Mary Ellen Schneider

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 settlement reached last year.

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 (UHG) 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 UHG conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UHG 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.

The company also 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. Physicians also 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, according to the AMA.

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

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 settlement reached last year.

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 (UHG) 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 UHG conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UHG 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.

The company also 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. Physicians also 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, according to the AMA.

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

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 settlement reached last year.

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 (UHG) 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 UHG conspired to systematically underpay physicians for out-of-network medical services by using an industry database of charges to justify lower reimbursements.

Last year, UHG 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.

The company also 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. Physicians also 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, according to the AMA.

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

The Federal Trade Commission has again delayed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they are required to 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 Federal Trade Commission has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and subsequently 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 also has 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 delayed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they are required to 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 Federal Trade Commission has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and subsequently 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 also has 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 delayed enforcement of the “Red Flags” rule, giving physicians until the end of 2010 before they are required to 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 Federal Trade Commission has delayed enforcement of the rule several times, first to give organizations more time to get familiar with the requirements and subsequently 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 also has 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.”

TORONTO — The American College of Physicians will soon begin issuing recommendations aimed at eliminating overused and misused diagnostic studies and treatments that do nothing to improve patient care.

The High-Value, Cost-Conscious Care Initiative, which was launched at the ACP's annual meeting in April, will compare treatments and diagnostics for a number of diseases and assess their benefits, harms, and costs. The ACP's Clinical Efficacy Assessment Technical Advisory Committee will make the recommendations and submit them to the Annals of Internal Medicine for publication.

They plan to start with the “low-hanging fruit” in health care where there is already sufficient evidence to make recommendations, ACP leaders said. These recommendations could include evaluations of the appropriateness of certain preoperative screening tests, for example.

“We feel that physicians really need to understand the value of different diagnostic and treatment strategies relative to each other and relative to the costs that are incurred,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP. “At the same time, patients must have sufficient information to make informed choices in conjunction with their physician's advice.”

Cost will be a factor in the ACP's assessment of treatments and diagnostics, but this is not rationing, Dr. Weinberger said. Instead, he called it a “rational” approach. For example, if treatment A is more effective than treatment B, but costs more, the ACP would not recommend limiting access to treatment A, he said.

But the ACP is staying away from thornier situations such as when treatment A is more effective and more costly, but treatment B is less expensive and also a good option for patients. Instead, Dr. Weinberger said the ACP plans to focus specifically on issues of overuse and misuse of ineffective treatments. That approach could yield real savings for the health care system. The Congressional Budget Office estimates that the United States spends as much as $700 billion per year on tests and procedures that do not improve health outcomes.

There are several factors that drive overuse and inappropriate use of treatments and diagnostics, Dr. Weinberger said, including the reflexive practice of medicine, defensive medicine, and patient expectations. In addition, the U.S. health care system has financial and cultural incentives to do more, not less, said Dr. Paul G. Shekelle, chair of the ACP's Clinical Efficacy Assessment Technical Advisory Committee. “As we've found, sometimes doing more isn't necessarily always doing better,” he said.

One potential benefit of the initiative is that it could help to better educate patients, according to Dr. Joseph Stubbs, president of the ACP. Dr. Stubbs, who practices internal medicine in Albany, Ga., said he often sees patients spending a lot of time and money on over-the-counter and supplement products whose benefits aren't supported by evidence. Although the per-pill cost may not be much, he said he hopes that if these patients stopped taking ineffective OTC remedies they would be more compliant with prescribed treatments that have a proven benefit. “That would be a significant step in the right direction,” he said.

As part of the new initiative, the ACP will also make changes to the next edition of its Medical Self-Assessment Program, which will include a focus on optimal diagnostic and treatment strategies, based on considerations of value, effectiveness, and avoidance of overuse and misuse. The ACP also plans to develop patient education materials and curricula for medical students and residents.

Because the initiative is a high priority for the ACP, the organization will initially fund the effort entirely through its own operating funds. However, Dr. Weinberger said they hope to get outside funding as the initiative is expanded to develop curricula for medical schools and residency programs.

The effort should compliment comparative effectiveness research being conducted by the Agency for Healthcare Research and Quality, according to Dr. Shekelle. Ideally, the AHRQ will develop the evidence base and the ACP will disseminate practical recommendations and guidelines, he said.

Dr. Steven E. Weinberger (left) and Dr. Paul G. Shekelle aim to complement the AHQR's effectiveness research.

Source Calvin Pierce/Elsevier Global Medical News

My Take

Better Info Aids Decision Making

While physicians generally recognize the need to tailor their diagnostic and treatment recommendations to the individual patient, most thoughtful physicians also understand the need to avoid wasteful or ineffective care. A great deal of attention is being properly given to the need for practitioners to consider the value of the services that they recommend, and it is laudable that responsible private sector organizations such as the American College of Physicians are stepping forward to provide physicians with better information to help them make correct decisions consistent with their patients' goals and desires.

