Mary Ellen Schneider

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that’s a major hurdle to improving patient safety in any organization.

“If you’re fearful and you’re worried about being sued, that has a very chilling effect on people’s willingness to step forward and say ‘we have a problem and we need to do something about it,’ ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The results of these tests could lay the groundwork for the additional medical malpractice studies called for under the Affordable Care Act, which authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that’s a major hurdle to improving patient safety in any organization.

“If you’re fearful and you’re worried about being sued, that has a very chilling effect on people’s willingness to step forward and say ‘we have a problem and we need to do something about it,’ ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The results of these tests could lay the groundwork for the additional medical malpractice studies called for under the Affordable Care Act, which authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

The Agency for Healthcare Research and Quality has awarded $25 million in grants to states and health systems to test various approaches to medical liability reform.

The grant awards follow through on a 2009 promise made by President Obama. In a speech to Congress last September, the president pledged to fund demonstration projects that would look at malpractice reforms that also improve patient safety.

The focus on patient safety is critical, said Dr. Carolyn Clancy, director of AHRQ, because when physicians fear being sued, they are less likely to be open about potential errors, near misses, and avoidable harms, and that’s a major hurdle to improving patient safety in any organization.

“If you’re fearful and you’re worried about being sued, that has a very chilling effect on people’s willingness to step forward and say ‘we have a problem and we need to do something about it,’ ” Dr. Clancy said during a press briefing.

The awards, which were announced on June 11, include 3-year grants to states and health systems of as much as $3 million. The $25 million pool also includes 1-year planning grants of as much as $300,000, and a $2 million grant to JBA/RAND Corp. to evaluate the various projects.

Many of the demonstration grants will focus on early disclosure of errors and early offers of compensation, Dr. Clancy said. The aim with early offers is not to short-circuit the system, she added, but to give both physicians and patients relief from a process that often drags on. Another common theme among the grants is to promote better communication among providers, patients, and families.

None of the grants will examine the concept of health courts. Although health courts have been talked about for years and praised as a possible solution by President Obama, none of the grant applicants proposed studying that concept. One project, however, will look at a judge-directed negotiation program that is currently in use in New York in combination with an early disclosure and settlement model.

The results of these tests could lay the groundwork for the additional medical malpractice studies called for under the Affordable Care Act, which authorizes an additional $50 million over 5 years to fund more studies, Dr. Clancy said.

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we’re charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags 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, or “red flags,” that could indicate identity theft. The 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, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don’t fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency has also tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, 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. The groups contend that not only are physicians not creditors, but that the rules would be burdensome and duplicate requirements already in place under the Health Insurance Portability and Accountability Act.

“Physicians are already ethically and legally responsible for ensuring the confidentiality and security of patients’ medical information,” said Dr. Peter E. Lavine, president of the Medical Society of the District of Columbia, said in a statement. “It is unnecessary to add to the existing web of federal security regulations physicians must follow.”

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we’re charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags 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, or “red flags,” that could indicate identity theft. The 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, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don’t fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency has also tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, 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. The groups contend that not only are physicians not creditors, but that the rules would be burdensome and duplicate requirements already in place under the Health Insurance Portability and Accountability Act.

“Physicians are already ethically and legally responsible for ensuring the confidentiality and security of patients’ medical information,” said Dr. Peter E. Lavine, president of the Medical Society of the District of Columbia, said in a statement. “It is unnecessary to add to the existing web of federal security regulations physicians must follow.”

The Federal Trade Commission has again postponed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they must implement identity-theft prevention programs in their practices.

Enforcement of the rule had been scheduled to begin on June 1. In a statement issued on May 28, the FTC said it was delaying enforcement to give Congress time to consider pending legislation that would exclude some small physician practices and small businesses from the rule. Last year, the House passed a bill (H.R. 3763) that would have exempted physician practices with 20 or fewer employees from having to comply with the Red Flags rule, but that legislation has failed to gain traction in the Senate.

FTC officials urged lawmakers to act quickly to clarify what groups should be covered by the regulation. “As an agency we’re charged with enforcing the law, and endless extensions delay enforcement,” FTC chairman Jon Leibowitz said in a statement.

The Red Flags 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, or “red flags,” that could indicate identity theft. The 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, first to give organizations more time to get familiar with the requirements and later at the request of members of Congress.

The rule has been controversial in the medical community because many physicians believe their practices don’t fit into the definition of a “creditor.” However, the FTC has continued to insist that physicians are in fact “creditors” because they allow their patients to defer payments over time.

The agency has also tried to assure physicians that the requirements should not be a burden and that small practices can come into compliance by implementing simple steps. For example, in low-risk settings, practice staff can ask patients for photo identification when they come in for an appointment.

The American Medical Association and other physician groups have been lobbying to get physicians excluded completely from the requirements. On May 21, 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. The groups contend that not only are physicians not creditors, but that the rules would be burdensome and duplicate requirements already in place under the Health Insurance Portability and Accountability Act.

“Physicians are already ethically and legally responsible for ensuring the confidentiality and security of patients’ medical information,” said Dr. Peter E. Lavine, president of the Medical Society of the District of Columbia, said in a statement. “It is unnecessary to add to the existing web of federal security regulations physicians must follow.”

As physicians and hospitals implement electronic health record systems in light of financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss areas where potential patient safety hazards exist. Topping the list were technology issues such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, cochair of the Health IT Policy Committee's Certification/Adoption Workgroup, straightforward technology problems are in the minority when it comes to safety issues. Once these problems are discovered, they can usually be easily and rapidly fixed.

Most safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT–related safety issues are local. Marc Probst, cochair of the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, chief information officer at Intermountain Healthcare in Salt Lake City.

The workgroup recommended that patients play a greater role in identifying errors, and called for the establishment of a national database and reporting system that would allow patients and providers to make confidential reports about incidents and potential hazards.

