Mary Ellen Schneider

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed this month, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed this month, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed this month, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule several times.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress. The most recent enforcement delay is set to expire on Dec. 31.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

Vitals

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress. The most recent enforcement delay is set to expire on Dec. 31.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

Vitals

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

Physicians currently have until Dec. 31 before the Federal Trade Commission is set to begin enforcing the Red Flags rule. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft. The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress. The most recent enforcement delay is set to expire on Dec. 31.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

Vitals

Root cause analysis has become a staple at most hospitals, but Dr. Adrienne Green is working to make sure that the lessons learned in these sessions last long after the case is presented in a hospital conference room.

Photo credit: Flickr user epugachev

As the chair of the Patient Safety Committee at the University of California, San Francisco (UCSF), Medical Center, Dr. Green wants to take the root cause analysis process to the next step: finding ways to ensure that systems changes implemented after the root cause analysis are sustained over the long term and disseminated throughout the hospital.

"We’re working on figuring out ways to disseminate our learnings, making sure that the changes that need to be spread get spread throughout the hospital, and trying to figure out a way to follow up on the sustainability of our improvements," said Dr. Green, a hospitalist and the associate chief medical officer at UCSF.

Dr. Green, whose portfolio as associate chief medical officer includes working to improve door to floor time for admitted patients and reducing preventable readmissions, said she is excited about taking root cause analysis in a new direction. "I really enjoy working to bring physicians together with other disciplines within the medical center to fix systems," she said.

The root cause analysis process has been in place at UCSF for more than 5 years. The analyses are conducted under the auspices of the Patient Safety Committee, whose members, together with local experts and front-line providers involved in an event, review serious events, reportable events, and near misses. The whole process has become more structured and rigorous over time, Dr. Green said.

Part of that evolution has involved generating action items at the close of each root cause analysis and assigning someone who is accountable for implementing each one. Those individuals then report back to the committee 6-8 weeks later, depending on the seriousness of the event. And they keep coming back until the committee is satisfied that the original problem has been addressed.

Over the last year, Dr. Green and her colleagues conducted a review of selected changes to determine if they were maintained over time. They found that about half of the changes that had been implemented through root cause analysis had been sustained, while others "had morphed, and some had just completely fallen by the wayside," Dr. Green said.

For other hospitalists looking to revamp their root cause analysis process, Dr. Green recommends imposing a firm structure and holding regular meetings. At UCSF, they meet every Wednesday. While this is time consuming, Dr. Green says it’s the best way to keep up with the initial analyses and the follow-up. She also recommends that hospitals adopt structured templates for documenting the root cause analysis and the resulting action items.

Dr. Green cautioned physicians who chair these committees not to try to do it all on their own. She relies heavily on her patient safety coordinator to analyze events and incident reports, help coordinate the initial root cause analysis and follow-up, and "play detective" when needed.

Another element that is critical to a successful root cause analysis process is to build a committee of experts who can ask challenging questions and command the respect of the hospital’s physicians and staff. Then people know that if they’ve promised something to the committee, they need to deliver it, Dr. Green said. "That comes through having the right people at the table."

Root cause analysis has become a staple at most hospitals, but Dr. Adrienne Green is working to make sure that the lessons learned in these sessions last long after the case is presented in a hospital conference room.

Photo credit: Flickr user epugachev

As the chair of the Patient Safety Committee at the University of California, San Francisco (UCSF), Medical Center, Dr. Green wants to take the root cause analysis process to the next step: finding ways to ensure that systems changes implemented after the root cause analysis are sustained over the long term and disseminated throughout the hospital.

"We’re working on figuring out ways to disseminate our learnings, making sure that the changes that need to be spread get spread throughout the hospital, and trying to figure out a way to follow up on the sustainability of our improvements," said Dr. Green, a hospitalist and the associate chief medical officer at UCSF.

Dr. Green, whose portfolio as associate chief medical officer includes working to improve door to floor time for admitted patients and reducing preventable readmissions, said she is excited about taking root cause analysis in a new direction. "I really enjoy working to bring physicians together with other disciplines within the medical center to fix systems," she said.

The root cause analysis process has been in place at UCSF for more than 5 years. The analyses are conducted under the auspices of the Patient Safety Committee, whose members, together with local experts and front-line providers involved in an event, review serious events, reportable events, and near misses. The whole process has become more structured and rigorous over time, Dr. Green said.

Part of that evolution has involved generating action items at the close of each root cause analysis and assigning someone who is accountable for implementing each one. Those individuals then report back to the committee 6-8 weeks later, depending on the seriousness of the event. And they keep coming back until the committee is satisfied that the original problem has been addressed.

Over the last year, Dr. Green and her colleagues conducted a review of selected changes to determine if they were maintained over time. They found that about half of the changes that had been implemented through root cause analysis had been sustained, while others "had morphed, and some had just completely fallen by the wayside," Dr. Green said.

For other hospitalists looking to revamp their root cause analysis process, Dr. Green recommends imposing a firm structure and holding regular meetings. At UCSF, they meet every Wednesday. While this is time consuming, Dr. Green says it’s the best way to keep up with the initial analyses and the follow-up. She also recommends that hospitals adopt structured templates for documenting the root cause analysis and the resulting action items.

Dr. Green cautioned physicians who chair these committees not to try to do it all on their own. She relies heavily on her patient safety coordinator to analyze events and incident reports, help coordinate the initial root cause analysis and follow-up, and "play detective" when needed.

Another element that is critical to a successful root cause analysis process is to build a committee of experts who can ask challenging questions and command the respect of the hospital’s physicians and staff. Then people know that if they’ve promised something to the committee, they need to deliver it, Dr. Green said. "That comes through having the right people at the table."

Root cause analysis has become a staple at most hospitals, but Dr. Adrienne Green is working to make sure that the lessons learned in these sessions last long after the case is presented in a hospital conference room.

Photo credit: Flickr user epugachev

As the chair of the Patient Safety Committee at the University of California, San Francisco (UCSF), Medical Center, Dr. Green wants to take the root cause analysis process to the next step: finding ways to ensure that systems changes implemented after the root cause analysis are sustained over the long term and disseminated throughout the hospital.

"We’re working on figuring out ways to disseminate our learnings, making sure that the changes that need to be spread get spread throughout the hospital, and trying to figure out a way to follow up on the sustainability of our improvements," said Dr. Green, a hospitalist and the associate chief medical officer at UCSF.

Dr. Green, whose portfolio as associate chief medical officer includes working to improve door to floor time for admitted patients and reducing preventable readmissions, said she is excited about taking root cause analysis in a new direction. "I really enjoy working to bring physicians together with other disciplines within the medical center to fix systems," she said.

The root cause analysis process has been in place at UCSF for more than 5 years. The analyses are conducted under the auspices of the Patient Safety Committee, whose members, together with local experts and front-line providers involved in an event, review serious events, reportable events, and near misses. The whole process has become more structured and rigorous over time, Dr. Green said.

Part of that evolution has involved generating action items at the close of each root cause analysis and assigning someone who is accountable for implementing each one. Those individuals then report back to the committee 6-8 weeks later, depending on the seriousness of the event. And they keep coming back until the committee is satisfied that the original problem has been addressed.