ALAN R. NELSON, M.D., is a special consultant to the CEO of the American College of Physicians.

TORONTO — The American College of Physicians will soon begin issuing recommendations aimed at eliminating overused and misused diagnostic studies and treatments that do nothing to improve patient care.

The High-Value, Cost-Conscious Care Initiative, which was launched at the ACP's annual meeting in April, will compare treatments and diagnostics for a number of diseases and assess their benefits, harms, and costs. The ACP's Clinical Efficacy Assessment Technical Advisory Committee will make the recommendations and submit them to the Annals of Internal Medicine for publication.

They plan to start with the “low-hanging fruit” in health care where there is already sufficient evidence to make recommendations, ACP leaders said. These recommendations could include evaluations of the appropriateness of certain preoperative screening tests, for example.

“We feel that physicians really need to understand the value of different diagnostic and treatment strategies relative to each other and relative to the costs that are incurred,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP. “At the same time, patients must have sufficient information to make informed choices in conjunction with their physician's advice.”

Cost will be a factor in the ACP's assessment of treatments and diagnostics, but this is not rationing, Dr. Weinberger said. Instead, he called it a “rational” approach. For example, if treatment A is more effective than treatment B, but costs more, the ACP would not recommend limiting access to treatment A, he said.

But the ACP is staying away from thornier situations such as when treatment A is more effective and more costly, but treatment B is less expensive and also a good option for patients. Instead, Dr. Weinberger said the ACP plans to focus specifically on issues of overuse and misuse of ineffective treatments. That approach could yield real savings for the health care system. The Congressional Budget Office estimates that the United States spends as much as $700 billion per year on tests and procedures that do not improve health outcomes.

There are several factors that drive overuse and inappropriate use of treatments and diagnostics, Dr. Weinberger said, including the reflexive practice of medicine, defensive medicine, and patient expectations. In addition, the U.S. health care system has financial and cultural incentives to do more, not less, said Dr. Paul G. Shekelle, chair of the ACP's Clinical Efficacy Assessment Technical Advisory Committee. “As we've found, sometimes doing more isn't necessarily always doing better,” he said.

One potential benefit of the initiative is that it could help to better educate patients, according to Dr. Joseph Stubbs, president of the ACP. Dr. Stubbs, who practices internal medicine in Albany, Ga., said he often sees patients spending a lot of time and money on over-the-counter and supplement products whose benefits aren't supported by evidence. Although the per-pill cost may not be much, he said he hopes that if these patients stopped taking ineffective OTC remedies they would be more compliant with prescribed treatments that have a proven benefit. “That would be a significant step in the right direction,” he said.

As part of the new initiative, the ACP will also make changes to the next edition of its Medical Self-Assessment Program, which will include a focus on optimal diagnostic and treatment strategies, based on considerations of value, effectiveness, and avoidance of overuse and misuse. The ACP also plans to develop patient education materials and curricula for medical students and residents.

Because the initiative is a high priority for the ACP, the organization will initially fund the effort entirely through its own operating funds. However, Dr. Weinberger said they hope to get outside funding as the initiative is expanded to develop curricula for medical schools and residency programs.

The effort should compliment comparative effectiveness research being conducted by the Agency for Healthcare Research and Quality, according to Dr. Shekelle. Ideally, the AHRQ will develop the evidence base and the ACP will disseminate practical recommendations and guidelines, he said.

Dr. Steven E. Weinberger (left) and Dr. Paul G. Shekelle aim to complement the AHQR's effectiveness research.

Source Calvin Pierce/Elsevier Global Medical News

My Take

Better Info Aids Decision Making

While physicians generally recognize the need to tailor their diagnostic and treatment recommendations to the individual patient, most thoughtful physicians also understand the need to avoid wasteful or ineffective care. A great deal of attention is being properly given to the need for practitioners to consider the value of the services that they recommend, and it is laudable that responsible private sector organizations such as the American College of Physicians are stepping forward to provide physicians with better information to help them make correct decisions consistent with their patients' goals and desires.

ALAN R. NELSON, M.D., is a special consultant to the CEO of the American College of Physicians.

TORONTO — The American College of Physicians will soon begin issuing recommendations aimed at eliminating overused and misused diagnostic studies and treatments that do nothing to improve patient care.

The High-Value, Cost-Conscious Care Initiative, which was launched at the ACP's annual meeting in April, will compare treatments and diagnostics for a number of diseases and assess their benefits, harms, and costs. The ACP's Clinical Efficacy Assessment Technical Advisory Committee will make the recommendations and submit them to the Annals of Internal Medicine for publication.