As physicians and hospitals implement electronic health record systems in light of financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss areas where potential patient safety hazards exist. Topping the list were technology issues such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, cochair of the Health IT Policy Committee's Certification/Adoption Workgroup, straightforward technology problems are in the minority when it comes to safety issues. Once these problems are discovered, they can usually be easily and rapidly fixed.

Most safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT–related safety issues are local. Marc Probst, cochair of the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, chief information officer at Intermountain Healthcare in Salt Lake City.

The workgroup recommended that patients play a greater role in identifying errors, and called for the establishment of a national database and reporting system that would allow patients and providers to make confidential reports about incidents and potential hazards.

As physicians and hospitals implement electronic health record systems in light of financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss areas where potential patient safety hazards exist. Topping the list were technology issues such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, cochair of the Health IT Policy Committee's Certification/Adoption Workgroup, straightforward technology problems are in the minority when it comes to safety issues. Once these problems are discovered, they can usually be easily and rapidly fixed.

Most safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT–related safety issues are local. Marc Probst, cochair of the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, chief information officer at Intermountain Healthcare in Salt Lake City.

The workgroup recommended that patients play a greater role in identifying errors, and called for the establishment of a national database and reporting system that would allow patients and providers to make confidential reports about incidents and potential hazards.

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible for compensation. Notices with instructions for filing claims were mailed out in May.

The settlement follows a nearly decade-long battle between United-Health Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database, and the company committed $50 million to fund the development of a new, independent database to determine rates for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

For details, contact Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible for compensation. Notices with instructions for filing claims were mailed out in May.

The settlement follows a nearly decade-long battle between United-Health Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database, and the company committed $50 million to fund the development of a new, independent database to determine rates for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

For details, contact Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible for compensation. Notices with instructions for filing claims were mailed out in May.

The settlement follows a nearly decade-long battle between United-Health Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database, and the company committed $50 million to fund the development of a new, independent database to determine rates for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

For details, contact Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

TORONTO — The massive health care reform overhaul passed by Congress this year is here to stay, but officials at the American College of Physicians are hoping that Congress will make some modifications to improve the law for physicians.

At the top of the organization's wish list are changes to the Independent Payment Advisory Board (IPAB) created by the law, making permanent the boost in primary care payment rates under Medicare and Medicaid, and eliminating newly created penalties for failing to report quality data to Medicare.

“Health care reform is an ongoing journey. It's not a destination,” Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, said at the meeting.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states roll out provisions in the law. States will have a major role in implementation, Mr. Doherty said, since they are responsible for setting up their own health insurance exchanges in 2014 and awarding competitive grants to fund primary care programs. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board, created by the Affordable Care Act, is charged with presenting proposals to Congress that would slow the growth of Medicare and private health care spending and improve the quality of care. The recommendations of the IPAB would take effect unless Congress votes to reject the proposals and in favor of its own plan for achieving the same level of savings. The IPAB is expected to submit its first recommendation to Congress in 2015.

The ACP also hopes that Congress will act to make permanent the temporary increases in primary care payments enacted under the law. For example, the health care reform law provides a 10% bonus payment to primary care physicians whose Medicare charges for office, nursing home, and home visits make up at least 60% of their total Medicare charges. Those payments will be available for 5 years, starting in 2011. The law also increases Medicaid payments up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014.

Mr. Doherty said that although the law's payment provisions are time limited, he thinks it will be difficult for Congress to take this benefit away once it is in effect. ACP officials also plan to lobby Congress to expand the eligibility for these increased payments so that more primary care physicians can qualify.

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures.

Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012-2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it was not politically feasible to get an SGR fix included in the reform legislation. However, Mr. Doherty said he expects that there will be a vote in the Senate on permanent repeal of the SGR this year.

The challenge, he said, will be to round up 60 votes in the Senate, where fiscal conservatives want to see a method to pay for the $200 billion price tag of an SGR fix. Mr. Doherty argues that the SGR fix would not be a “real cost,” because it assumes that Congress would otherwise let the cuts happen each year.

In the meantime, the ACP, the American Medical Association, and other physician organizations have stopped helping lawmakers round up the votes needed for short-term fixes, instead opting to lobby only in favor of a permanent fix to the formula. “The only acceptable option is total repeal,” Mr. Doherty said.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work.

TORONTO — The massive health care reform overhaul passed by Congress this year is here to stay, but officials at the American College of Physicians are hoping that Congress will make some modifications to improve the law for physicians.

At the top of the organization's wish list are changes to the Independent Payment Advisory Board (IPAB) created by the law, making permanent the boost in primary care payment rates under Medicare and Medicaid, and eliminating newly created penalties for failing to report quality data to Medicare.

“Health care reform is an ongoing journey. It's not a destination,” Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, said at the meeting.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states roll out provisions in the law. States will have a major role in implementation, Mr. Doherty said, since they are responsible for setting up their own health insurance exchanges in 2014 and awarding competitive grants to fund primary care programs. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board, created by the Affordable Care Act, is charged with presenting proposals to Congress that would slow the growth of Medicare and private health care spending and improve the quality of care. The recommendations of the IPAB would take effect unless Congress votes to reject the proposals and in favor of its own plan for achieving the same level of savings. The IPAB is expected to submit its first recommendation to Congress in 2015.

The ACP also hopes that Congress will act to make permanent the temporary increases in primary care payments enacted under the law. For example, the health care reform law provides a 10% bonus payment to primary care physicians whose Medicare charges for office, nursing home, and home visits make up at least 60% of their total Medicare charges. Those payments will be available for 5 years, starting in 2011. The law also increases Medicaid payments up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014.

Mr. Doherty said that although the law's payment provisions are time limited, he thinks it will be difficult for Congress to take this benefit away once it is in effect. ACP officials also plan to lobby Congress to expand the eligibility for these increased payments so that more primary care physicians can qualify.

