Mary Ellen Schneider

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of 2011.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of 2011.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse, says a report from the Centers for Medicare and Medicaid Services. The changes are expected to save $7.8 billion for the Medicare program by the end of 2011.

Health and Human Services Secretary Kathleen Sebelius said at a press conference that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. CMS also expects the establishment of the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending.

Ms. Sebelius said she expects private insurers to implement some of these payment changes as they prove effective in the Medicare program.

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal. The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process.

The new federal appeals regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal. The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process.

The new federal appeals regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

New federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules will allow consumers in new health plans to appeal decisions both through their insurer's internal process and to an outside, independent entity. While most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, according to the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans and another 10 million people in new individual market plans who will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal. The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process.

The new federal appeals regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

Lawsuits Plague Ob.Gyns.

Nearly 70% of obstetricians and gynecologists have been sued during their careers, according to a survey by the American Medical Association. Ob.gyns. share the top of the most-sued-specialties list with general surgeons. About half of ob.gyns and general surgeons have been sued at least twice in their careers. Within the past 12 months, 9.5% of ob.gyns. have faced lawsuits. The AMA compiled the report from data in its 2007-2008 Physician Practice Information survey. “The findings in this report validate the need for national and state medical liability reform to rein in our out-of-control system where lawsuits are a matter of when, not if, for physicians,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

Med Students Want More Sex Ed

More than half of medical students completing an Internet survey said they had not received enough training on sexual issues to address their patients' sexual concerns clinically, a study in the journal Academic Medicine found. Despite this, four of five of the students said they felt comfortable dealing with their patients' sexuality issues. Students reporting limited sexual experience, being at risk for sexual problems, and feeling that they had not been trained adequately admitted more unease talking about sexual issues than other medical students did. The survey of U.S. and Canadian medical students included 1,343 women and 910 men.

Breast Information Mandated

Breast cancer patients in New York will soon be getting more information about their reconstruction options, thanks to a new law. Starting Jan. 1, 2011, hospitals throughout the state will be required to inform the women about the availability and insurance coverage of reconstructive surgery before they undergo a mastectomy, lymph node dissection, or lumpectomy. Since 1998, federal law has guaranteed universal coverage for reconstruction, but many women aren't aware of it or don't know where to get the procedure, according to Dr. Evan Garfein, a plastic and reconstructive surgeon in New York who pushed for the state's new law. Women who are poor, less educated, and in minority groups are disproportionately affected, he said in a statement. “Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women,” Dr. Garfein said.

Panel to Shape Cancer Research

Late this month, a federal advisory panel will begin work on a research agenda to clarify environmental and genetic factors in breast cancer. The new Interagency Breast Cancer and Environmental Research Coordinating Committee will hold its first meeting on Sept. 30 and will begin to review all breast cancer research that is conducted or supported by federal agencies. The committee is to recommend ways to improve and expand research opportunities. The 19-member panel includes representatives of federal agencies, physicians, other health professionals, scientists, and patient advocates. “The broad range of expertise and insight of these individuals will ensure the federal research portfolio continues to advance our understanding of the critical links between our environment, our genes, and our health,” Linda Birnbaum, Ph.D., director of the National Institute of Environmental Health Sciences and the National Toxicology Program, said in a statement.

$42 Million for HIV Prevention

The Centers for Disease Control and Prevention has awarded $42 million to 133 community-based organizations to fight HIV among at-risk populations, which include blacks, Hispanics, gay and bisexual men, and illicit-drug injectors. The organizations will receive an average $323,000 per year for 5 years to implement HIV-prevention programs, increase HIV testing, and promote knowledge of HIV status among individuals. The organizations will use small amounts of each grant to measure their effectiveness. According to the CDC, a local organization has community knowledge and perspective that enable it to reach people who might not otherwise get tested for HIV or access preventive services.

Part D Premiums Edge Up

Medicare beneficiaries can expect their monthly Part D prescription drug premiums to rise next year, but only by about $1, according to the Centers for Medicare and Medicaid Services. Officials at the agency estimated that the average monthly premium for standard Part D drug coverage will be $30, about $1 more than in 2010. By shopping around, beneficiaries may be able to find plans with lower premiums than they are paying now, CMS Administrator Donald Berwick said during a press conference to announce the new rates. He and other officials said premium rates will remain relatively steady in 2011 because minor cost increases for the Part D plans have been offset by increased use of generic drugs. Also starting in 2011, Medicare beneficiaries will be eligible for 50% discounts of if they spend enough on brand name prescriptions to reach the Part D coverage gap, or “doughnut hole.”