They plan to start with the “low-hanging fruit” in health care where there is already sufficient evidence to make recommendations, ACP leaders said. These recommendations could include evaluations of the appropriateness of certain preoperative screening tests, for example.

“We feel that physicians really need to understand the value of different diagnostic and treatment strategies relative to each other and relative to the costs that are incurred,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP. “At the same time, patients must have sufficient information to make informed choices in conjunction with their physician's advice.”

Cost will be a factor in the ACP's assessment of treatments and diagnostics, but this is not rationing, Dr. Weinberger said. Instead, he called it a “rational” approach. For example, if treatment A is more effective than treatment B, but costs more, the ACP would not recommend limiting access to treatment A, he said.

But the ACP is staying away from thornier situations such as when treatment A is more effective and more costly, but treatment B is less expensive and also a good option for patients. Instead, Dr. Weinberger said the ACP plans to focus specifically on issues of overuse and misuse of ineffective treatments. That approach could yield real savings for the health care system. The Congressional Budget Office estimates that the United States spends as much as $700 billion per year on tests and procedures that do not improve health outcomes.

There are several factors that drive overuse and inappropriate use of treatments and diagnostics, Dr. Weinberger said, including the reflexive practice of medicine, defensive medicine, and patient expectations. In addition, the U.S. health care system has financial and cultural incentives to do more, not less, said Dr. Paul G. Shekelle, chair of the ACP's Clinical Efficacy Assessment Technical Advisory Committee. “As we've found, sometimes doing more isn't necessarily always doing better,” he said.

One potential benefit of the initiative is that it could help to better educate patients, according to Dr. Joseph Stubbs, president of the ACP. Dr. Stubbs, who practices internal medicine in Albany, Ga., said he often sees patients spending a lot of time and money on over-the-counter and supplement products whose benefits aren't supported by evidence. Although the per-pill cost may not be much, he said he hopes that if these patients stopped taking ineffective OTC remedies they would be more compliant with prescribed treatments that have a proven benefit. “That would be a significant step in the right direction,” he said.

As part of the new initiative, the ACP will also make changes to the next edition of its Medical Self-Assessment Program, which will include a focus on optimal diagnostic and treatment strategies, based on considerations of value, effectiveness, and avoidance of overuse and misuse. The ACP also plans to develop patient education materials and curricula for medical students and residents.

Because the initiative is a high priority for the ACP, the organization will initially fund the effort entirely through its own operating funds. However, Dr. Weinberger said they hope to get outside funding as the initiative is expanded to develop curricula for medical schools and residency programs.

The effort should compliment comparative effectiveness research being conducted by the Agency for Healthcare Research and Quality, according to Dr. Shekelle. Ideally, the AHRQ will develop the evidence base and the ACP will disseminate practical recommendations and guidelines, he said.

Dr. Steven E. Weinberger (left) and Dr. Paul G. Shekelle aim to complement the AHQR's effectiveness research.

Source Calvin Pierce/Elsevier Global Medical News

My Take

Better Info Aids Decision Making

While physicians generally recognize the need to tailor their diagnostic and treatment recommendations to the individual patient, most thoughtful physicians also understand the need to avoid wasteful or ineffective care. A great deal of attention is being properly given to the need for practitioners to consider the value of the services that they recommend, and it is laudable that responsible private sector organizations such as the American College of Physicians are stepping forward to provide physicians with better information to help them make correct decisions consistent with their patients' goals and desires.

ALAN R. NELSON, M.D., is a special consultant to the CEO of the American College of Physicians.

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 group's 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.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states do their part to 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.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board is charged with presenting proposals to Congress that would slow the growth of spending and improve the quality of care. The IPAB's recommendations 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.

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 wasn't 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 spring. 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.

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 group's 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.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states do their part to 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.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board is charged with presenting proposals to Congress that would slow the growth of spending and improve the quality of care. The IPAB's recommendations 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.

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 wasn't 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 spring. 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.

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 group's 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.

The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states do their part to 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.

The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board is charged with presenting proposals to Congress that would slow the growth of spending and improve the quality of care. The IPAB's recommendations 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.

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 wasn't 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 spring. 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.

Pay Increased for DXA

Starting June 1, Medicare is increasing payments for dual-energy x-ray absorptiometry services. With the increase, DXA payments will be slightly less than 70% of what they were in 2006, when Congress first mandated payment cuts. The current increase is required under the recently enacted Patient Protection and Affordable Care Act. The act increased payments for 2010 and 2011 and called for a study of the impact of past payment reductions. Officials at the Centers for Medicare and Medicaid Services said that procedures performed between Jan. 1 and May 31, 2010, will be retroactively paid at the higher rates, but details on handling those claims are still being worked out, according to the American College of Rheumatology. The college, which praised the increased DXA payment, estimates that the nonfacility fee for CPT code 77080 will rise from the current $45.21 to $97.92. The same service was paid at $143.32 in 2006.