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures.

Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012-2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it was not politically feasible to get an SGR fix included in the reform legislation. However, Mr. Doherty said he expects that there will be a vote in the Senate on permanent repeal of the SGR this year.

The challenge, he said, will be to round up 60 votes in the Senate, where fiscal conservatives want to see a method to pay for the $200 billion price tag of an SGR fix. Mr. Doherty argues that the SGR fix would not be a “real cost,” because it assumes that Congress would otherwise let the cuts happen each year.

In the meantime, the ACP, the American Medical Association, and other physician organizations have stopped helping lawmakers round up the votes needed for short-term fixes, instead opting to lobby only in favor of a permanent fix to the formula. “The only acceptable option is total repeal,” Mr. Doherty said.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work.

TORONTO — The massive health care reform overhaul passed by Congress this year is here to stay, but officials at the American College of Physicians are hoping that Congress will make some modifications to improve the law for physicians.

At the top of the organization's wish list are changes to the Independent Payment Advisory Board (IPAB) created by the law, making permanent the boost in primary care payment rates under Medicare and Medicaid, and eliminating newly created penalties for failing to report quality data to Medicare.

“Health care reform is an ongoing journey. It's not a destination,” Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, said at the meeting.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states roll out provisions in the law. States will have a major role in implementation, Mr. Doherty said, since they are responsible for setting up their own health insurance exchanges in 2014 and awarding competitive grants to fund primary care programs. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board, created by the Affordable Care Act, is charged with presenting proposals to Congress that would slow the growth of Medicare and private health care spending and improve the quality of care. The recommendations of the IPAB would take effect unless Congress votes to reject the proposals and in favor of its own plan for achieving the same level of savings. The IPAB is expected to submit its first recommendation to Congress in 2015.

The ACP also hopes that Congress will act to make permanent the temporary increases in primary care payments enacted under the law. For example, the health care reform law provides a 10% bonus payment to primary care physicians whose Medicare charges for office, nursing home, and home visits make up at least 60% of their total Medicare charges. Those payments will be available for 5 years, starting in 2011. The law also increases Medicaid payments up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014.

Mr. Doherty said that although the law's payment provisions are time limited, he thinks it will be difficult for Congress to take this benefit away once it is in effect. ACP officials also plan to lobby Congress to expand the eligibility for these increased payments so that more primary care physicians can qualify.

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures.

Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012-2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it was not politically feasible to get an SGR fix included in the reform legislation. However, Mr. Doherty said he expects that there will be a vote in the Senate on permanent repeal of the SGR this year.

The challenge, he said, will be to round up 60 votes in the Senate, where fiscal conservatives want to see a method to pay for the $200 billion price tag of an SGR fix. Mr. Doherty argues that the SGR fix would not be a “real cost,” because it assumes that Congress would otherwise let the cuts happen each year.

In the meantime, the ACP, the American Medical Association, and other physician organizations have stopped helping lawmakers round up the votes needed for short-term fixes, instead opting to lobby only in favor of a permanent fix to the formula. “The only acceptable option is total repeal,” Mr. Doherty said.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work.

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

Endocrinologists, for example, face challenges in qualifying as the medical home. The average endocrinologist spends about 50%-60% of his or her time treating and managing diabetes patients, and the remaining time consulting on other conditions, according to Dr. R. Mack Harrell, an endocrinologist in Fort Lauderdale, Fla., and a member of the board of directors of the American Association of Clinical Endocrinologists.

The AACE and the American College of Rheumatology are among a handful of medical specialty societies that have not signed on to the concept of the patient-centered medical home. “We're a little bit frustrated about where we fit in,” added Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the ACR's Committee on Rheumatologic Care.

It's not that ACR members don't support increased access for patients or coordinated care; rather, Dr. Kolba said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practicebased care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

“It's hard to see how you could completely give up your consulting role so you could fit into a medical home–type model for half your practice,” added Dr. Harrell.

The AACE is working to get endocrinologists, and all physicians, paid for those administrative burdens that take up so much time. The organization is currently working to generate a new CPT code for preauthorizations. “We're looking for other avenues to get paid for what we do,” he said.

As tests continue on the value of the medical home, Dr. Harrell said the key will be to ensure that primary care physicians and specialists find better ways to communicate with one another. But he anticipates that communication will be an ongoing challenge, especially since Medicare is no longer paying specialists more to perform consultations. “None of the codes, as they are presently written, are specifically constructed to pay for communication between physicians, which could potentially exacerbate an already difficult situation,” he said.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

One group that has given a lot of thought to how specialists could and should function in the medical home model is the American College of Physicians, whose membership includes both subspecialists and primary care physicians.

Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement, said the medical home model is set up so that some subspecialists would have the opportunity to qualify. For example, a nephrologist who cares for patients with end-stage renal disease would certainly be a good candidate. Whether that physician would want to go through the recognition process is a separate issue, he said.

“There is definitely a place in the restructuring of the way we deliver health care for general internists, family physicians, pediatricians, and all of our subspecialty colleagues,” Dr. Barr said. “This is about providing better care for people and populations.”

Down the line, subspecialists are also likely to play a role as part of a medical home neighborhood, he said. That concept is still being defined, but the idea is to improve communication among physicians on patient hand-offs and find a way to reimburse physicians for some of the interactions that currently go unrecognized, Dr. Barr said. For example, a conversation between an orthopedic surgeon and an internist about managing a patient's back pain could save the health care system a significant amount of money on unnecessary procedures. Right now these conversations are done on a collegial basis, but in the future, the medical home neighborhood model might allow payment to both physicians for this type of early collaboration, he said.

The hope is that the money to fund additional payments for specialists and primary care physicians could come from overall health system savings, such as reductions in unnecessary emergency department visits and hospital admissions and readmissions, Dr. Barr said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555-8).