Lawsuits Plague Ob.Gyns.

Nearly 70% of obstetricians and gynecologists have been sued during their careers, according to a survey by the American Medical Association. Ob.gyns. share the top of the most-sued-specialties list with general surgeons. About half of ob.gyns and general surgeons have been sued at least twice in their careers. Within the past 12 months, 9.5% of ob.gyns. have faced lawsuits. The AMA compiled the report from data in its 2007-2008 Physician Practice Information survey. “The findings in this report validate the need for national and state medical liability reform to rein in our out-of-control system where lawsuits are a matter of when, not if, for physicians,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

Med Students Want More Sex Ed

More than half of medical students completing an Internet survey said they had not received enough training on sexual issues to address their patients' sexual concerns clinically, a study in the journal Academic Medicine found. Despite this, four of five of the students said they felt comfortable dealing with their patients' sexuality issues. Students reporting limited sexual experience, being at risk for sexual problems, and feeling that they had not been trained adequately admitted more unease talking about sexual issues than other medical students did. The survey of U.S. and Canadian medical students included 1,343 women and 910 men.

Breast Information Mandated

Breast cancer patients in New York will soon be getting more information about their reconstruction options, thanks to a new law. Starting Jan. 1, 2011, hospitals throughout the state will be required to inform the women about the availability and insurance coverage of reconstructive surgery before they undergo a mastectomy, lymph node dissection, or lumpectomy. Since 1998, federal law has guaranteed universal coverage for reconstruction, but many women aren't aware of it or don't know where to get the procedure, according to Dr. Evan Garfein, a plastic and reconstructive surgeon in New York who pushed for the state's new law. Women who are poor, less educated, and in minority groups are disproportionately affected, he said in a statement. “Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women,” Dr. Garfein said.

Panel to Shape Cancer Research

Late this month, a federal advisory panel will begin work on a research agenda to clarify environmental and genetic factors in breast cancer. The new Interagency Breast Cancer and Environmental Research Coordinating Committee will hold its first meeting on Sept. 30 and will begin to review all breast cancer research that is conducted or supported by federal agencies. The committee is to recommend ways to improve and expand research opportunities. The 19-member panel includes representatives of federal agencies, physicians, other health professionals, scientists, and patient advocates. “The broad range of expertise and insight of these individuals will ensure the federal research portfolio continues to advance our understanding of the critical links between our environment, our genes, and our health,” Linda Birnbaum, Ph.D., director of the National Institute of Environmental Health Sciences and the National Toxicology Program, said in a statement.

$42 Million for HIV Prevention

The Centers for Disease Control and Prevention has awarded $42 million to 133 community-based organizations to fight HIV among at-risk populations, which include blacks, Hispanics, gay and bisexual men, and illicit-drug injectors. The organizations will receive an average $323,000 per year for 5 years to implement HIV-prevention programs, increase HIV testing, and promote knowledge of HIV status among individuals. The organizations will use small amounts of each grant to measure their effectiveness. According to the CDC, a local organization has community knowledge and perspective that enable it to reach people who might not otherwise get tested for HIV or access preventive services.

Part D Premiums Edge Up

Medicare beneficiaries can expect their monthly Part D prescription drug premiums to rise next year, but only by about $1, according to the Centers for Medicare and Medicaid Services. Officials at the agency estimated that the average monthly premium for standard Part D drug coverage will be $30, about $1 more than in 2010. By shopping around, beneficiaries may be able to find plans with lower premiums than they are paying now, CMS Administrator Donald Berwick said during a press conference to announce the new rates. He and other officials said premium rates will remain relatively steady in 2011 because minor cost increases for the Part D plans have been offset by increased use of generic drugs. Also starting in 2011, Medicare beneficiaries will be eligible for 50% discounts of if they spend enough on brand name prescriptions to reach the Part D coverage gap, or “doughnut hole.”

Lawsuits Plague Ob.Gyns.