Osteoporosis Screening Increases

The percentage of women aged 65 and older who are being screened for osteoporosis has risen dramatically, from 34% to 64% in 2001-2006, according to new data from the Agency for Healthcare Research and Quality. The increase occurred among all racial, ethnic, and income groups. However, the rise was the most pronounced among white and Hispanic women. Black women on Medicare had a screening increase from 16% to 38%.

Women Hear More About Lupus

Efforts to educate women about lupus through the media may be working, according to the results of a survey commissioned by the Ad Council and the Department of Health and Human Services. In an online survey of more than 400 women without lupus (aged 18-44 years) 15% said they had recently heard, seen, or read something about lupus, compared with 10% in 2009. Officials at the Ad Council and HHS have been working to raise awareness of lupus among young, minority women for the past year. “When we started this campaign, we faced a very limited awareness and knowledge about lupus among women at greatest risk,” Frances E. Ashe-Goins, acting director of the Office on Women's Health at HHS, said in a statement.

NIH OKs 13 Stem Cell Lines

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for federal funding. The lines have also been added to the NIH Stem Cell Registry. The registry now includes 64 stem cell lines that are eligible for federal funding. Another 100 lines are pending approval at NIH. Four of the recently approved stem cell lines were originally approved under the Bush administration, and two of them were widely used by researchers over the years, said the NIH. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to researchers who have been working with lines developed earlier. “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.

Providers Asked to Find 'Bad Ads'

The FDA has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the agency said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report any potential violation in drug promotion by sending an e-mail to

badad@fda.gov

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the DHHS to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, whereas the Indiana Health Information Exchange in Indianapolis—the largest health information exchange in the country—received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

Pay Increased for DXA

Starting June 1, Medicare is increasing payments for dual-energy x-ray absorptiometry services. With the increase, DXA payments will be slightly less than 70% of what they were in 2006, when Congress first mandated payment cuts. The current increase is required under the recently enacted Patient Protection and Affordable Care Act. The act increased payments for 2010 and 2011 and called for a study of the impact of past payment reductions. Officials at the Centers for Medicare and Medicaid Services said that procedures performed between Jan. 1 and May 31, 2010, will be retroactively paid at the higher rates, but details on handling those claims are still being worked out, according to the American College of Rheumatology. The college, which praised the increased DXA payment, estimates that the nonfacility fee for CPT code 77080 will rise from the current $45.21 to $97.92. The same service was paid at $143.32 in 2006.

Osteoporosis Screening Increases

The percentage of women aged 65 and older who are being screened for osteoporosis has risen dramatically, from 34% to 64% in 2001-2006, according to new data from the Agency for Healthcare Research and Quality. The increase occurred among all racial, ethnic, and income groups. However, the rise was the most pronounced among white and Hispanic women. Black women on Medicare had a screening increase from 16% to 38%.

Women Hear More About Lupus

Efforts to educate women about lupus through the media may be working, according to the results of a survey commissioned by the Ad Council and the Department of Health and Human Services. In an online survey of more than 400 women without lupus (aged 18-44 years) 15% said they had recently heard, seen, or read something about lupus, compared with 10% in 2009. Officials at the Ad Council and HHS have been working to raise awareness of lupus among young, minority women for the past year. “When we started this campaign, we faced a very limited awareness and knowledge about lupus among women at greatest risk,” Frances E. Ashe-Goins, acting director of the Office on Women's Health at HHS, said in a statement.

NIH OKs 13 Stem Cell Lines

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for federal funding. The lines have also been added to the NIH Stem Cell Registry. The registry now includes 64 stem cell lines that are eligible for federal funding. Another 100 lines are pending approval at NIH. Four of the recently approved stem cell lines were originally approved under the Bush administration, and two of them were widely used by researchers over the years, said the NIH. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to researchers who have been working with lines developed earlier. “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.

Providers Asked to Find 'Bad Ads'

The FDA has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the agency said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report any potential violation in drug promotion by sending an e-mail to

badad@fda.gov

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the DHHS to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, whereas the Indiana Health Information Exchange in Indianapolis—the largest health information exchange in the country—received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

Pay Increased for DXA

Starting June 1, Medicare is increasing payments for dual-energy x-ray absorptiometry services. With the increase, DXA payments will be slightly less than 70% of what they were in 2006, when Congress first mandated payment cuts. The current increase is required under the recently enacted Patient Protection and Affordable Care Act. The act increased payments for 2010 and 2011 and called for a study of the impact of past payment reductions. Officials at the Centers for Medicare and Medicaid Services said that procedures performed between Jan. 1 and May 31, 2010, will be retroactively paid at the higher rates, but details on handling those claims are still being worked out, according to the American College of Rheumatology. The college, which praised the increased DXA payment, estimates that the nonfacility fee for CPT code 77080 will rise from the current $45.21 to $97.92. The same service was paid at $143.32 in 2006.