Dr. Bove said he suspects that cardiologists are acting as medical homes for a larger number of patients than cited in that study. But either way, he thinks a system could be developed that would allow cardiologists who are willing to invest the time in qualifying as medical homes to be recognized and paid, even if another portion of their practice is devoted primarily to procedural services.

For its part, the ACC has established a Patient Centered Care Committee that is working on cardiology models for the patient-centered medical home. The committee is setting up protocols so that cardiologists who are interested can apply to medical home pilots being set up under the new health care reform law.

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

Endocrinologists, for example, face challenges in qualifying as the medical home. The average endocrinologist spends about 50%-60% of his or her time treating and managing diabetes patients, and the remaining time consulting on other conditions, according to Dr. R. Mack Harrell, an endocrinologist in Fort Lauderdale, Fla., and a member of the board of directors of the American Association of Clinical Endocrinologists.

The AACE and the American College of Rheumatology are among a handful of medical specialty societies that have not signed on to the concept of the patient-centered medical home. “We're a little bit frustrated about where we fit in,” added Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the ACR's Committee on Rheumatologic Care.

It's not that ACR members don't support increased access for patients or coordinated care; rather, Dr. Kolba said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practicebased care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

“It's hard to see how you could completely give up your consulting role so you could fit into a medical home–type model for half your practice,” added Dr. Harrell.

The AACE is working to get endocrinologists, and all physicians, paid for those administrative burdens that take up so much time. The organization is currently working to generate a new CPT code for preauthorizations. “We're looking for other avenues to get paid for what we do,” he said.

As tests continue on the value of the medical home, Dr. Harrell said the key will be to ensure that primary care physicians and specialists find better ways to communicate with one another. But he anticipates that communication will be an ongoing challenge, especially since Medicare is no longer paying specialists more to perform consultations. “None of the codes, as they are presently written, are specifically constructed to pay for communication between physicians, which could potentially exacerbate an already difficult situation,” he said.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

One group that has given a lot of thought to how specialists could and should function in the medical home model is the American College of Physicians, whose membership includes both subspecialists and primary care physicians.

Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement, said the medical home model is set up so that some subspecialists would have the opportunity to qualify. For example, a nephrologist who cares for patients with end-stage renal disease would certainly be a good candidate. Whether that physician would want to go through the recognition process is a separate issue, he said.

“There is definitely a place in the restructuring of the way we deliver health care for general internists, family physicians, pediatricians, and all of our subspecialty colleagues,” Dr. Barr said. “This is about providing better care for people and populations.”

Down the line, subspecialists are also likely to play a role as part of a medical home neighborhood, he said. That concept is still being defined, but the idea is to improve communication among physicians on patient hand-offs and find a way to reimburse physicians for some of the interactions that currently go unrecognized, Dr. Barr said. For example, a conversation between an orthopedic surgeon and an internist about managing a patient's back pain could save the health care system a significant amount of money on unnecessary procedures. Right now these conversations are done on a collegial basis, but in the future, the medical home neighborhood model might allow payment to both physicians for this type of early collaboration, he said.

The hope is that the money to fund additional payments for specialists and primary care physicians could come from overall health system savings, such as reductions in unnecessary emergency department visits and hospital admissions and readmissions, Dr. Barr said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555-8).

Dr. Bove said he suspects that cardiologists are acting as medical homes for a larger number of patients than cited in that study. But either way, he thinks a system could be developed that would allow cardiologists who are willing to invest the time in qualifying as medical homes to be recognized and paid, even if another portion of their practice is devoted primarily to procedural services.

For its part, the ACC has established a Patient Centered Care Committee that is working on cardiology models for the patient-centered medical home. The committee is setting up protocols so that cardiologists who are interested can apply to medical home pilots being set up under the new health care reform law.

As implementation of health reform gains momentum, subspecialist physicians are concerned about their lack of a role in care coordination and the patient-centered medical home model.

Endocrinologists, for example, face challenges in qualifying as the medical home. The average endocrinologist spends about 50%-60% of his or her time treating and managing diabetes patients, and the remaining time consulting on other conditions, according to Dr. R. Mack Harrell, an endocrinologist in Fort Lauderdale, Fla., and a member of the board of directors of the American Association of Clinical Endocrinologists.

The AACE and the American College of Rheumatology are among a handful of medical specialty societies that have not signed on to the concept of the patient-centered medical home. “We're a little bit frustrated about where we fit in,” added Dr. Karen Kolba, a rheumatologist in solo practice in Santa Maria, Calif., and chair of the ACR's Committee on Rheumatologic Care.

It's not that ACR members don't support increased access for patients or coordinated care; rather, Dr. Kolba said, they feel they have been excluded from the model.

In 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association issued a paper outlining the principles of the patient-centered medical home, which seeks to provide comprehensive primary care to children and adults.

Under the model, each patient has a personal physician who directs a practicebased care team and is responsible for providing all of the patient's health care needs or coordinating that care with another provider. The model also emphasizes evidence-based medicine and clinical decision support, enhanced access for patients, and additional payment for the personal physician for providing care coordination and improving quality.

A voluntary recognition program created by the National Committee for Quality Assurance (NCQA) aims to operationalize the model; physicians who meet the program's standards can qualify for additional payment from certain health plans. The standards measure a practice on access and communication, patient tracking and registry functions, care management, referral tracking, and electronic prescribing, among others.

Although the medical home model doesn't specify that only a primary care physician can qualify, the criteria make it nearly impossible for specialists to act as a medical home, Dr. Kolba said. For example, rheumatologists frequently are the main point of medical contact for patients with chronic rheumatologic diseases and they provide a significant amount of coordination of care, she said. However, few perform or coordinate nonrheumatologic care such as a patient's regular mammogram. And that's a sticking point in being able to qualify as a personal physician under the medical home, she said.