Over the last year, Dr. Green and her colleagues conducted a review of selected changes to determine if they were maintained over time. They found that about half of the changes that had been implemented through root cause analysis had been sustained, while others "had morphed, and some had just completely fallen by the wayside," Dr. Green said.

For other hospitalists looking to revamp their root cause analysis process, Dr. Green recommends imposing a firm structure and holding regular meetings. At UCSF, they meet every Wednesday. While this is time consuming, Dr. Green says it’s the best way to keep up with the initial analyses and the follow-up. She also recommends that hospitals adopt structured templates for documenting the root cause analysis and the resulting action items.

Dr. Green cautioned physicians who chair these committees not to try to do it all on their own. She relies heavily on her patient safety coordinator to analyze events and incident reports, help coordinate the initial root cause analysis and follow-up, and "play detective" when needed.

Another element that is critical to a successful root cause analysis process is to build a committee of experts who can ask challenging questions and command the respect of the hospital’s physicians and staff. Then people know that if they’ve promised something to the committee, they need to deliver it, Dr. Green said. "That comes through having the right people at the table."

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service wasn't the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in non-grandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service wasn't the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in non-grandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

New health plans will soon be required to offer a range of recommended preventive health services to patients free of charge under the Affordable Care Act.

The requirements will affect new private health plans in the individual and group markets starting with plan years that begin on or after Sept. 23. The Health and Human Services department estimates that in 2011, the rules will impact about 30 million people in group health plans and another 10 million in individual market plans. The rules do not apply to grandfathered plans.

The administration released an interim final regulation detailing the new requirements on July 14.

Under the final rule, health plans may not collect copayments, coinsurance, or deductibles for a number of recommended preventive services. However, they may collect fees for the associated office visit if the preventive service wasn't the primary purpose of the visit. Patients may also incur cost sharing if they go out of network for the recommended screenings.

The covered services include those given an evidence rating of “A” or “B” from the U.S. Preventive Services Task Force. Those services include breast and colon cancer screenings, diabetes screenings, blood pressure and cholesterol testing, and screening for vitamin deficiencies during pregnancy. Tobacco cessation counseling is also given a high evidence rating by the U.S. Preventive Services Task Force and would be covered under the new rule.

Health plans will have some extra time to begin covering newly recommended services. For recommendations that have been in effect for less than a year, plans will have 1 year to comply after the effective date, according to the interim final rule.

Health plans will also be required to cover the list of adult and childhood vaccines recommended by the Advisory Committee on Immunization Practices.

The rule also calls for coverage of additional preventive services for women, which will be developed by an independent group of experts. The recommendations from that group are expected by Aug. 1, 2011. There was no word from HHS on whether those recommendations are likely to include coverage for contraceptives, something many reproductive health advocates have been lobbying for in recent months.

HHS officials expect that the move to expand coverage and eliminate out-of-pocket costs for these services will decrease costs for many Americans, especially those at high risk for certain health conditions. At the same time, the change is expected to increase premiums for enrollees in non-grandfathered plans. The federal government estimates that premiums in the affected plans could increase about 1.5% on average.

A list of the recommended preventive services is available online at www.healthcare.gov/center/regulations/prevention/recommendations.html

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid programhcan earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contracts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

healthit.hhs.gov/extensionprogram

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid programhcan earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contracts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

healthit.hhs.gov/extensionprogram

In less than 6 months, doctors can begin to qualify for tens of thousands of dollars in incentive payments from the federal government for using electronic health record technology. Many physicians are asking: How do I get ready?

The first step, experts agree, is to prepare your practice. Implementing an electronic health record (EHR) effectively is only partially about the technology, said Mary Griskewicz, senior director for ambulatory information systems at Healthcare Information and Management Systems Society (HIMSS), a nonprofit organization.

Most of the work is about reengineering the practice, assessing and changing processes and workflows. “This is not a small task, in particular for small practices,” she said.

And before practices jump into an implementation, Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, suggests that they examine their motivation for using an EHR. He cautioned physicians not to do it just to take advantage of the new federal incentives.

Physicians who qualify as “meaningful users” of EHR technology through the Medicare program can receive up to $44,000 over 5 years, and those who qualify through the Medicaid programhcan earn about $64,000. But that may not cover the costs of a new system, Dr. Waldren said, so physicians should have other reasons for making the switch.

“They shouldn't be doing this for the $44,000,” Dr. Waldren said. “They should be doing it because they believe it's the right thing to do for them, their practice, and their patients. Without that, you don't have the commitment to make it actually happen.”

Once a practice has decided to purchase an EHR and laid the groundwork with the staff, there are still a number of challenges. For example, under the HITECH Act, which established the EHR incentive program, physicians can qualify only if they are meaningful users of certified EHR technology. While the government has released regulations defining meaningful use requirements, as well as requirements for certification, there are currently no certified products on the market. The first products are expected to gain certification sometime this fall, according to the Office of the National Coordinator for Health Information Technology, which is shepherding this effort.

But the current lack of certified products shouldn't keep physicians from shopping for a system now, experts said. One way to deal with it is to build a guarantee of certification into the contract with the vendor. Physicians just need to be sure to get any assurances in writing, said Dr. Waldren. And they need to be clear on the terms of the guarantee. For example, will the guarantee allow you to get your money back if the vendor fails to become certified or does it allow you to withhold payments until the vendor becomes certified?

Physicians also should look to include service level agreements in their contracts with vendors, Dr. Waldren said. This ensures that the practice will get specific levels of support within certain time frames. If the company fails to deliver on the promised level of service, the practice may be able to make reduced payments or hold payments until that service level is met. These agreements could become important, Dr. Waldren said, since vendors are likely to be very busy as more practices adopt EHRs over the next few years.

When choosing an EHR product, there are several factors to consider, Ms. Griskewicz said, such as whether the software will fit in with the workflow of the practice and whether it is usable by everyone in the office.

One way to answer some of those questions is to talk to clinicians at other practices who have already implemented the product. It's best to try to find practices that are similar to your own, Ms. Griskewicz said. And ask about integration issues such as how the system will work with existing billing software or how it can help the practice to handle future regulatory changes such as the switch from ICD-9 to ICD-10, she said.

Physicians should consider future meaningful use requirements when choosing a product, Dr. Waldren advised. Right now, physicians have to meet stage 1 criteria for meaningful use, but the requirements will get more difficult in stages 2 and 3 and require different functionality from the EHR technology, he said.

For now, physicians may be able to meet many of the early requirements through the implementation of e-prescribing and registry programs. Since the law does not require that physicians implement a full EHR system to qualify for incentive payments, physicians who are buying an EHR product for the first time may want to consider purchasing individual EHR modules, Dr. Waldren said.

The modules are significantly less expensive than traditional full systems. However, physicians who are considering a modular approach need to find out how the vendor would support stages 2 and 3 of meaningful use. And they would need a plan for how to move their data if they decided to switch to a different system later, he said.

For those practices that have already implemented an EHR system, the work is not over. They now have to ensure that they can meet the meaningful use requirements and that their system will be certified under the new federal rules. Many vendors will be offering upgrades to meet the certification requirements at varying costs.

