket expenses are limited by law each year; in 2010 and 2011, this amount was $5,950; in 2012, it is $6,050.

Twenty-seven states run their own plans, and 23 states and the District of Columbia have plans operated by the federal government.

The Affordable Care Act appropriated $5 billion to pay out claims. So far, the program has spent $600 million, Mr. Larsen said. When asked whether the remaining funds would be enough to cover claims through 2014 – when enrollees will be transitioned to the state health exchanges – Mr. Larsen did not give a direct answer, but said that the program was managing so far.

Costs for enrollees have been higher than anticipated, possibly because of deferred health care prior to their enrollment, he said. They had more than 1.5 times as many claims, office visits, emergency room visits, and procedures as enrollees in the Federal Employees Health Benefits plan, and more than five times as many hospital admissions. The pre-existing plan enrollees were 3.5 times more likely to have claims of more than $10,000.

More than three-quarters (78%) of the costs for enrollees in the federal PCIP were for four conditions: cancer (27% of total); circulatory system conditions such as coronary artery disease (19%); rehabilitative care and aftercare, such as postsurgical care and certain forms of radiation and chemotherapy (18%); and degenerative joint diseases, such as osteoarthritis (14%). Extrapolating the known numbers of people with these conditions in the federally run plans, the report estimates that the PCIP program served nearly 1,900 people with cancer and 4,700 with heart disease in 2011. Other prevalent conditions included organ failures requiring a transplant, and hemophilia.

The largest proportion of PCIP enrollees are over age 55 years. The report said that these enrollees are likely "retired or no longer working, do not have access to employer-sponsored health insurance, and have not yet reached the age when they can enroll in Medicare."