Dr. Kolba said she supports increasing payment for primary care, but not at the expense of other physicians. And she said primary care physicians ought to be entitled to additional pay for the work they do, without creating a new system to justify the increases.

“It's hard to see how you could completely give up your consulting role so you could fit into a medical home–type model for half your practice,” added Dr. Harrell.

The AACE is working to get endocrinologists, and all physicians, paid for those administrative burdens that take up so much time. The organization is currently working to generate a new CPT code for preauthorizations. “We're looking for other avenues to get paid for what we do,” he said.

As tests continue on the value of the medical home, Dr. Harrell said the key will be to ensure that primary care physicians and specialists find better ways to communicate with one another. But he anticipates that communication will be an ongoing challenge, especially since Medicare is no longer paying specialists more to perform consultations. “None of the codes, as they are presently written, are specifically constructed to pay for communication between physicians, which could potentially exacerbate an already difficult situation,” he said.

AAFP leaders defend the medical home model and specialists' role in it. The patient-centered medical home was very purposefully defined to include a “personal physician”—not a primary care physician, said Dr. Terry McGeeney, president and CEO of TransforMED, a subsidiary of the AAFP that helps primary care practices transition to the medical home model.

Although most practices using the medical home model will be led by primary care physicians, not all will be. The personal physician could be an infectious disease specialist, a neurologist, or an oncologist, he said.

But the key, Dr. McGeeney said, is that the physician must provide a medical home for the whole patient, and not focus on a certain disease or organ system. That means that a neurologist, for example, must keep track not only of the neurologic care, but also the patient's cholesterol levels and mammogram results. They don't have to perform these services themselves, but they have to coordinate and track them, he said. In the medical home, the personal physician is the “quarterback” for the patient's care and there's no “free pass” on those responsibilities for specialists, he said.

Specialists who do want to provide a medical home may even have an advantage, according to Dr. McGeeney, who pointed out that specialty practices tend to have more resources to invest in practice transformation. That said, specialists often have not been trained to provide the types and level of care required of medical homes.

Where specialists may fit in more easily, Dr. McGeeney said, is in the “medical home neighborhood,” which includes all the physicians caring for a patient, as well as the emergency department, the hospital, and the pharmacy.

TransforMED is encouraging medical home practices to have letters of agreement with specialists regarding care coordination. As part of the agreement, the primary care physician promises to send all the patient's information to the specialist and to communicate with them about tests and results. These agreements aren't legally binding on either party, but they force everyone to have a conversation about coordination of care, he said.

One group that has given a lot of thought to how specialists could and should function in the medical home model is the American College of Physicians, whose membership includes both subspecialists and primary care physicians.

Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement, said the medical home model is set up so that some subspecialists would have the opportunity to qualify. For example, a nephrologist who cares for patients with end-stage renal disease would certainly be a good candidate. Whether that physician would want to go through the recognition process is a separate issue, he said.

“There is definitely a place in the restructuring of the way we deliver health care for general internists, family physicians, pediatricians, and all of our subspecialty colleagues,” Dr. Barr said. “This is about providing better care for people and populations.”

Down the line, subspecialists are also likely to play a role as part of a medical home neighborhood, he said. That concept is still being defined, but the idea is to improve communication among physicians on patient hand-offs and find a way to reimburse physicians for some of the interactions that currently go unrecognized, Dr. Barr said. For example, a conversation between an orthopedic surgeon and an internist about managing a patient's back pain could save the health care system a significant amount of money on unnecessary procedures. Right now these conversations are done on a collegial basis, but in the future, the medical home neighborhood model might allow payment to both physicians for this type of early collaboration, he said.

The hope is that the money to fund additional payments for specialists and primary care physicians could come from overall health system savings, such as reductions in unnecessary emergency department visits and hospital admissions and readmissions, Dr. Barr said.

Some specialists remain skeptical about their role in the medical home and the medical home neighborhood. Dr. Alfred Bove, past president of the American College of Cardiology and emeritus professor of medicine at Temple University, Philadelphia, said cardiologists frequently act as a medical home for heart failure and transplantation patients, for example, and don't want to be left out. For years, many cardiologists have worked in multidisciplinary care teams, used electronic health records, and provided immunizations and screening, he said.

“We have all the ingredients needed to be a patient-centered medical home in an area of chronic disease that probably is better done by cardiologists that have a lot of experience in managing very sick heart failure patients than in a primary care practice where there's a broad spectrum of different kinds of patients,” Dr. Bove said.

The ACC has been advocating for specialty-based patient-centered medical homes in specific areas where the cardiologist's expertise is unique and they would be willing to assume responsibility for preventive care.

But another issue is what to do about specialty practices that act as a medical home for only a portion of their patients. In a recent article in the New England Journal of Medicine, researchers looked at single-specialty practices in cardiology, endocrinology, and pulmonology to find out to what extent those specialty practices function as medical homes.

They found that a large percentage of the practices provided both primary care and specialty care, but generally for a subset of patients. For example, 81% of the 373 practices surveyed said they served as primary care physicians for 10% or fewer of their patients. Only 2.7% of the practices said they act as primary care physicians for more than 50% of their patients (N. Engl. J. Med. 2010;362:1555-8).

Dr. Bove said he suspects that cardiologists are acting as medical homes for a larger number of patients than cited in that study. But either way, he thinks a system could be developed that would allow cardiologists who are willing to invest the time in qualifying as medical homes to be recognized and paid, even if another portion of their practice is devoted primarily to procedural services.

For its part, the ACC has established a Patient Centered Care Committee that is working on cardiology models for the patient-centered medical home. The committee is setting up protocols so that cardiologists who are interested can apply to medical home pilots being set up under the new health care reform law.

One of the cornerstones of the health care reform law is a massive expansion of the Medicaid program.

Starting in 2014, all states will be required to expand eligibility of their Medicaid programs to all adults at or below 133% of poverty, regardless of whether they have children or are disabled. States can now choose to open up programs to these new enrollees early.