If you're satisfied with your current system, it makes sense to stay with that vendor even if certification requirements can't be met right away, Dr. Waldren said. Although physicians can begin to qualify for meaningful use on Jan. 1, 2011, they can start submitting information to the government as late as October 2012 and still be eligible for the full incentive payments under Medicare.

Physicians who are not satisfied with their current system and who want to switch to a new product should consider that it may take some time to migrate the data from one product to another, Dr. Waldren added. Since vendors will be focused on trying to add as many new users as possible, getting the support and service for data migration may be challenging, he said.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She recommends that physicians seek out trusted sources such as the Centers for Medicare and Medicaid Services and their medical professional societies, many of which are offering free Webinars and other online information. “The big thing right now is that they educate themselves as to what are the requirements” and what they need to do and what is the best fit for their practice, she said.

Don't Wait, but Don't Rush

Dr. David Blumenthal, the national coordinator for health information technology, has been making the rounds, getting the word out to physicians about the new meaningful use requirements and how to qualify for incentive payments for using EHRs.

During recent Webinars offered by professional medical societies, Dr. Blumenthal told physicians that they should get started on EHR implementation, but that they don't have to rush to be using the system by Jan. 1, when the new incentive program begins. At that point, physicians can begin to apply to the Centers for Medicare and Medicaid Services to become meaningful users.

Those who qualify could begin receiving incentive payments as early as May 2011, according to Dr. Blumenthal. However, under the Medicare program, physicians can take advantage of the full amount of incentive payments, just at a later date, as long as they can become meaningful users by Oct. 1, 2012.

“You have time to learn to be a meaningful user,” Dr. Blumenthal said during a Webinar sponsored by the Medical Group Management Association.

For physicians who need assistance selecting or implementing EHR technology, Dr. Blumenthal recommended that they contact their local regional extension centers. The Office of the National Coordinator for Health Information Technology has awarded grant money to set up 60 of these centers around the country. The centers are focused on assisting primary care physicians in small practices and in underserved areas, but no practices will be turned away, Dr. Blumenthal said. For more information about the regional extension program, go to

healthit.hhs.gov/extensionprogram

The National Committee for Quality Assurance has convened a task force to study the concept of accountable care organizations, and this fall it plans to release its recommendations for what qualifying criteria these organizations should meet.

The task force includes representatives from organizations that consider themselves to be ACOs or that are developing plans to launch one. The diverse group has been working on setting out specific criteria – from governance structures to the ability to manage financial risk – that will help ACOs to succeed in the coming years.

“The idea [of ACOs] is mom and apple pie, and it's terrific to talk about in its generalities,” said Tricia Barrett, vice president of product development at the National Committee for Quality Assurance (NCQA). “But as soon as you start talking about specifics, you realize that nobody's talking about the same thing.”

Over the past few months, task force members have delved into the details and found some common ground, she said, recognizing that there will be a variety of ways to run an ACO. For example, there is consensus within the task force that primary care and the principles of the patient-centered medical home need to be at the foundation of the ACO. The extent to which specialists and hospitals are part of the same legal entity, rather than contracted with primary care physicians, will depend on the dynamics in individual marketplaces, she said.

The task force is also making headway on the specific qualifying criteria that ACOs should meet to demonstrate that they are set up for success. For example, task force members generally agree that there should be rules around the composition of provider networks within ACOs. This would ensure that patients have a certain level of access to both primary care and specialist physicians.

Performance measurement will also be a critical way to evaluate ACOs, Ms. Barrett said.

The NCQA task force members are also focused on ensuring that there are consumer protections built into the ACO structure. Consumers need to be considered in the design and policies of an ACO so that they have a full understanding of what their obligations and rights are, Ms. Barrett said.

The National Committee for Quality Assurance has convened a task force to study the concept of accountable care organizations, and this fall it plans to release its recommendations for what qualifying criteria these organizations should meet.

The task force includes representatives from organizations that consider themselves to be ACOs or that are developing plans to launch one. The diverse group has been working on setting out specific criteria – from governance structures to the ability to manage financial risk – that will help ACOs to succeed in the coming years.

“The idea [of ACOs] is mom and apple pie, and it's terrific to talk about in its generalities,” said Tricia Barrett, vice president of product development at the National Committee for Quality Assurance (NCQA). “But as soon as you start talking about specifics, you realize that nobody's talking about the same thing.”

Over the past few months, task force members have delved into the details and found some common ground, she said, recognizing that there will be a variety of ways to run an ACO. For example, there is consensus within the task force that primary care and the principles of the patient-centered medical home need to be at the foundation of the ACO. The extent to which specialists and hospitals are part of the same legal entity, rather than contracted with primary care physicians, will depend on the dynamics in individual marketplaces, she said.

The task force is also making headway on the specific qualifying criteria that ACOs should meet to demonstrate that they are set up for success. For example, task force members generally agree that there should be rules around the composition of provider networks within ACOs. This would ensure that patients have a certain level of access to both primary care and specialist physicians.

Performance measurement will also be a critical way to evaluate ACOs, Ms. Barrett said.

The NCQA task force members are also focused on ensuring that there are consumer protections built into the ACO structure. Consumers need to be considered in the design and policies of an ACO so that they have a full understanding of what their obligations and rights are, Ms. Barrett said.

The National Committee for Quality Assurance has convened a task force to study the concept of accountable care organizations, and this fall it plans to release its recommendations for what qualifying criteria these organizations should meet.

The task force includes representatives from organizations that consider themselves to be ACOs or that are developing plans to launch one. The diverse group has been working on setting out specific criteria – from governance structures to the ability to manage financial risk – that will help ACOs to succeed in the coming years.

“The idea [of ACOs] is mom and apple pie, and it's terrific to talk about in its generalities,” said Tricia Barrett, vice president of product development at the National Committee for Quality Assurance (NCQA). “But as soon as you start talking about specifics, you realize that nobody's talking about the same thing.”

Over the past few months, task force members have delved into the details and found some common ground, she said, recognizing that there will be a variety of ways to run an ACO. For example, there is consensus within the task force that primary care and the principles of the patient-centered medical home need to be at the foundation of the ACO. The extent to which specialists and hospitals are part of the same legal entity, rather than contracted with primary care physicians, will depend on the dynamics in individual marketplaces, she said.

The task force is also making headway on the specific qualifying criteria that ACOs should meet to demonstrate that they are set up for success. For example, task force members generally agree that there should be rules around the composition of provider networks within ACOs. This would ensure that patients have a certain level of access to both primary care and specialist physicians.

Performance measurement will also be a critical way to evaluate ACOs, Ms. Barrett said.

The NCQA task force members are also focused on ensuring that there are consumer protections built into the ACO structure. Consumers need to be considered in the design and policies of an ACO so that they have a full understanding of what their obligations and rights are, Ms. Barrett said.

Most of Dr. Vineet Arora’s time is spent at the nexus of quality and graduate medical education.

When she’s not teaching residents, she’s researching the impact of their duty hours on sleep, or how they handle patient handoffs. And when she’s not studying residents, she’s inviting them to be part of her research team and advising them on the best ways to reach their career goals as hospitalists.

“That sort of keeps me going,” said Dr. Arora, assistant dean for scholarship and discovery at the University of Chicago.