Nearly 70% of obstetricians and gynecologists have been sued during their careers, according to a survey by the American Medical Association. Ob.gyns. share the top of the most-sued-specialties list with general surgeons. About half of ob.gyns and general surgeons have been sued at least twice in their careers. Within the past 12 months, 9.5% of ob.gyns. have faced lawsuits. The AMA compiled the report from data in its 2007-2008 Physician Practice Information survey. “The findings in this report validate the need for national and state medical liability reform to rein in our out-of-control system where lawsuits are a matter of when, not if, for physicians,” Dr. J. James Rohack, AMA immediate past president, said in a statement.

Med Students Want More Sex Ed

More than half of medical students completing an Internet survey said they had not received enough training on sexual issues to address their patients' sexual concerns clinically, a study in the journal Academic Medicine found. Despite this, four of five of the students said they felt comfortable dealing with their patients' sexuality issues. Students reporting limited sexual experience, being at risk for sexual problems, and feeling that they had not been trained adequately admitted more unease talking about sexual issues than other medical students did. The survey of U.S. and Canadian medical students included 1,343 women and 910 men.

Breast Information Mandated

Breast cancer patients in New York will soon be getting more information about their reconstruction options, thanks to a new law. Starting Jan. 1, 2011, hospitals throughout the state will be required to inform the women about the availability and insurance coverage of reconstructive surgery before they undergo a mastectomy, lymph node dissection, or lumpectomy. Since 1998, federal law has guaranteed universal coverage for reconstruction, but many women aren't aware of it or don't know where to get the procedure, according to Dr. Evan Garfein, a plastic and reconstructive surgeon in New York who pushed for the state's new law. Women who are poor, less educated, and in minority groups are disproportionately affected, he said in a statement. “Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women,” Dr. Garfein said.

Panel to Shape Cancer Research

Late this month, a federal advisory panel will begin work on a research agenda to clarify environmental and genetic factors in breast cancer. The new Interagency Breast Cancer and Environmental Research Coordinating Committee will hold its first meeting on Sept. 30 and will begin to review all breast cancer research that is conducted or supported by federal agencies. The committee is to recommend ways to improve and expand research opportunities. The 19-member panel includes representatives of federal agencies, physicians, other health professionals, scientists, and patient advocates. “The broad range of expertise and insight of these individuals will ensure the federal research portfolio continues to advance our understanding of the critical links between our environment, our genes, and our health,” Linda Birnbaum, Ph.D., director of the National Institute of Environmental Health Sciences and the National Toxicology Program, said in a statement.

$42 Million for HIV Prevention

The Centers for Disease Control and Prevention has awarded $42 million to 133 community-based organizations to fight HIV among at-risk populations, which include blacks, Hispanics, gay and bisexual men, and illicit-drug injectors. The organizations will receive an average $323,000 per year for 5 years to implement HIV-prevention programs, increase HIV testing, and promote knowledge of HIV status among individuals. The organizations will use small amounts of each grant to measure their effectiveness. According to the CDC, a local organization has community knowledge and perspective that enable it to reach people who might not otherwise get tested for HIV or access preventive services.

Part D Premiums Edge Up

Medicare beneficiaries can expect their monthly Part D prescription drug premiums to rise next year, but only by about $1, according to the Centers for Medicare and Medicaid Services. Officials at the agency estimated that the average monthly premium for standard Part D drug coverage will be $30, about $1 more than in 2010. By shopping around, beneficiaries may be able to find plans with lower premiums than they are paying now, CMS Administrator Donald Berwick said during a press conference to announce the new rates. He and other officials said premium rates will remain relatively steady in 2011 because minor cost increases for the Part D plans have been offset by increased use of generic drugs. Also starting in 2011, Medicare beneficiaries will be eligible for 50% discounts of if they spend enough on brand name prescriptions to reach the Part D coverage gap, or “doughnut hole.”

The American College of Obstetricians and Gynecologists has endorsed federal recommendations to routinely vaccinate girls 11-12 years old against the human papillomavirus using either the quadrivalent or bivalent vaccines.

Echoing the advice of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, ACOG officials said the vaccine can be given to girls as young as 9 years old and that catch-up vaccination should be offered through age 26 years (Obstet. Gynecol. 2010;116:800-3).

Although ob.gyns. are unlikely to care for girls in the initial vaccination group, ACOG said that ob.gyns. should offer the vaccine to girls in the catch-up group and routinely document human papillomavirus (HPV) vaccine status in the patient's record.