Osteoporosis Screening Increases

The percentage of women aged 65 and older who are being screened for osteoporosis has risen dramatically, from 34% to 64% in 2001-2006, according to new data from the Agency for Healthcare Research and Quality. The increase occurred among all racial, ethnic, and income groups. However, the rise was the most pronounced among white and Hispanic women. Black women on Medicare had a screening increase from 16% to 38%.

Women Hear More About Lupus

Efforts to educate women about lupus through the media may be working, according to the results of a survey commissioned by the Ad Council and the Department of Health and Human Services. In an online survey of more than 400 women without lupus (aged 18-44 years) 15% said they had recently heard, seen, or read something about lupus, compared with 10% in 2009. Officials at the Ad Council and HHS have been working to raise awareness of lupus among young, minority women for the past year. “When we started this campaign, we faced a very limited awareness and knowledge about lupus among women at greatest risk,” Frances E. Ashe-Goins, acting director of the Office on Women's Health at HHS, said in a statement.

NIH OKs 13 Stem Cell Lines

Officials at the National Institutes of Health have approved an additional 13 human embryonic stem cell lines for federal funding. The lines have also been added to the NIH Stem Cell Registry. The registry now includes 64 stem cell lines that are eligible for federal funding. Another 100 lines are pending approval at NIH. Four of the recently approved stem cell lines were originally approved under the Bush administration, and two of them were widely used by researchers over the years, said the NIH. NIH Director Francis S. Collins said the approval of these older lines should provide reassurance to researchers who have been working with lines developed earlier. “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.

Providers Asked to Find 'Bad Ads'

The FDA has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the agency said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report any potential violation in drug promotion by sending an e-mail to

badad@fda.gov

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the DHHS to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, whereas the Indiana Health Information Exchange in Indianapolis—the largest health information exchange in the country—received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

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. And 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 the 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 do not 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,” he added.

UnitedHealth Group estimates that the cost to permanently boost Medicaid payments to physicians would be about $63 billion from 2013 to 2019, with about $50 billion of that cost currently not funded by the health care reform law.

What needs to be avoided, Mr. Stevens said, is a new Medicaid “doc fix problem” in which the federal government or the states temporarily make adjustments to Medicaid physician payments after 2014 in the same way they have been heading off payment cuts in Medicare 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. And 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 the 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 do not 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,” he added.

UnitedHealth Group estimates that the cost to permanently boost Medicaid payments to physicians would be about $63 billion from 2013 to 2019, with about $50 billion of that cost currently not funded by the health care reform law.

What needs to be avoided, Mr. Stevens said, is a new Medicaid “doc fix problem” in which the federal government or the states temporarily make adjustments to Medicaid physician payments after 2014 in the same way they have been heading off payment cuts in Medicare 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. And 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 the 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 do not 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,” he added.

UnitedHealth Group estimates that the cost to permanently boost Medicaid payments to physicians would be about $63 billion from 2013 to 2019, with about $50 billion of that cost currently not funded by the health care reform law.

What needs to be avoided, Mr. Stevens said, is a new Medicaid “doc fix problem” in which the federal government or the states temporarily make adjustments to Medicaid physician payments after 2014 in the same way they have been heading off payment cuts in Medicare in recent years.

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

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

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

Pediatricians have spent the past several years watching their costs climb as their payments drop or stay flat.

While most national efforts have focused on trying to increase the reimbursement side, the Kentucky chapter of the American Academy of Pediatrics has worked out a group purchasing arrangement aimed at reducing costs on everything from medical supplies and equipment to computer hardware and construction materials.

“We realized that pediatricians out in the state quite often were paying quite a bit for medical supplies and vaccines, and there seemed to be a different pricing structure depending on the size of the practice,” said Dr. Rob Revelette, group purchasing chair at the Kentucky chapter of the AAP and the chapter's past president.

The Kentucky chapter's work goes back about 3.5 years, when officials there first started brainstorming about ways to pool the purchasing power of their more than 700 physician members to lower costs for supplies, especially vaccines.

They quickly discovered that even 700 physicians didn't have much leverage when negotiating with large national vendors. So they began investigating national group purchasing organizations, which negotiate prices with preferred vendors for their members.

After a lengthy process of submitting proposals and conducting interviews, the chapter chose to contract with Amerinet, a St. Louis–based group purchasing organization (GPO) that has been around since 1986.

“What we were aiming at was to be able to get a big organization behind us to support our efforts to reduce cost,” he said.

“Pediatricians, and all physicians, are really struggling.”

It's definitely been a lot of work, but Dr. Revelette said that since signing on with Amerinet about 1.5 years ago, pediatricians are saving money.