Dr. Arora first became interested in research and quality improvement when she was a chief resident at the University of Chicago. In that role, she served on hospital quality committees and started looking at questions such as why weren’t blood tests always ordered in the right way. She got to thinking that these were the types of questions that researchers should be studying, but too often weren’t. And rather than working harder to fix things one at a time, she was interested in redesigning the system of care. “When I was a resident, I would always see systems problems and I’d want to fix them,” she said.

When her stint as a chief resident was up, Dr. Arora decided go back to school and get the tools she needed. Because traditional medical education didn’t prepare her to make and evaluate systems changes, she went back to get a masters in public policy. While getting that degree, she began studying the resident duty hour restrictions that went into effect in 2003, particularly one of the unintended consequences of that change: increased problems with patient handoffs.

Dr. Arora’s research on handoffs and resident sleep has been published in premier journals. With her own research career taking off, she tries to devote time to mentoring. Dr. Arora’s goal is to help her students carve out careers in hospital medicine that allow them to have time for patient care, research, and mentoring.

One piece of advice she always offers students and residents who are interested in research is to work in teams. Dr. Arora’s own research team includes other physicians, social scientists, health services researchers, and medical educators. And she includes students and residents on her team as well.

It’s a great opportunity for students and residents, but Dr. Arora says she benefits just as much. By working with a large and diverse team, she’s able to focus on broader research topics. And she knows that the research will continue even when she’s teaching, doing clinical work in the hospital, or taking a vacation. “By having a team approach, you’re able to get a lot more done,” she said.

Hospitalists who try to do research on their own, without a team and without dedicated research time, often find that they can’t get their projects off the ground, she said.

For young hospitalists and residents who are interested in research, Dr. Arora recommends two paths to distinguish themselves. The first is to consider a fellowship in hospital medicine. That training time is protected time to learn and begin a research project, she said.

The other pathway is to become a “good citizen” within the hospital. Consider taking a faculty development program in your area of interest, and volunteering to serve on committees that aren’t as popular within the hospital, such as recruitment. “Fill holes that are critically needed in your institution such that you’re indispensable,” Dr. Arora said.

Finally, Dr. Arora counsels her residents to stay focused. Dr. Arora admits that she sometimes tries to do too much, but it’s a luxury she can afford because she’s backed by a talented team of fellow researchers. For hospitalists who are just starting out, overextending themselves can be “deadly,” she said.

Her advice: Do one thing and do it well. If your interest is in clinical teaching, cultivate a focus on teaching in a specific area, such as physical exam skills. Then get further training in that area, she advised.

Reporting by Mary Ellen Schneider, Hospitalist News Digital Network 

Most of Dr. Vineet Arora’s time is spent at the nexus of quality and graduate medical education.

When she’s not teaching residents, she’s researching the impact of their duty hours on sleep, or how they handle patient handoffs. And when she’s not studying residents, she’s inviting them to be part of her research team and advising them on the best ways to reach their career goals as hospitalists.

“That sort of keeps me going,” said Dr. Arora, assistant dean for scholarship and discovery at the University of Chicago.

Dr. Arora first became interested in research and quality improvement when she was a chief resident at the University of Chicago. In that role, she served on hospital quality committees and started looking at questions such as why weren’t blood tests always ordered in the right way. She got to thinking that these were the types of questions that researchers should be studying, but too often weren’t. And rather than working harder to fix things one at a time, she was interested in redesigning the system of care. “When I was a resident, I would always see systems problems and I’d want to fix them,” she said.

When her stint as a chief resident was up, Dr. Arora decided go back to school and get the tools she needed. Because traditional medical education didn’t prepare her to make and evaluate systems changes, she went back to get a masters in public policy. While getting that degree, she began studying the resident duty hour restrictions that went into effect in 2003, particularly one of the unintended consequences of that change: increased problems with patient handoffs.

Dr. Arora’s research on handoffs and resident sleep has been published in premier journals. With her own research career taking off, she tries to devote time to mentoring. Dr. Arora’s goal is to help her students carve out careers in hospital medicine that allow them to have time for patient care, research, and mentoring.

One piece of advice she always offers students and residents who are interested in research is to work in teams. Dr. Arora’s own research team includes other physicians, social scientists, health services researchers, and medical educators. And she includes students and residents on her team as well.

It’s a great opportunity for students and residents, but Dr. Arora says she benefits just as much. By working with a large and diverse team, she’s able to focus on broader research topics. And she knows that the research will continue even when she’s teaching, doing clinical work in the hospital, or taking a vacation. “By having a team approach, you’re able to get a lot more done,” she said.

Hospitalists who try to do research on their own, without a team and without dedicated research time, often find that they can’t get their projects off the ground, she said.

For young hospitalists and residents who are interested in research, Dr. Arora recommends two paths to distinguish themselves. The first is to consider a fellowship in hospital medicine. That training time is protected time to learn and begin a research project, she said.

The other pathway is to become a “good citizen” within the hospital. Consider taking a faculty development program in your area of interest, and volunteering to serve on committees that aren’t as popular within the hospital, such as recruitment. “Fill holes that are critically needed in your institution such that you’re indispensable,” Dr. Arora said.

Finally, Dr. Arora counsels her residents to stay focused. Dr. Arora admits that she sometimes tries to do too much, but it’s a luxury she can afford because she’s backed by a talented team of fellow researchers. For hospitalists who are just starting out, overextending themselves can be “deadly,” she said.

Her advice: Do one thing and do it well. If your interest is in clinical teaching, cultivate a focus on teaching in a specific area, such as physical exam skills. Then get further training in that area, she advised.

Reporting by Mary Ellen Schneider, Hospitalist News Digital Network 

Most of Dr. Vineet Arora’s time is spent at the nexus of quality and graduate medical education.

When she’s not teaching residents, she’s researching the impact of their duty hours on sleep, or how they handle patient handoffs. And when she’s not studying residents, she’s inviting them to be part of her research team and advising them on the best ways to reach their career goals as hospitalists.

“That sort of keeps me going,” said Dr. Arora, assistant dean for scholarship and discovery at the University of Chicago.

Dr. Arora first became interested in research and quality improvement when she was a chief resident at the University of Chicago. In that role, she served on hospital quality committees and started looking at questions such as why weren’t blood tests always ordered in the right way. She got to thinking that these were the types of questions that researchers should be studying, but too often weren’t. And rather than working harder to fix things one at a time, she was interested in redesigning the system of care. “When I was a resident, I would always see systems problems and I’d want to fix them,” she said.

When her stint as a chief resident was up, Dr. Arora decided go back to school and get the tools she needed. Because traditional medical education didn’t prepare her to make and evaluate systems changes, she went back to get a masters in public policy. While getting that degree, she began studying the resident duty hour restrictions that went into effect in 2003, particularly one of the unintended consequences of that change: increased problems with patient handoffs.

Dr. Arora’s research on handoffs and resident sleep has been published in premier journals. With her own research career taking off, she tries to devote time to mentoring. Dr. Arora’s goal is to help her students carve out careers in hospital medicine that allow them to have time for patient care, research, and mentoring.