Two HPV vaccines are currently licensed by the Food and Drug Administration for sale in the United States. Merck's Gardasil, which is offered as a three-dose course, is a quadrivalent vaccine that provides protection against cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and genital warts associated with HPV genotypes 6, 11, 16, and 18.

Last year, the FDA approved the bivalent HPV vaccine Cervarix. This new vaccine, marketed by GlaxoSmithKline, is also offered as a three-dose course and is thought to provide protection similar to that of Gardasil for infections caused by the HPV genotypes 16 and 18. About 70% of all cervical cancer cases are associated with HPV genotypes 16 and 18, and about 90% of genital warts are associated with the HPV genotypes 6 and 11, according to the CDC.

In the policy statement issued by ACOG's Committee on Adolescent Health Care, the organization urged girls to get vaccinated before they are sexually active.

“The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” Dr. Diane F. Merritt, chair of the committee, said in a statement.

“For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26,” she said.

Dr. Merritt said physicians should counsel patients that the HPV vaccine may be less effective if they have already been exposed to the virus.

ACOG does not recommend that girls and women be tested for HPV before they are vaccinated. Serologic assays to test for HPV DNA are unreliable and aren't currently commercially available, according to the organization.

“More importantly, it's unlikely that someone would have been exposed to all of the HPV strains that the vaccines protect against, so testing is somewhat pointless,” according to the obstetrician gynecologist.

But women should have routine cervical cytology screening, according to ACOG. The organization said cervical cancer screening is needed in all women aged 21 years and older, even if they received the HPV vaccine before becoming sexually active.

HPV vaccination is not recommended during pregnancy, but physicians do not need to routinely perform pregnancy testing before giving the vaccine, according to ACOG. Instead, ACOG officials advised physicians to remind their patients to use contraception while they are receiving the vaccine series.

If a woman becomes pregnant while receiving the vaccine, the series should be delayed until the end of the pregnancy. The vaccine is safe for breastfeeding women, ACOG said, because the virus it contains is inactive.

The American College of Obstetricians and Gynecologists has endorsed federal recommendations to routinely vaccinate girls 11-12 years old against the human papillomavirus using either the quadrivalent or bivalent vaccines.

Echoing the advice of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, ACOG officials said the vaccine can be given to girls as young as 9 years old and that catch-up vaccination should be offered through age 26 years (Obstet. Gynecol. 2010;116:800-3).

Although ob.gyns. are unlikely to care for girls in the initial vaccination group, ACOG said that ob.gyns. should offer the vaccine to girls in the catch-up group and routinely document human papillomavirus (HPV) vaccine status in the patient's record.

Two HPV vaccines are currently licensed by the Food and Drug Administration for sale in the United States. Merck's Gardasil, which is offered as a three-dose course, is a quadrivalent vaccine that provides protection against cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and genital warts associated with HPV genotypes 6, 11, 16, and 18.

Last year, the FDA approved the bivalent HPV vaccine Cervarix. This new vaccine, marketed by GlaxoSmithKline, is also offered as a three-dose course and is thought to provide protection similar to that of Gardasil for infections caused by the HPV genotypes 16 and 18. About 70% of all cervical cancer cases are associated with HPV genotypes 16 and 18, and about 90% of genital warts are associated with the HPV genotypes 6 and 11, according to the CDC.

In the policy statement issued by ACOG's Committee on Adolescent Health Care, the organization urged girls to get vaccinated before they are sexually active.

“The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” Dr. Diane F. Merritt, chair of the committee, said in a statement.

“For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26,” she said.

Dr. Merritt said physicians should counsel patients that the HPV vaccine may be less effective if they have already been exposed to the virus.

ACOG does not recommend that girls and women be tested for HPV before they are vaccinated. Serologic assays to test for HPV DNA are unreliable and aren't currently commercially available, according to the organization.

“More importantly, it's unlikely that someone would have been exposed to all of the HPV strains that the vaccines protect against, so testing is somewhat pointless,” according to the obstetrician gynecologist.

But women should have routine cervical cytology screening, according to ACOG. The organization said cervical cancer screening is needed in all women aged 21 years and older, even if they received the HPV vaccine before becoming sexually active.