In his 10-pediatrician practice in Lexington, Dr. Revelette was able to save about 5% on a recent purchase of computer hardware, and he saved about 20% on medical supplies last year.

He's even saved on vaccines by making small adjustments in his purchases.

Finding a way to bring down vaccine costs has been a big focus of the chapter's group purchasing initiative. One way to do this is through competition.

Amerinet has contracts with three of the top vaccines makers (GlaxoSmithKline, Sanofi Pasteur, and Merck & Co.) and Dr. Revelette said they are trying to capitalize on that competition to bring down prices on any vaccines for which there is head-to-head competition among the manufacturers.

At the request of the Kentucky chapter, Amerinet also has set up a vaccine calculator: Physicians input the reimbursement they receive for vaccines, and the calculator automatically tabulates where they may be losing money.

Having the calculator means that pediatricians don't have to rely on vaccine sales reps to explain where they can save money, Dr. Revelette said.

The purchasing program is voluntary; so far, about 20-25 practices in the state have elected to sign up.

For physicians who have joined, the program is free and there are no loyalty clauses, which means that the practices can purchase supplies elsewhere if they can get a better deal. Although the Kentucky chapter itself did have to sign a 3-year contract with Amerinet, there are no costs incurred by the chapter either, Dr. Revelette said.

Physician practices and hospitals sign up as members of Amerinet, but the company earns its money by charging an administrative fee to the vendors for the promotion of their products. That fee is typically 1.5%-3.0%, and Amerinet returns a portion of the fee to the Kentucky AAP chapter.

Those funds go directly to support research and educational initiatives at the chapter, such as efforts to reduce childhood obesity.

Dr. Revelette would not reveal how much money the chapter has received so far, but he said that they hope to double their annual income based on the revenues from Amerinet.

This will help the chapter to fund activities they otherwise wouldn't be able to afford, he said.

Going forward, Dr. Revelette said they hope to fine-tune the model and offer it to other AAP chapters.

The interest is there, he said, but it is a challenge to convince practices to turn away from their current medical suppliers and consider a GPO.

Although Dr. Revelette said he has no intention of pushing the Amerinet product, he said that chapters should consider doing something to help their members.

“Overhead has increased and increased and increased over many years for pediatricians, he said.

“Our goal is to try to cut the cost side of this so that pediatricians are able to sustain their business and maintain the quality of care that they're giving their patients,” Dr. Revelette concluded.

Pediatricians have spent the past several years watching their costs climb as their payments drop or stay flat.

While most national efforts have focused on trying to increase the reimbursement side, the Kentucky chapter of the American Academy of Pediatrics has worked out a group purchasing arrangement aimed at reducing costs on everything from medical supplies and equipment to computer hardware and construction materials.

“We realized that pediatricians out in the state quite often were paying quite a bit for medical supplies and vaccines, and there seemed to be a different pricing structure depending on the size of the practice,” said Dr. Rob Revelette, group purchasing chair at the Kentucky chapter of the AAP and the chapter's past president.

The Kentucky chapter's work goes back about 3.5 years, when officials there first started brainstorming about ways to pool the purchasing power of their more than 700 physician members to lower costs for supplies, especially vaccines.

They quickly discovered that even 700 physicians didn't have much leverage when negotiating with large national vendors. So they began investigating national group purchasing organizations, which negotiate prices with preferred vendors for their members.

After a lengthy process of submitting proposals and conducting interviews, the chapter chose to contract with Amerinet, a St. Louis–based group purchasing organization (GPO) that has been around since 1986.

“What we were aiming at was to be able to get a big organization behind us to support our efforts to reduce cost,” he said.

“Pediatricians, and all physicians, are really struggling.”

It's definitely been a lot of work, but Dr. Revelette said that since signing on with Amerinet about 1.5 years ago, pediatricians are saving money.

In his 10-pediatrician practice in Lexington, Dr. Revelette was able to save about 5% on a recent purchase of computer hardware, and he saved about 20% on medical supplies last year.

He's even saved on vaccines by making small adjustments in his purchases.

Finding a way to bring down vaccine costs has been a big focus of the chapter's group purchasing initiative. One way to do this is through competition.

Amerinet has contracts with three of the top vaccines makers (GlaxoSmithKline, Sanofi Pasteur, and Merck & Co.) and Dr. Revelette said they are trying to capitalize on that competition to bring down prices on any vaccines for which there is head-to-head competition among the manufacturers.

At the request of the Kentucky chapter, Amerinet also has set up a vaccine calculator: Physicians input the reimbursement they receive for vaccines, and the calculator automatically tabulates where they may be losing money.

Having the calculator means that pediatricians don't have to rely on vaccine sales reps to explain where they can save money, Dr. Revelette said.