One piece of advice she always offers students and residents who are interested in research is to work in teams. Dr. Arora’s own research team includes other physicians, social scientists, health services researchers, and medical educators. And she includes students and residents on her team as well.

It’s a great opportunity for students and residents, but Dr. Arora says she benefits just as much. By working with a large and diverse team, she’s able to focus on broader research topics. And she knows that the research will continue even when she’s teaching, doing clinical work in the hospital, or taking a vacation. “By having a team approach, you’re able to get a lot more done,” she said.

Hospitalists who try to do research on their own, without a team and without dedicated research time, often find that they can’t get their projects off the ground, she said.

For young hospitalists and residents who are interested in research, Dr. Arora recommends two paths to distinguish themselves. The first is to consider a fellowship in hospital medicine. That training time is protected time to learn and begin a research project, she said.

The other pathway is to become a “good citizen” within the hospital. Consider taking a faculty development program in your area of interest, and volunteering to serve on committees that aren’t as popular within the hospital, such as recruitment. “Fill holes that are critically needed in your institution such that you’re indispensable,” Dr. Arora said.

Finally, Dr. Arora counsels her residents to stay focused. Dr. Arora admits that she sometimes tries to do too much, but it’s a luxury she can afford because she’s backed by a talented team of fellow researchers. For hospitalists who are just starting out, overextending themselves can be “deadly,” she said.

Her advice: Do one thing and do it well. If your interest is in clinical teaching, cultivate a focus on teaching in a specific area, such as physical exam skills. Then get further training in that area, she advised.

Reporting by Mary Ellen Schneider, Hospitalist News Digital Network 

NEW YORK — Surgery alone won't completely treat infertility in women with endometriosis, according to one infertility expert.

Instead, physicians need to consider all of their options. In women with significant endometriosis, the best course for improving pregnancy rates may be surgery plus some form of assisted reproductive technology (ART), Dr. Hugh S. Taylor, director of reproductive endocrinology and infertility at Yale University, New Haven, Conn., said at the meeting.

Prospective randomized trials examining surgical interventions in endometriosis do demonstrate improvements in pregnancy rates. In a study by the Canadian Collaborative Group on Endometriosis that included 341 infertile women with mild endometriosis who underwent either a diagnostic laparoscopy or resection or ablation of visible endometriosis, pregnancy rates nearly doubled with removal of endometriotic lesions. Diagnostic laparoscopy resulted in a subsequent pregnancy rate of about 17.7%, while the pregnancy rate was 30.7% in women whose lesions were removed. The pregnancy rates per month rose from about 2.4% in the control group to about 4.7% in the intervention group (N. Engl. J. Med. 1997;337:217-22).

Although the study showed an increase in pregnancy rates, those rates are still very low. Comparatively, without treatment, women with stage I or II endometriosis-associated infertility have a spontaneous monthly fecundity rate between 2% and 3%, Dr. Taylor said, and treatment with in vitro fertilization (IVF) can result in monthly pregnancy rates of 30%-50% in women with endometriosis.

One reason that surgery doesn't provide a meaningful boost in fertility is that surgeons often fail to identify endometriotic lesions and so don't perform a full resection. Adding to this problem, the staging system used for endometriosis isn't very accurate and doesn't correlate well with pain or infertility.

The biggest problem, however, in using surgery to correct fertility problems associated with endometriosis is that the disease creates epigenetic changes in the endometrium that may not be reversible, even if the endometriotic lesions are fully removed. “Once that DNA is modified, it stays that way,” Dr. Taylor said. “So we can be removing all of the endometriosis, and yet that change in the uterus won't revert simply by treating the endometriosis.”

In an effort to get a better handle on this phenomenon, Dr. Taylor has been studying the effect of the HOXA10 gene – which is required for an embryo to attach to the uterus – in mouse and primate models. In mouse models, when the gene is not expressed the uterus will not be receptive to embryos, even normal embryos. In humans, expression of the HOXA10 gene varies with the menstrual cycle. It increases at the time of implantation and is regulated by estrogen and progesterone. “It looks like it's playing an important role in that implantation process.” In women with endometriosis, the HOXA10 gene generally fails to increase, suggesting that there is an implantation defect in women with endometriosis. Dr. Taylor has shown that this failure is due to epigenetic reprogramming of the HOXA10 gene (Semin. Reprod. Med. 2010;28:69-74).

But there is some hopeful news for women with endometriosis who want to conceive, Dr. Taylor said. Researchers are looking at ways to use stem cells to replace the damaged cells. The idea is that placing new cells in the endometrium can restore fertility by making the endometrium more receptive to implantation.

Disclosures: Dr. Taylor said he had no conflicts of interest to disclose.

Endometriosis creates epigenetic changes in the endometrium that may not be reversible.

Source DR. TAYLOR

NEW YORK — Surgery alone won't completely treat infertility in women with endometriosis, according to one infertility expert.

Instead, physicians need to consider all of their options. In women with significant endometriosis, the best course for improving pregnancy rates may be surgery plus some form of assisted reproductive technology (ART), Dr. Hugh S. Taylor, director of reproductive endocrinology and infertility at Yale University, New Haven, Conn., said at the meeting.

Prospective randomized trials examining surgical interventions in endometriosis do demonstrate improvements in pregnancy rates. In a study by the Canadian Collaborative Group on Endometriosis that included 341 infertile women with mild endometriosis who underwent either a diagnostic laparoscopy or resection or ablation of visible endometriosis, pregnancy rates nearly doubled with removal of endometriotic lesions. Diagnostic laparoscopy resulted in a subsequent pregnancy rate of about 17.7%, while the pregnancy rate was 30.7% in women whose lesions were removed. The pregnancy rates per month rose from about 2.4% in the control group to about 4.7% in the intervention group (N. Engl. J. Med. 1997;337:217-22).

Although the study showed an increase in pregnancy rates, those rates are still very low. Comparatively, without treatment, women with stage I or II endometriosis-associated infertility have a spontaneous monthly fecundity rate between 2% and 3%, Dr. Taylor said, and treatment with in vitro fertilization (IVF) can result in monthly pregnancy rates of 30%-50% in women with endometriosis.

One reason that surgery doesn't provide a meaningful boost in fertility is that surgeons often fail to identify endometriotic lesions and so don't perform a full resection. Adding to this problem, the staging system used for endometriosis isn't very accurate and doesn't correlate well with pain or infertility.

The biggest problem, however, in using surgery to correct fertility problems associated with endometriosis is that the disease creates epigenetic changes in the endometrium that may not be reversible, even if the endometriotic lesions are fully removed. “Once that DNA is modified, it stays that way,” Dr. Taylor said. “So we can be removing all of the endometriosis, and yet that change in the uterus won't revert simply by treating the endometriosis.”

In an effort to get a better handle on this phenomenon, Dr. Taylor has been studying the effect of the HOXA10 gene – which is required for an embryo to attach to the uterus – in mouse and primate models. In mouse models, when the gene is not expressed the uterus will not be receptive to embryos, even normal embryos. In humans, expression of the HOXA10 gene varies with the menstrual cycle. It increases at the time of implantation and is regulated by estrogen and progesterone. “It looks like it's playing an important role in that implantation process.” In women with endometriosis, the HOXA10 gene generally fails to increase, suggesting that there is an implantation defect in women with endometriosis. Dr. Taylor has shown that this failure is due to epigenetic reprogramming of the HOXA10 gene (Semin. Reprod. Med. 2010;28:69-74).