HPV vaccination is not recommended during pregnancy, but physicians do not need to routinely perform pregnancy testing before giving the vaccine, according to ACOG. Instead, ACOG officials advised physicians to remind their patients to use contraception while they are receiving the vaccine series.

If a woman becomes pregnant while receiving the vaccine, the series should be delayed until the end of the pregnancy. The vaccine is safe for breastfeeding women, ACOG said, because the virus it contains is inactive.

The American College of Obstetricians and Gynecologists has endorsed federal recommendations to routinely vaccinate girls 11-12 years old against the human papillomavirus using either the quadrivalent or bivalent vaccines.

Echoing the advice of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, ACOG officials said the vaccine can be given to girls as young as 9 years old and that catch-up vaccination should be offered through age 26 years (Obstet. Gynecol. 2010;116:800-3).

Although ob.gyns. are unlikely to care for girls in the initial vaccination group, ACOG said that ob.gyns. should offer the vaccine to girls in the catch-up group and routinely document human papillomavirus (HPV) vaccine status in the patient's record.

Two HPV vaccines are currently licensed by the Food and Drug Administration for sale in the United States. Merck's Gardasil, which is offered as a three-dose course, is a quadrivalent vaccine that provides protection against cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and genital warts associated with HPV genotypes 6, 11, 16, and 18.

Last year, the FDA approved the bivalent HPV vaccine Cervarix. This new vaccine, marketed by GlaxoSmithKline, is also offered as a three-dose course and is thought to provide protection similar to that of Gardasil for infections caused by the HPV genotypes 16 and 18. About 70% of all cervical cancer cases are associated with HPV genotypes 16 and 18, and about 90% of genital warts are associated with the HPV genotypes 6 and 11, according to the CDC.

In the policy statement issued by ACOG's Committee on Adolescent Health Care, the organization urged girls to get vaccinated before they are sexually active.

“The ideal time for girls to receive the HPV vaccination is before they become sexually active and become exposed to HPV,” Dr. Diane F. Merritt, chair of the committee, said in a statement.

“For those already sexually active, we also recommend the HPV vaccination for adolescents and young women up to age 26,” she said.

Dr. Merritt said physicians should counsel patients that the HPV vaccine may be less effective if they have already been exposed to the virus.

ACOG does not recommend that girls and women be tested for HPV before they are vaccinated. Serologic assays to test for HPV DNA are unreliable and aren't currently commercially available, according to the organization.

“More importantly, it's unlikely that someone would have been exposed to all of the HPV strains that the vaccines protect against, so testing is somewhat pointless,” according to the obstetrician gynecologist.

But women should have routine cervical cytology screening, according to ACOG. The organization said cervical cancer screening is needed in all women aged 21 years and older, even if they received the HPV vaccine before becoming sexually active.

HPV vaccination is not recommended during pregnancy, but physicians do not need to routinely perform pregnancy testing before giving the vaccine, according to ACOG. Instead, ACOG officials advised physicians to remind their patients to use contraception while they are receiving the vaccine series.

If a woman becomes pregnant while receiving the vaccine, the series should be delayed until the end of the pregnancy. The vaccine is safe for breastfeeding women, ACOG said, because the virus it contains is inactive.

Federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions through their insurer's internal process and to an outside, independent entity. Although most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans, and another 10 million people in new individual market plans will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

Federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions through their insurer's internal process and to an outside, independent entity. Although most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans, and another 10 million people in new individual market plans will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

Federal regulations mandated by the Affordable Care Act will give patients new rights to appeal claims denials made by their health plans.

The rules, which were announced on July 22, will allow consumers in new health plans to appeal decisions through their insurer's internal process and to an outside, independent entity. Although most health plans already provide for an internal appeals process, not all offer an external review of plan decisions, said the U.S. Department of Health and Human Services. The types of appeals processes often depend on individual state laws.

HHS officials estimate that in 2011 there will be about 31 million people in new employer plans, and another 10 million people in new individual market plans will be able to take advantage of these new appeals opportunities. By 2013, that number is expected to grow to 88 million people. The rules do not apply to grandfathered health plans.

Under the new rules, health plans that begin on or after Sept. 23, 2010, must have an internal appeals process that allows consumers to appeal whenever the plan denies a claim for a covered service or rescinds coverage. The internal appeals process must also offer consumers detailed information about the grounds for their denial and information on how to file an appeal.