The purchasing program is voluntary; so far, about 20-25 practices in the state have elected to sign up.

For physicians who have joined, the program is free and there are no loyalty clauses, which means that the practices can purchase supplies elsewhere if they can get a better deal. Although the Kentucky chapter itself did have to sign a 3-year contract with Amerinet, there are no costs incurred by the chapter either, Dr. Revelette said.

Physician practices and hospitals sign up as members of Amerinet, but the company earns its money by charging an administrative fee to the vendors for the promotion of their products. That fee is typically 1.5%-3.0%, and Amerinet returns a portion of the fee to the Kentucky AAP chapter.

Those funds go directly to support research and educational initiatives at the chapter, such as efforts to reduce childhood obesity.

Dr. Revelette would not reveal how much money the chapter has received so far, but he said that they hope to double their annual income based on the revenues from Amerinet.

This will help the chapter to fund activities they otherwise wouldn't be able to afford, he said.

Going forward, Dr. Revelette said they hope to fine-tune the model and offer it to other AAP chapters.

The interest is there, he said, but it is a challenge to convince practices to turn away from their current medical suppliers and consider a GPO.

Although Dr. Revelette said he has no intention of pushing the Amerinet product, he said that chapters should consider doing something to help their members.

“Overhead has increased and increased and increased over many years for pediatricians, he said.

“Our goal is to try to cut the cost side of this so that pediatricians are able to sustain their business and maintain the quality of care that they're giving their patients,” Dr. Revelette concluded.

Pediatricians have spent the past several years watching their costs climb as their payments drop or stay flat.

While most national efforts have focused on trying to increase the reimbursement side, the Kentucky chapter of the American Academy of Pediatrics has worked out a group purchasing arrangement aimed at reducing costs on everything from medical supplies and equipment to computer hardware and construction materials.

“We realized that pediatricians out in the state quite often were paying quite a bit for medical supplies and vaccines, and there seemed to be a different pricing structure depending on the size of the practice,” said Dr. Rob Revelette, group purchasing chair at the Kentucky chapter of the AAP and the chapter's past president.

The Kentucky chapter's work goes back about 3.5 years, when officials there first started brainstorming about ways to pool the purchasing power of their more than 700 physician members to lower costs for supplies, especially vaccines.

They quickly discovered that even 700 physicians didn't have much leverage when negotiating with large national vendors. So they began investigating national group purchasing organizations, which negotiate prices with preferred vendors for their members.

After a lengthy process of submitting proposals and conducting interviews, the chapter chose to contract with Amerinet, a St. Louis–based group purchasing organization (GPO) that has been around since 1986.

“What we were aiming at was to be able to get a big organization behind us to support our efforts to reduce cost,” he said.

“Pediatricians, and all physicians, are really struggling.”

It's definitely been a lot of work, but Dr. Revelette said that since signing on with Amerinet about 1.5 years ago, pediatricians are saving money.

In his 10-pediatrician practice in Lexington, Dr. Revelette was able to save about 5% on a recent purchase of computer hardware, and he saved about 20% on medical supplies last year.

He's even saved on vaccines by making small adjustments in his purchases.

Finding a way to bring down vaccine costs has been a big focus of the chapter's group purchasing initiative. One way to do this is through competition.

Amerinet has contracts with three of the top vaccines makers (GlaxoSmithKline, Sanofi Pasteur, and Merck & Co.) and Dr. Revelette said they are trying to capitalize on that competition to bring down prices on any vaccines for which there is head-to-head competition among the manufacturers.

At the request of the Kentucky chapter, Amerinet also has set up a vaccine calculator: Physicians input the reimbursement they receive for vaccines, and the calculator automatically tabulates where they may be losing money.

Having the calculator means that pediatricians don't have to rely on vaccine sales reps to explain where they can save money, Dr. Revelette said.

The purchasing program is voluntary; so far, about 20-25 practices in the state have elected to sign up.

For physicians who have joined, the program is free and there are no loyalty clauses, which means that the practices can purchase supplies elsewhere if they can get a better deal. Although the Kentucky chapter itself did have to sign a 3-year contract with Amerinet, there are no costs incurred by the chapter either, Dr. Revelette said.

Physician practices and hospitals sign up as members of Amerinet, but the company earns its money by charging an administrative fee to the vendors for the promotion of their products. That fee is typically 1.5%-3.0%, and Amerinet returns a portion of the fee to the Kentucky AAP chapter.

Those funds go directly to support research and educational initiatives at the chapter, such as efforts to reduce childhood obesity.

Dr. Revelette would not reveal how much money the chapter has received so far, but he said that they hope to double their annual income based on the revenues from Amerinet.

This will help the chapter to fund activities they otherwise wouldn't be able to afford, he said.

Going forward, Dr. Revelette said they hope to fine-tune the model and offer it to other AAP chapters.