But there is some hopeful news for women with endometriosis who want to conceive, Dr. Taylor said. Researchers are looking at ways to use stem cells to replace the damaged cells. The idea is that placing new cells in the endometrium can restore fertility by making the endometrium more receptive to implantation.

Disclosures: Dr. Taylor said he had no conflicts of interest to disclose.

Endometriosis creates epigenetic changes in the endometrium that may not be reversible.

Source DR. TAYLOR

NEW YORK — Surgery alone won't completely treat infertility in women with endometriosis, according to one infertility expert.

Instead, physicians need to consider all of their options. In women with significant endometriosis, the best course for improving pregnancy rates may be surgery plus some form of assisted reproductive technology (ART), Dr. Hugh S. Taylor, director of reproductive endocrinology and infertility at Yale University, New Haven, Conn., said at the meeting.

Prospective randomized trials examining surgical interventions in endometriosis do demonstrate improvements in pregnancy rates. In a study by the Canadian Collaborative Group on Endometriosis that included 341 infertile women with mild endometriosis who underwent either a diagnostic laparoscopy or resection or ablation of visible endometriosis, pregnancy rates nearly doubled with removal of endometriotic lesions. Diagnostic laparoscopy resulted in a subsequent pregnancy rate of about 17.7%, while the pregnancy rate was 30.7% in women whose lesions were removed. The pregnancy rates per month rose from about 2.4% in the control group to about 4.7% in the intervention group (N. Engl. J. Med. 1997;337:217-22).

Although the study showed an increase in pregnancy rates, those rates are still very low. Comparatively, without treatment, women with stage I or II endometriosis-associated infertility have a spontaneous monthly fecundity rate between 2% and 3%, Dr. Taylor said, and treatment with in vitro fertilization (IVF) can result in monthly pregnancy rates of 30%-50% in women with endometriosis.

One reason that surgery doesn't provide a meaningful boost in fertility is that surgeons often fail to identify endometriotic lesions and so don't perform a full resection. Adding to this problem, the staging system used for endometriosis isn't very accurate and doesn't correlate well with pain or infertility.

The biggest problem, however, in using surgery to correct fertility problems associated with endometriosis is that the disease creates epigenetic changes in the endometrium that may not be reversible, even if the endometriotic lesions are fully removed. “Once that DNA is modified, it stays that way,” Dr. Taylor said. “So we can be removing all of the endometriosis, and yet that change in the uterus won't revert simply by treating the endometriosis.”

In an effort to get a better handle on this phenomenon, Dr. Taylor has been studying the effect of the HOXA10 gene – which is required for an embryo to attach to the uterus – in mouse and primate models. In mouse models, when the gene is not expressed the uterus will not be receptive to embryos, even normal embryos. In humans, expression of the HOXA10 gene varies with the menstrual cycle. It increases at the time of implantation and is regulated by estrogen and progesterone. “It looks like it's playing an important role in that implantation process.” In women with endometriosis, the HOXA10 gene generally fails to increase, suggesting that there is an implantation defect in women with endometriosis. Dr. Taylor has shown that this failure is due to epigenetic reprogramming of the HOXA10 gene (Semin. Reprod. Med. 2010;28:69-74).

But there is some hopeful news for women with endometriosis who want to conceive, Dr. Taylor said. Researchers are looking at ways to use stem cells to replace the damaged cells. The idea is that placing new cells in the endometrium can restore fertility by making the endometrium more receptive to implantation.

Disclosures: Dr. Taylor said he had no conflicts of interest to disclose.

Endometriosis creates epigenetic changes in the endometrium that may not be reversible.

Source DR. TAYLOR

Some researchers studying human embryonic stem cells are surprised, disappointed, and even angry over the legal back-and-forth over the federal government policy on funding research using the cells.

On Aug. 23, a federal judge issued a ruling that barred the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health stopped accepting submissions of information on human embryonic stem cell lines for NIH review and suspended all review of embryonic stem cell lines. On Aug. 31, the Justice Department asked for a stay of the lower court's injunction, which was granted on a very short basis on Sept. 9. The Sept. 9 temporary administrative stay granted by the U.S. Court of Appeals for the District of Columbia Circuit called on both parties to the suit to present information to the court by Sept. 20.

Last year, President Obama greatly expanded opportunities for embryonic stem cell research when he issued an executive order that eliminated many of the restrictions placed on funding during the George W. Bush administration. The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the judicial ping-ponging, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The Coalition for the Advancement of Medical Research, which advocates for stem cell funding, called the original injunction a “blow to the hopes of millions of patients and their families suffering from fatal and chronic diseases and disorders.”

The halt on funding for embryonic stem cell research has implications for all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds.

“The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue their work. However, even those with deep pockets are concerned that private funding alone is not enough.

“It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute. “It's a blow to the field.” The institute, a collaborative of stem cell researchers from around Massachusetts, has raised $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another concern involves legal issues. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. The Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth did not find the argument persuasive. “[Embryonic stem cell] research is clearly research in which an embryo is destroyed,” he wrote in the order. “Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

Some researchers studying human embryonic stem cells are surprised, disappointed, and even angry over the legal back-and-forth over the federal government policy on funding research using the cells.

On Aug. 23, a federal judge issued a ruling that barred the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health stopped accepting submissions of information on human embryonic stem cell lines for NIH review and suspended all review of embryonic stem cell lines. On Aug. 31, the Justice Department asked for a stay of the lower court's injunction, which was granted on a very short basis on Sept. 9. The Sept. 9 temporary administrative stay granted by the U.S. Court of Appeals for the District of Columbia Circuit called on both parties to the suit to present information to the court by Sept. 20.

Last year, President Obama greatly expanded opportunities for embryonic stem cell research when he issued an executive order that eliminated many of the restrictions placed on funding during the George W. Bush administration. The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the judicial ping-ponging, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The Coalition for the Advancement of Medical Research, which advocates for stem cell funding, called the original injunction a “blow to the hopes of millions of patients and their families suffering from fatal and chronic diseases and disorders.”

The halt on funding for embryonic stem cell research has implications for all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds.

“The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue their work. However, even those with deep pockets are concerned that private funding alone is not enough.

“It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute. “It's a blow to the field.” The institute, a collaborative of stem cell researchers from around Massachusetts, has raised $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another concern involves legal issues. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. The Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth did not find the argument persuasive. “[Embryonic stem cell] research is clearly research in which an embryo is destroyed,” he wrote in the order. “Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

Some researchers studying human embryonic stem cells are surprised, disappointed, and even angry over the legal back-and-forth over the federal government policy on funding research using the cells.

On Aug. 23, a federal judge issued a ruling that barred the use of federal funds for any research involving human embryonic stem cells. As a result of the temporary injunction, the National Institutes of Health stopped accepting submissions of information on human embryonic stem cell lines for NIH review and suspended all review of embryonic stem cell lines. On Aug. 31, the Justice Department asked for a stay of the lower court's injunction, which was granted on a very short basis on Sept. 9. The Sept. 9 temporary administrative stay granted by the U.S. Court of Appeals for the District of Columbia Circuit called on both parties to the suit to present information to the court by Sept. 20.