The new rules aim to make internal appeals more objective by ensuring that the person considering the appeal does not have a conflict of interest. For example, the health plan is not allowed to offer financial incentives to employees based on the number of claims that are denied. Health plans will also have to provide an expedited appeals process, which would allow urgent cases to be reviewed within 24 hours.

The regulations also standardize rules for external appeals. Currently, 44 states require health plans to have some type of external appeal but those processes vary greatly, according to HHS. Under the federal rules, health plans must provide clear information about external appeals and expedited access to the process. The decisions made through external appeals are binding under the new federal rules.

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement.

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. It would also bar the sale of protected health information without explicit authorization from the patient.

In addition, it implements elements of the 2009 Health Information Technology for Economic and Clinical Health Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans. Individuals can provide comments on the rule until Sept. 11.

The HHS has also launched a new Web site (www.hhs.gov/healthprivacy/index.html

The proposed requirements are available at www.ofr.gov/OFRUpload/OFRData/2010-16718_PI.pdf

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement.

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. It would also bar the sale of protected health information without explicit authorization from the patient.

In addition, it implements elements of the 2009 Health Information Technology for Economic and Clinical Health Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans. Individuals can provide comments on the rule until Sept. 11.

The HHS has also launched a new Web site (www.hhs.gov/healthprivacy/index.html

The proposed requirements are available at www.ofr.gov/OFRUpload/OFRData/2010-16718_PI.pdf

Patients could gain greater access to their health information and have more power to limit disclosures of certain personal information to health plans under a new proposal from the Health and Human Services department.

The new requirements are aimed at beefing up privacy and security, as the Obama administration pushes to get more physicians using electronic health records over the next few years.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” Georgina Verdugo, director of the HHS Office for Civil Rights, said in a statement.

The proposal alters the Health Insurance Portability and Accountability Act (HIPAA) rules by setting new limits on the use of disclosure of protected health information for marketing and fundraising and by requiring business associates of HIPAA-covered entities to follow most of the same rules that covered entities follow. It would also bar the sale of protected health information without explicit authorization from the patient.

In addition, it implements elements of the 2009 Health Information Technology for Economic and Clinical Health Act, which requires physicians and other covered entities to grant patient requests to restrict certain information from their health plans. Individuals can provide comments on the rule until Sept. 11.

The HHS has also launched a new Web site (www.hhs.gov/healthprivacy/index.html

The proposed requirements are available at www.ofr.gov/OFRUpload/OFRData/2010-16718_PI.pdf

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, says a report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year. The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

The new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole, Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. It also expects the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings.

Ms. Sebelius said she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, says a report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year. The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

The new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole, Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. It also expects the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings.

Ms. Sebelius said she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, says a report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year. The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

The new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole, Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians. It also expects the Independent Payment Advisory Board, which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings.

Ms. Sebelius said she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.

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 partly 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 buy an EHR and laid the ground work with the staff, numerous challenges remain. 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, Dr. Waldren said. 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 contacts 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 might 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, consider 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.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She advises seeking 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.

When choosing an EHR product, get advice from clinicians with practices similar to your own.

Source MS. GRISKEWICZ

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 partly 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 buy an EHR and laid the ground work with the staff, numerous challenges remain. 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, Dr. Waldren said. 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 contacts 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 might 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, consider 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.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She advises seeking 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.

When choosing an EHR product, get advice from clinicians with practices similar to your own.

Source MS. GRISKEWICZ

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 partly 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 buy an EHR and laid the ground work with the staff, numerous challenges remain. 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, Dr. Waldren said. 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 contacts 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 might 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, consider 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.

As physicians consider their options, the key is to get educated, Ms. Griskewicz said. She advises seeking 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.

When choosing an EHR product, get advice from clinicians with practices similar to your own.

Source MS. GRISKEWICZ

The federal government has released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

“We very much want well-intentioned providers to become meaningful users,” Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions. The revision was made so that the requirement would be achievable by average practices in the early years of the program, he said.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians also must to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's American Recovery Act.

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

The final rule on the meaningful use of EHRs is available at www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdfwww.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

Elsevier Global Medical News

The federal government has released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

“We very much want well-intentioned providers to become meaningful users,” Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions. The revision was made so that the requirement would be achievable by average practices in the early years of the program, he said.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians also must to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's American Recovery Act.