This is the first time in the history of the Medicaid program that states can receive federal funds for providing coverage for adults based solely on income levels.

In April, officials at the Centers for Medicare and Medicaid Services released the first details on how the new eligibility requirements will work. States that choose to begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular Federal Medical Assistance Percentage (FMAP) rate.

Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to CMS. The agency plans to issue separate guidance on this issue later.

The immediate impact on states will probably vary based on whether they are already covering some of the newly eligible adults with their own funds. In those states, the new federal money will mean an immediate savings. States that don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients.

Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

A survey of 944 primary care physicians conducted by UnitedHealth Group found that 67% think that new Medicaid patients will struggle to find a suitable primary care physician if the Medicaid expansion is not accompanied by other reforms, such as payment increases. If payment is increased to at least Medicare levels, about half of physicians (49%) said they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor that will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years.”

One of the cornerstones of the health care reform law is a massive expansion of the Medicaid program.

Starting in 2014, all states will be required to expand eligibility of their Medicaid programs to all adults at or below 133% of poverty, regardless of whether they have children or are disabled. States can now choose to open up programs to these new enrollees early.

This is the first time in the history of the Medicaid program that states can receive federal funds for providing coverage for adults based solely on income levels.

In April, officials at the Centers for Medicare and Medicaid Services released the first details on how the new eligibility requirements will work. States that choose to begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular Federal Medical Assistance Percentage (FMAP) rate.

Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to CMS. The agency plans to issue separate guidance on this issue later.

The immediate impact on states will probably vary based on whether they are already covering some of the newly eligible adults with their own funds. In those states, the new federal money will mean an immediate savings. States that don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients.

Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

A survey of 944 primary care physicians conducted by UnitedHealth Group found that 67% think that new Medicaid patients will struggle to find a suitable primary care physician if the Medicaid expansion is not accompanied by other reforms, such as payment increases. If payment is increased to at least Medicare levels, about half of physicians (49%) said they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor that will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years.”

One of the cornerstones of the health care reform law is a massive expansion of the Medicaid program.

Starting in 2014, all states will be required to expand eligibility of their Medicaid programs to all adults at or below 133% of poverty, regardless of whether they have children or are disabled. States can now choose to open up programs to these new enrollees early.

This is the first time in the history of the Medicaid program that states can receive federal funds for providing coverage for adults based solely on income levels.

In April, officials at the Centers for Medicare and Medicaid Services released the first details on how the new eligibility requirements will work. States that choose to begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular Federal Medical Assistance Percentage (FMAP) rate.

Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to CMS. The agency plans to issue separate guidance on this issue later.

The immediate impact on states will probably vary based on whether they are already covering some of the newly eligible adults with their own funds. In those states, the new federal money will mean an immediate savings. States that don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients.

Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

A survey of 944 primary care physicians conducted by UnitedHealth Group found that 67% think that new Medicaid patients will struggle to find a suitable primary care physician if the Medicaid expansion is not accompanied by other reforms, such as payment increases. If payment is increased to at least Medicare levels, about half of physicians (49%) said they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor that will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years.”

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims were mailed in May.

The $350 million settlement comes after a nearly decade-long legal battle between UnitedHealth Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database and the company committed $50 million to fund the development of a new, independent database that will determine the rates paid for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, in order to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

Physicians billed via an assignment if they received a payment directly from the health plan, if they completed box 13 on the HCFA/CMS 1500 form, or if they marked yes in the benefits assignment indicator on an electronic health care claim.

Physicians who are owed money by a patient for a covered out-of-network service or supply cannot file a claim through the settlement; however, they can contact the Settlement Claims Administrator to find out if any of their patients have submitted claims to the settlement fund.

For more information, contact the Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims were mailed in May.

The $350 million settlement comes after a nearly decade-long legal battle between UnitedHealth Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database and the company committed $50 million to fund the development of a new, independent database that will determine the rates paid for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, in order to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

Physicians billed via an assignment if they received a payment directly from the health plan, if they completed box 13 on the HCFA/CMS 1500 form, or if they marked yes in the benefits assignment indicator on an electronic health care claim.

Physicians who are owed money by a patient for a covered out-of-network service or supply cannot file a claim through the settlement; however, they can contact the Settlement Claims Administrator to find out if any of their patients have submitted claims to the settlement fund.

For more information, contact the Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

Check your mailbox. If you provided covered out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims were mailed in May.

The $350 million settlement comes after a nearly decade-long legal battle between UnitedHealth Group and several plaintiffs, including the AMA, the Medical Society of the State of New York, and the Missouri State Medical Association. The groups alleged that UnitedHealth Group conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UnitedHealth Group reached a settlement with New York State Attorney General Andrew Cuomo to discontinue use of the database and the company committed $50 million to fund the development of a new, independent database that will determine the rates paid for out-of-network care.

In a separate settlement, the company agreed to pay $350 million to reimburse health plan members and out-of-network providers who were underpaid as a result of the flawed database calculations.

Physicians and patients have until July 27, 2010, to opt out of the settlement. Claims for payments from the settlement fund are due by Oct. 5, 2010.

To be eligible to receive part of the settlement, physicians must have provided covered out-of-network services or supplies between March 15, 1994, and Nov. 18, 2009, to patients covered by a health plan that was either administered or insured by UnitedHealthcare, Oxford Health Plans, Metropolitan Life Insurance Companies, American Airlines, or one of their affiliates. In addition, in order to be eligible, physicians must have been given an assignment by the patient to bill the health plan.

Physicians billed via an assignment if they received a payment directly from the health plan, if they completed box 13 on the HCFA/CMS 1500 form, or if they marked yes in the benefits assignment indicator on an electronic health care claim.