Last year, President Obama greatly expanded opportunities for embryonic stem cell research when he issued an executive order that eliminated many of the restrictions placed on funding during the George W. Bush administration. The NIH followed with guidelines that allowed research to be conducted on embryonic stem cells derived from embryos created through in vitro fertilization and donated for research.

With the judicial ping-ponging, some researchers worry that the development of therapies that use embryonic stem cells will be set back and that the loss of federal funding will have a chilling effect on newly minted researchers who are considering whether to enter the field.

The Coalition for the Advancement of Medical Research, which advocates for stem cell funding, called the original injunction a “blow to the hopes of millions of patients and their families suffering from fatal and chronic diseases and disorders.”

The halt on funding for embryonic stem cell research has implications for all types of stem cell research, said Alan Trounson, Ph.D., president of the California Institute for Regenerative Medicine, which issues grants to researchers in California who use state funds.

“The decision is a deplorable brake on all stem cell research,” he said in a statement. “Many discoveries with other cell types, notably the so-called reprogrammed [induced pluripotent stem] cells, would not happen without ongoing research in human embryonic stem cells.”

Dr. Trounson said the California institute's funding plans would not be affected by the federal court decision. Institutions that have obtained private funding for their stem cell work will also be able to continue their work. However, even those with deep pockets are concerned that private funding alone is not enough.

“It's a blow to us,” said B.D. Colen, a spokesman for the Harvard Stem Cell Institute. “It's a blow to the field.” The institute, a collaborative of stem cell researchers from around Massachusetts, has raised $120 million in private funds since its founding 2004, but those sources are not unlimited, Mr. Colen said. The loss of federal funding that was expected to go to the institute's researchers will be disruptive, he said, and the impact will be worse for those researchers who do not have private funding sources to fall back on.

Another concern involves legal issues. An earlier lawsuit challenging the Obama stem cell guidelines had been dismissed after the court ruled that the plaintiffs had no standing to challenge it. However, the recent injunction came about after the court decided that two researchers who work with adult stem cells could challenge the guidelines because funding of embryonic stem cell research was harming their chances for receiving federal funds for adult stem cells.

“This judge opens the door for every scientist who ever has a grant request rejected on the merits to sue the federal government,” the American Society for Reproductive Medicine said in a statement condemning the court decision.

In granting the temporary injunction, Judge Royce C. Lamberth, chief judge in the U.S. District Court for the District of Columbia, said the NIH guidelines violated the intent of Congress to bar the use of federal funds for research in which human embryos are destroyed. He said the rules violated the Dickey-Wicker amendment, a rider generally attached to health spending bills each year. It prohibits the use of federal funds for the creation of a human embryo or embryos for research purposes or research in which a human embryo or embryos are destroyed or discarded. The Obama administration has argued that the amendment doesn't apply because federal funds are used for research on the embryonic stem cell lines, not in the destruction of the embryos.

Judge Lamberth did not find the argument persuasive. “[Embryonic stem cell] research is clearly research in which an embryo is destroyed,” he wrote in the order. “Despite defendants' attempt to separate the derivation of [embryonic stem cells] from research on the [embryonic stem cells], the two cannot be separated.”

One new concept to come out of the health reform debate is the Accountable Care Organization (ACO). The concept builds off the idea of the patient-centered medical home and calls for primary care physicians, specialists, and hospitals to band together to provide high-quality care for patients. Under the ACO concept, payments would be linked to quality, and ACO providers would have the opportunity to share in any savings realized through better, more cost-effective care. Under the Affordable Care Act, Medicare will launch a shared savings program in 2012 to test the concept.

Dr. Lori Heim, president of the American Academy of Family Physicians, explains how these ACOs might work and what might drive their popularity.

PEDIATRIC NEWS: The AAFP has spent a lot of time promoting the concept of the patient-centered medical home and the medical home neighborhood. Is an ACO the next logical step?

Dr. Heim: The ACO builds on the foundation of a medical home based in primary care. Both have the same goals for the patient: coordinated care that ensures a seamless transition from one service to another and one level of care to another.

The core of an ACO is effective primary care with a focus on prevention, early diagnosis, chronic disease management, and other services delivered through primary care practices. We believe that in order to be successful, ACOs will require a robust network of practices founded in primary care. They may involve other primary care practices, subspecialists, and in some cases hospitals. Envision the ACO as an expanding circle of health professionals with the patient and the patient's medical home in the center.

The ACO concept requires that medical-home practices commit to performance improvement and publicly reported performance results. ACOs are a formalization of the medical home neighborhood, which is essential for a medical home to realize its full potential. Thus, an ACO may be the next logical step for physicians whose practices offer a mix of services; however, isolated rural practices will have more barriers to overcome to become members of an ACO.

PEDIATRIC NEWS: What are the advantages and disadvantages of an ACO?

Dr. Heim: ACOs will improve information flow and communication. They will offer payment incentives designed to produce high-quality, patient-centered, efficient care. The problem areas are in aligning the financial incentives in a way that provides the best value to the patient.

Cost savings to support an ACO will come largely from reductions in three areas: inappropriate hospital admissions and readmissions, diagnostic testing and imaging, and subspecialist expenses.

One of the greatest challenges to implementing an ACO is managing the conflicts associated with the internal distribution of funds. So, while we're likely to see improved referral patterns and communication that will provide seamless, high-quality health care, we also are likely to see tension as health communities move away from competition and toward cooperation and collaboration.

PEDIATRIC NEWS: In the future, will all physicians be part of an ACO?

Dr. Heim: Because this concept is so new, it's hard to say. Decisions on organizing the delivery system will be local. We're going to see considerable experimentation with different structural models, different financing models, and different approaches to sharing payment or system savings among all providers. The medical home is important because its performance can be quantified and compensated relative to the value it brings to the entire system.

The movement will likely begin in large and well-organized independent practice associations (IPAs), multispecialty groups, and integrated delivery systems. For efficiencies of scale, other physicians will first need to organize into groups that can assume performance risk (for quality and efficiency, not insurance risk) and contract with specialists, hospitals, and other providers to build out the ACO model that will be attractive to employers and insurers.

PEDIATRIC NEWS: What do physicians need to do now if they want to experiment with the ACO idea?

Dr. Heim: The first step is to become a high-performing practice by implementing medical procedures, protocols, and services, as well as quality improvement systems. The second step is to think about how physicians' practices fit into a larger health care community to provide comprehensive, integrated care. Physicians need to know their options for organizing into groups to create or become a part of an ACO. They need to understand their options for, and the implications of, contracting with or being employed by hospitals.

Hospitals are strategically buying primary care and subspecialty practices in markets where ACOs are mostly likely to form in order to maintain a flexible posture for the future. It is important for us to examine future contracts in light of potential shared savings for ACO and other payment models, whether we remain in private practice and negotiate contracts, or consider becoming salaried physicians.

One new concept to come out of the health reform debate is the Accountable Care Organization (ACO). The concept builds off the idea of the patient-centered medical home and calls for primary care physicians, specialists, and hospitals to band together to provide high-quality care for patients. Under the ACO concept, payments would be linked to quality, and ACO providers would have the opportunity to share in any savings realized through better, more cost-effective care. Under the Affordable Care Act, Medicare will launch a shared savings program in 2012 to test the concept.