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

The final rule on the meaningful use of EHRs is available at www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdfwww.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

Elsevier Global Medical News

The federal government has released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in the Health and Human Services department had outlined in a proposal published in January. Physician organizations had objected to the initial proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all or nothing framework of the proposal, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

“We very much want well-intentioned providers to become meaningful users,” Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions. The revision was made so that the requirement would be achievable by average practices in the early years of the program, he said.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians also must to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's American Recovery Act.

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to $18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to $44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives.

A similar program is in place under the Medicaid program, with physicians eligible to receive up to $64,000 over 6 years for the adoption and use of certified EHRs.

The final rule on the meaningful use of EHRs is available at www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdfwww.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

Elsevier Global Medical News

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, according to a new report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year.

The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

“For too long, we've paid too much for health care, gotten too little in return, and watched the situation get worse each and every year,” Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

“The Affordable Care Act is already putting our health care system on a new course, bringing down costs while improving the quality of care and giving all Americans more value for their dollars,” she said.

Ms. Sebelius noted that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

Over the long-term, CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians.

CMS also expects the establishment of the Independent Payment Advisory Board (IPAB), which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings by cutting Medicare costs by about $23 billion by 2019.

Many physician groups have been critical of the board, saying that Congress has placed too much authority in the hands of an unelected body. Under the Affordable Care Act, the IPAB's recommendations will take effect unless Congress passes legislation that meets the same budgetary targets.

Ms. Sebelius said that she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, according to a new report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year.

The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

“For too long, we've paid too much for health care, gotten too little in return, and watched the situation get worse each and every year,” Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

“The Affordable Care Act is already putting our health care system on a new course, bringing down costs while improving the quality of care and giving all Americans more value for their dollars,” she said.

Ms. Sebelius noted that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

Over the long-term, CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians.

CMS also expects the establishment of the Independent Payment Advisory Board (IPAB), which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings by cutting Medicare costs by about $23 billion by 2019.

Many physician groups have been critical of the board, saying that Congress has placed too much authority in the hands of an unelected body. Under the Affordable Care Act, the IPAB's recommendations will take effect unless Congress passes legislation that meets the same budgetary targets.

Ms. Sebelius said that she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.

Provisions of the new Affordable Care Act, coupled with other payment changes, will save Medicare nearly $8 billion over 2 years and extend the solvency of the Medicare Trust Funds by 12 years, according to a new report from the Centers for Medicare and Medicaid Services.

The immediate savings come from cuts to Medicare Advantage payments, competitive bidding for durable medical equipment, changes to how Medicare pays for advanced imaging services, productivity improvements in the hospital, and efforts to reduce waste, fraud, and abuse. These changes are expected to save $7.8 billion for the Medicare program by the end of next year.

The report, issued Aug. 2, analyzes cost-cutting provisions that CMS has already implemented or will be implementing soon.

“For too long, we've paid too much for health care, gotten too little in return, and watched the situation get worse each and every year,” Health and Human Services Secretary Kathleen Sebelius said at a press conference to release the report.

“The Affordable Care Act is already putting our health care system on a new course, bringing down costs while improving the quality of care and giving all Americans more value for their dollars,” she said.

Ms. Sebelius noted that the new law will protect Medicare beneficiaries by maintaining current benefits and adding new ones such as free preventive care and the eventually closing the Medicare Part D prescription drug doughnut hole.

Over the long-term, CMS officials estimate that Medicare savings will exceed $418 billion by 2019. Some of those savings will come from reducing hospital readmissions and hospital-acquired infections, bundling payments for end-stage renal disease care, promoting Accountable Care Organizations, and improving quality reporting by physicians.

CMS also expects the establishment of the Independent Payment Advisory Board (IPAB), which will recommend payment changes aimed at slowing growth in Medicare spending, to contribute to those savings by cutting Medicare costs by about $23 billion by 2019.

Many physician groups have been critical of the board, saying that Congress has placed too much authority in the hands of an unelected body. Under the Affordable Care Act, the IPAB's recommendations will take effect unless Congress passes legislation that meets the same budgetary targets.

Ms. Sebelius said that she expects private insurers to follow the federal government's lead in implementing some of these payment changes as they prove effective in the Medicare program.