Physicians who are owed money by a patient for a covered out-of-network service or supply cannot file a claim through the settlement; however, they can contact the Settlement Claims Administrator to find out if any of their patients have submitted claims to the settlement fund.

For more information, contact the Berdon Claims Administration LLC at 800-443-1073 or unitedhealthcare@berdonclaimsllc.com

Women Know Little About Stroke

In a survey, few women could name the primary stroke symptoms, and many weren't concerned about experiencing a stroke in their lifetimes. Commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians, the online survey of about 2,000 adult women found that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). Only about 30% were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Osteoporosis Screening Increases

The percentage of women aged 65 and older being screened for osteoporosis has risen dramatically in recent years, according to data from the Agency for Healthcare Research and Quality. From 2001 to 2006, the percentage of that Medicare population reporting being screened rose from 34% to 64%. The increase occurred among all racial, ethnic, and income groups. However, the rise was most pronounced among white and Hispanic women. Among white women on Medicare, reports of osteoporosis screening climbed from 36% in 2001 to 67% in 2006. Among Hispanic women on Medicare, screening increased from 22% to 55%. Black women on Medicare had screening increase from 16% to 38%. The data come from the agency's 2009 National Healthcare Disparities Report.

State's Abortion Law Challenged

The Center for Reproductive Rights is seeking to overturn a new Oklahoma law that requires a woman seeking an abortion to first have an ultrasound whose image is then shown to her by a physician. The Center for Reproductive Rights says the law intrudes on patient privacy. Although Oklahoma is not the first state to require that an ultrasound be performed before an abortion, its law is the most extreme, the center charged, because it requires a physician to describe the image in detail, even if the woman objects. The law also offers no exemption for victims of rape or incest. “Politicians have no business making medical decisions,” center staff attorney Stephanie Toti said in a statement. The Oklahoma legislature triggered the ultrasound requirement in April by overriding a veto by Gov. Brad Henry (D). At the same time, another veto override made it impossible for Oklahoma women and their families to sue a physician who withholds information about a fetal abnormality.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement. In March 2009, President Obama issued an executive order removing some previous barriers to federal funding of stem cell research

Abortion Rate High Among Poor

In 2008, the abortion rate among poor women was more than twice that of women in higher income brackets, according to a report from the Guttmacher Institute. And the proportion of abortion patients who were poor increased from 27% in 2000 to 42% in 2008. The findings are from the institute's fourth national survey of abortion patients, which includes responses from more than 9,400 women who had abortions between April 2008 and May 2009. The results indicate that abortion is becoming more concentrated among women with incomes below the federal poverty level, according to the institute. The change may be due to both the economic recession and increased efforts by abortion providers to make services available to poor women, according to the report, available online at

www.guttmacher.org/pubs/US-Abortion-Patients.pdf

Women Know Little About Stroke

In a survey, few women could name the primary stroke symptoms, and many weren't concerned about experiencing a stroke in their lifetimes. Commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians, the online survey of about 2,000 adult women found that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). Only about 30% were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Osteoporosis Screening Increases

The percentage of women aged 65 and older being screened for osteoporosis has risen dramatically in recent years, according to data from the Agency for Healthcare Research and Quality. From 2001 to 2006, the percentage of that Medicare population reporting being screened rose from 34% to 64%. The increase occurred among all racial, ethnic, and income groups. However, the rise was most pronounced among white and Hispanic women. Among white women on Medicare, reports of osteoporosis screening climbed from 36% in 2001 to 67% in 2006. Among Hispanic women on Medicare, screening increased from 22% to 55%. Black women on Medicare had screening increase from 16% to 38%. The data come from the agency's 2009 National Healthcare Disparities Report.

State's Abortion Law Challenged

The Center for Reproductive Rights is seeking to overturn a new Oklahoma law that requires a woman seeking an abortion to first have an ultrasound whose image is then shown to her by a physician. The Center for Reproductive Rights says the law intrudes on patient privacy. Although Oklahoma is not the first state to require that an ultrasound be performed before an abortion, its law is the most extreme, the center charged, because it requires a physician to describe the image in detail, even if the woman objects. The law also offers no exemption for victims of rape or incest. “Politicians have no business making medical decisions,” center staff attorney Stephanie Toti said in a statement. The Oklahoma legislature triggered the ultrasound requirement in April by overriding a veto by Gov. Brad Henry (D). At the same time, another veto override made it impossible for Oklahoma women and their families to sue a physician who withholds information about a fetal abnormality.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement. In March 2009, President Obama issued an executive order removing some previous barriers to federal funding of stem cell research

Abortion Rate High Among Poor

In 2008, the abortion rate among poor women was more than twice that of women in higher income brackets, according to a report from the Guttmacher Institute. And the proportion of abortion patients who were poor increased from 27% in 2000 to 42% in 2008. The findings are from the institute's fourth national survey of abortion patients, which includes responses from more than 9,400 women who had abortions between April 2008 and May 2009. The results indicate that abortion is becoming more concentrated among women with incomes below the federal poverty level, according to the institute. The change may be due to both the economic recession and increased efforts by abortion providers to make services available to poor women, according to the report, available online at

www.guttmacher.org/pubs/US-Abortion-Patients.pdf

Women Know Little About Stroke

In a survey, few women could name the primary stroke symptoms, and many weren't concerned about experiencing a stroke in their lifetimes. Commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians, the online survey of about 2,000 adult women found that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). Only about 30% were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Osteoporosis Screening Increases

The percentage of women aged 65 and older being screened for osteoporosis has risen dramatically in recent years, according to data from the Agency for Healthcare Research and Quality. From 2001 to 2006, the percentage of that Medicare population reporting being screened rose from 34% to 64%. The increase occurred among all racial, ethnic, and income groups. However, the rise was most pronounced among white and Hispanic women. Among white women on Medicare, reports of osteoporosis screening climbed from 36% in 2001 to 67% in 2006. Among Hispanic women on Medicare, screening increased from 22% to 55%. Black women on Medicare had screening increase from 16% to 38%. The data come from the agency's 2009 National Healthcare Disparities Report.