Dr. Lori Heim, president of the American Academy of Family Physicians, explains how these ACOs might work and what might drive their popularity.

PEDIATRIC NEWS: The AAFP has spent a lot of time promoting the concept of the patient-centered medical home and the medical home neighborhood. Is an ACO the next logical step?

Dr. Heim: The ACO builds on the foundation of a medical home based in primary care. Both have the same goals for the patient: coordinated care that ensures a seamless transition from one service to another and one level of care to another.

The core of an ACO is effective primary care with a focus on prevention, early diagnosis, chronic disease management, and other services delivered through primary care practices. We believe that in order to be successful, ACOs will require a robust network of practices founded in primary care. They may involve other primary care practices, subspecialists, and in some cases hospitals. Envision the ACO as an expanding circle of health professionals with the patient and the patient's medical home in the center.

The ACO concept requires that medical-home practices commit to performance improvement and publicly reported performance results. ACOs are a formalization of the medical home neighborhood, which is essential for a medical home to realize its full potential. Thus, an ACO may be the next logical step for physicians whose practices offer a mix of services; however, isolated rural practices will have more barriers to overcome to become members of an ACO.

PEDIATRIC NEWS: What are the advantages and disadvantages of an ACO?

Dr. Heim: ACOs will improve information flow and communication. They will offer payment incentives designed to produce high-quality, patient-centered, efficient care. The problem areas are in aligning the financial incentives in a way that provides the best value to the patient.

Cost savings to support an ACO will come largely from reductions in three areas: inappropriate hospital admissions and readmissions, diagnostic testing and imaging, and subspecialist expenses.

One of the greatest challenges to implementing an ACO is managing the conflicts associated with the internal distribution of funds. So, while we're likely to see improved referral patterns and communication that will provide seamless, high-quality health care, we also are likely to see tension as health communities move away from competition and toward cooperation and collaboration.

PEDIATRIC NEWS: In the future, will all physicians be part of an ACO?

Dr. Heim: Because this concept is so new, it's hard to say. Decisions on organizing the delivery system will be local. We're going to see considerable experimentation with different structural models, different financing models, and different approaches to sharing payment or system savings among all providers. The medical home is important because its performance can be quantified and compensated relative to the value it brings to the entire system.

The movement will likely begin in large and well-organized independent practice associations (IPAs), multispecialty groups, and integrated delivery systems. For efficiencies of scale, other physicians will first need to organize into groups that can assume performance risk (for quality and efficiency, not insurance risk) and contract with specialists, hospitals, and other providers to build out the ACO model that will be attractive to employers and insurers.

PEDIATRIC NEWS: What do physicians need to do now if they want to experiment with the ACO idea?

Dr. Heim: The first step is to become a high-performing practice by implementing medical procedures, protocols, and services, as well as quality improvement systems. The second step is to think about how physicians' practices fit into a larger health care community to provide comprehensive, integrated care. Physicians need to know their options for organizing into groups to create or become a part of an ACO. They need to understand their options for, and the implications of, contracting with or being employed by hospitals.

Hospitals are strategically buying primary care and subspecialty practices in markets where ACOs are mostly likely to form in order to maintain a flexible posture for the future. It is important for us to examine future contracts in light of potential shared savings for ACO and other payment models, whether we remain in private practice and negotiate contracts, or consider becoming salaried physicians.

One new concept to come out of the health reform debate is the Accountable Care Organization (ACO). The concept builds off the idea of the patient-centered medical home and calls for primary care physicians, specialists, and hospitals to band together to provide high-quality care for patients. Under the ACO concept, payments would be linked to quality, and ACO providers would have the opportunity to share in any savings realized through better, more cost-effective care. Under the Affordable Care Act, Medicare will launch a shared savings program in 2012 to test the concept.

Dr. Lori Heim, president of the American Academy of Family Physicians, explains how these ACOs might work and what might drive their popularity.

PEDIATRIC NEWS: The AAFP has spent a lot of time promoting the concept of the patient-centered medical home and the medical home neighborhood. Is an ACO the next logical step?

Dr. Heim: The ACO builds on the foundation of a medical home based in primary care. Both have the same goals for the patient: coordinated care that ensures a seamless transition from one service to another and one level of care to another.

The core of an ACO is effective primary care with a focus on prevention, early diagnosis, chronic disease management, and other services delivered through primary care practices. We believe that in order to be successful, ACOs will require a robust network of practices founded in primary care. They may involve other primary care practices, subspecialists, and in some cases hospitals. Envision the ACO as an expanding circle of health professionals with the patient and the patient's medical home in the center.

The ACO concept requires that medical-home practices commit to performance improvement and publicly reported performance results. ACOs are a formalization of the medical home neighborhood, which is essential for a medical home to realize its full potential. Thus, an ACO may be the next logical step for physicians whose practices offer a mix of services; however, isolated rural practices will have more barriers to overcome to become members of an ACO.

PEDIATRIC NEWS: What are the advantages and disadvantages of an ACO?

Dr. Heim: ACOs will improve information flow and communication. They will offer payment incentives designed to produce high-quality, patient-centered, efficient care. The problem areas are in aligning the financial incentives in a way that provides the best value to the patient.

Cost savings to support an ACO will come largely from reductions in three areas: inappropriate hospital admissions and readmissions, diagnostic testing and imaging, and subspecialist expenses.

One of the greatest challenges to implementing an ACO is managing the conflicts associated with the internal distribution of funds. So, while we're likely to see improved referral patterns and communication that will provide seamless, high-quality health care, we also are likely to see tension as health communities move away from competition and toward cooperation and collaboration.

PEDIATRIC NEWS: In the future, will all physicians be part of an ACO?

Dr. Heim: Because this concept is so new, it's hard to say. Decisions on organizing the delivery system will be local. We're going to see considerable experimentation with different structural models, different financing models, and different approaches to sharing payment or system savings among all providers. The medical home is important because its performance can be quantified and compensated relative to the value it brings to the entire system.

The movement will likely begin in large and well-organized independent practice associations (IPAs), multispecialty groups, and integrated delivery systems. For efficiencies of scale, other physicians will first need to organize into groups that can assume performance risk (for quality and efficiency, not insurance risk) and contract with specialists, hospitals, and other providers to build out the ACO model that will be attractive to employers and insurers.

PEDIATRIC NEWS: What do physicians need to do now if they want to experiment with the ACO idea?

Dr. Heim: The first step is to become a high-performing practice by implementing medical procedures, protocols, and services, as well as quality improvement systems. The second step is to think about how physicians' practices fit into a larger health care community to provide comprehensive, integrated care. Physicians need to know their options for organizing into groups to create or become a part of an ACO. They need to understand their options for, and the implications of, contracting with or being employed by hospitals.

Hospitals are strategically buying primary care and subspecialty practices in markets where ACOs are mostly likely to form in order to maintain a flexible posture for the future. It is important for us to examine future contracts in light of potential shared savings for ACO and other payment models, whether we remain in private practice and negotiate contracts, or consider becoming salaried physicians.