The interest is there, he said, but it is a challenge to convince practices to turn away from their current medical suppliers and consider a GPO.

Although Dr. Revelette said he has no intention of pushing the Amerinet product, he said that chapters should consider doing something to help their members.

“Overhead has increased and increased and increased over many years for pediatricians, he said.

“Our goal is to try to cut the cost side of this so that pediatricians are able to sustain their business and maintain the quality of care that they're giving their patients,” Dr. Revelette concluded.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning 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 some of the 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 was the interaction of people and technology.

According to Paul Egerman, who cochairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually in the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that 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, who is 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, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT (HIT) 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, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician's office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning 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 some of the 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 was the interaction of people and technology.

According to Paul Egerman, who cochairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually in the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that 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, who is 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, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT (HIT) 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, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician's office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning 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 some of the 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 was the interaction of people and technology.

According to Paul Egerman, who cochairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually in the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that 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, who is 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, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT (HIT) 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, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician's office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards.

Physicians have a new option this year for vaccinating patients aged 65 and older against seasonal influenza, but vaccine experts can't say for sure whether it will keep more people from getting the flu, according to findings in the Morbidity and Mortality Weekly Report.

On Dec. 23, 2009, the Food and Drug Administration licensed Sanofi-Pasteur's Fluzone High-Dose vaccine, an injectable inactivated trivalent influenza vaccine that provides four times the amount of antigen contained in standard flu vaccines. The aim is to increase the immune response among older adults, who are at greater risk for hospitalization and death from seasonal influenza. The new vaccine will be available for the first time in the 2010–2011 flu season.

Immunogenicity data from pre-licensure clinical trials showed that people aged 65 and older who received the high-dose vaccine had significantly higher hemagglutination inhibition titers against all three influenza virus strains, compared to the standard-dose Fluzone vaccine. While the higher immune response to vaccination generally correlates with protection against influenza, it is still unclear whether it will translate into fewer vaccine recipients getting the flu this year, according to the report (MMWR. 2010;59:485-6).

About 36% of 2,572 people who received Fluzone High-Dose reported injection-site pain in the week after receiving the vaccine, compared with 24% of 1,275 who received standard-dose Fluzone. However, the reactions were generally mild and didn't last long.

Physicians have a new option this year for vaccinating patients aged 65 and older against seasonal influenza, but vaccine experts can't say for sure whether it will keep more people from getting the flu, according to findings in the Morbidity and Mortality Weekly Report.

On Dec. 23, 2009, the Food and Drug Administration licensed Sanofi-Pasteur's Fluzone High-Dose vaccine, an injectable inactivated trivalent influenza vaccine that provides four times the amount of antigen contained in standard flu vaccines. The aim is to increase the immune response among older adults, who are at greater risk for hospitalization and death from seasonal influenza. The new vaccine will be available for the first time in the 2010–2011 flu season.

Immunogenicity data from pre-licensure clinical trials showed that people aged 65 and older who received the high-dose vaccine had significantly higher hemagglutination inhibition titers against all three influenza virus strains, compared to the standard-dose Fluzone vaccine. While the higher immune response to vaccination generally correlates with protection against influenza, it is still unclear whether it will translate into fewer vaccine recipients getting the flu this year, according to the report (MMWR. 2010;59:485-6).

About 36% of 2,572 people who received Fluzone High-Dose reported injection-site pain in the week after receiving the vaccine, compared with 24% of 1,275 who received standard-dose Fluzone. However, the reactions were generally mild and didn't last long.

Physicians have a new option this year for vaccinating patients aged 65 and older against seasonal influenza, but vaccine experts can't say for sure whether it will keep more people from getting the flu, according to findings in the Morbidity and Mortality Weekly Report.

On Dec. 23, 2009, the Food and Drug Administration licensed Sanofi-Pasteur's Fluzone High-Dose vaccine, an injectable inactivated trivalent influenza vaccine that provides four times the amount of antigen contained in standard flu vaccines. The aim is to increase the immune response among older adults, who are at greater risk for hospitalization and death from seasonal influenza. The new vaccine will be available for the first time in the 2010–2011 flu season.

Immunogenicity data from pre-licensure clinical trials showed that people aged 65 and older who received the high-dose vaccine had significantly higher hemagglutination inhibition titers against all three influenza virus strains, compared to the standard-dose Fluzone vaccine. While the higher immune response to vaccination generally correlates with protection against influenza, it is still unclear whether it will translate into fewer vaccine recipients getting the flu this year, according to the report (MMWR. 2010;59:485-6).

About 36% of 2,572 people who received Fluzone High-Dose reported injection-site pain in the week after receiving the vaccine, compared with 24% of 1,275 who received standard-dose Fluzone. However, the reactions were generally mild and didn't last long.