State's Abortion Law Challenged

The Center for Reproductive Rights is seeking to overturn a new Oklahoma law that requires a woman seeking an abortion to first have an ultrasound whose image is then shown to her by a physician. The Center for Reproductive Rights says the law intrudes on patient privacy. Although Oklahoma is not the first state to require that an ultrasound be performed before an abortion, its law is the most extreme, the center charged, because it requires a physician to describe the image in detail, even if the woman objects. The law also offers no exemption for victims of rape or incest. “Politicians have no business making medical decisions,” center staff attorney Stephanie Toti said in a statement. The Oklahoma legislature triggered the ultrasound requirement in April by overriding a veto by Gov. Brad Henry (D). At the same time, another veto override made it impossible for Oklahoma women and their families to sue a physician who withholds information about a fetal abnormality.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement. In March 2009, President Obama issued an executive order removing some previous barriers to federal funding of stem cell research

Abortion Rate High Among Poor

In 2008, the abortion rate among poor women was more than twice that of women in higher income brackets, according to a report from the Guttmacher Institute. And the proportion of abortion patients who were poor increased from 27% in 2000 to 42% in 2008. The findings are from the institute's fourth national survey of abortion patients, which includes responses from more than 9,400 women who had abortions between April 2008 and May 2009. The results indicate that abortion is becoming more concentrated among women with incomes below the federal poverty level, according to the institute. The change may be due to both the economic recession and increased efforts by abortion providers to make services available to poor women, according to the report, available online at

www.guttmacher.org/pubs/US-Abortion-Patients.pdf

Women Know Little About Stroke

A survey has found that few women could name the primary stroke symptoms and many weren't concerned about experiencing a stroke in their lifetimes. The online survey of about 2,000 adult women was commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians. The findings showed that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). About only 30% of the participants were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pled guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Medicare Weighs Oxygen Coverage

Officials at the Centers for Medicare and Medicaid Services are considering Medicare coverage of home use of oxygen for cluster headache treatment. Currently, the program covers home oxygen only for patients with significant chronic stable hypoxemia. Last month, the American Academy of Neurology told the CMS that home oxygen is effective against cluster headaches, especially in the Medicare population. Other available cluster headache treatments, such as blood vessel constrictors and high-dose narcotics, may be contraindicated or pose dependency risks, Dr. Robert C. Griggs, AAN president, wrote in comments to the agency. Oxygen therapy, on the other hand, can be administered more than once a day without risk and is rapid in its effect, he said. The CMS is scheduled to propose a coverage decision in October and perhaps finalize it by next January.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH director Dr. Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement.

Women Know Little About Stroke

A survey has found that few women could name the primary stroke symptoms and many weren't concerned about experiencing a stroke in their lifetimes. The online survey of about 2,000 adult women was commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians. The findings showed that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). About only 30% of the participants were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pled guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Medicare Weighs Oxygen Coverage

Officials at the Centers for Medicare and Medicaid Services are considering Medicare coverage of home use of oxygen for cluster headache treatment. Currently, the program covers home oxygen only for patients with significant chronic stable hypoxemia. Last month, the American Academy of Neurology told the CMS that home oxygen is effective against cluster headaches, especially in the Medicare population. Other available cluster headache treatments, such as blood vessel constrictors and high-dose narcotics, may be contraindicated or pose dependency risks, Dr. Robert C. Griggs, AAN president, wrote in comments to the agency. Oxygen therapy, on the other hand, can be administered more than once a day without risk and is rapid in its effect, he said. The CMS is scheduled to propose a coverage decision in October and perhaps finalize it by next January.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH director Dr. Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement.

Women Know Little About Stroke

A survey has found that few women could name the primary stroke symptoms and many weren't concerned about experiencing a stroke in their lifetimes. The online survey of about 2,000 adult women was commissioned by HealthyWomen, the National Stroke Association, and the American College of Emergency Physicians. The findings showed that only 27% of women could name more than two of the six primary stroke symptoms (sudden numbness or weakness on one side of the face; sudden numbness or weakness in an arm or leg; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; sudden severe headache with no known cause). About only 30% of the participants were aware that women are at higher risk for stroke than men. “The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues,” Elizabeth Battaglino Cahill, executive director of HealthyWomen, said in a statement. “As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems like stroke.” The biotech company Genentech Inc. provided support for the survey.

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pled guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Medicare Weighs Oxygen Coverage

Officials at the Centers for Medicare and Medicaid Services are considering Medicare coverage of home use of oxygen for cluster headache treatment. Currently, the program covers home oxygen only for patients with significant chronic stable hypoxemia. Last month, the American Academy of Neurology told the CMS that home oxygen is effective against cluster headaches, especially in the Medicare population. Other available cluster headache treatments, such as blood vessel constrictors and high-dose narcotics, may be contraindicated or pose dependency risks, Dr. Robert C. Griggs, AAN president, wrote in comments to the agency. Oxygen therapy, on the other hand, can be administered more than once a day without risk and is rapid in its effect, he said. The CMS is scheduled to propose a coverage decision in October and perhaps finalize it by next January.

New Stem Cell Lines Okayed

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for research supported by federal funding. The lines have also been added to the NIH stem cell registry, which now includes 64 lines eligible for federal research funding. Another 100 lines are pending approval at the NIH. Four of the new stem cell lines were originally approved during the George W. Bush administration, and two of those lines have been widely used by researchers, according to the announcement. NIH director Dr. Francis S. Collins said the approval of these older lines should provide reassurance to many researchers. “Scientists can continue their studies without interruption, and we can all be assured that valuable work will not be lost,” Dr. Collins said in a statement.