Mary Ellen Schneider

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 beginning last month, states could 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 don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that only about half of primary care physicians 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 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 at a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing.”

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 beginning last month, states could 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 don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that only about half of primary care physicians 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 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 at a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing.”

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 beginning last month, states could 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 don't already offer expanded coverage will be spending new money to pick up their share of covering new beneficiaries.

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that only about half of primary care physicians 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 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 at a news conference to discuss Medicaid expansion. “Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing.”

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.

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 a recent 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 prelicensure 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 with 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).

People who received the high-dose Fluzone vaccine were also more likely to experience injection site reactions and systemic adverse events following vaccination. For example, in a study of 2,572 people who received Fluzone High-Dose and 1,275 who received standard-dose Fluzone, about 36% of high-dose vaccine recipients reported injection site pain in the week after receiving the vaccine, compared with 24% of standard dose vaccine recipients. However, the reactions were generally mild and didn't last long.

The Advisory Committee on Immunization Practices (ACIP), which advises the Department of Health and Human Services on vaccine-related issues, has not expressed a preference for whether the new high-dose vaccine should be used over existing vaccines in the 65 and older population. ACIP officials are awaiting postlicensure data that will show whether the vaccine actually offers greater protection against influenza illness for older people.

The results of a 3-year postlicensure study on Fluzone High-Dose, compared with standard-dose Fluzone, are expected sometime in 2012, the report said.

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 a recent 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 prelicensure 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 with 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).

People who received the high-dose Fluzone vaccine were also more likely to experience injection site reactions and systemic adverse events following vaccination. For example, in a study of 2,572 people who received Fluzone High-Dose and 1,275 who received standard-dose Fluzone, about 36% of high-dose vaccine recipients reported injection site pain in the week after receiving the vaccine, compared with 24% of standard dose vaccine recipients. However, the reactions were generally mild and didn't last long.

The Advisory Committee on Immunization Practices (ACIP), which advises the Department of Health and Human Services on vaccine-related issues, has not expressed a preference for whether the new high-dose vaccine should be used over existing vaccines in the 65 and older population. ACIP officials are awaiting postlicensure data that will show whether the vaccine actually offers greater protection against influenza illness for older people.

The results of a 3-year postlicensure study on Fluzone High-Dose, compared with standard-dose Fluzone, are expected sometime in 2012, the report said.

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 a recent 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 prelicensure 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 with 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).

People who received the high-dose Fluzone vaccine were also more likely to experience injection site reactions and systemic adverse events following vaccination. For example, in a study of 2,572 people who received Fluzone High-Dose and 1,275 who received standard-dose Fluzone, about 36% of high-dose vaccine recipients reported injection site pain in the week after receiving the vaccine, compared with 24% of standard dose vaccine recipients. However, the reactions were generally mild and didn't last long.

The Advisory Committee on Immunization Practices (ACIP), which advises the Department of Health and Human Services on vaccine-related issues, has not expressed a preference for whether the new high-dose vaccine should be used over existing vaccines in the 65 and older population. ACIP officials are awaiting postlicensure data that will show whether the vaccine actually offers greater protection against influenza illness for older people.

The results of a 3-year postlicensure study on Fluzone High-Dose, compared with standard-dose Fluzone, are expected sometime in 2012, the report 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 organization's wish list are changes to the Independent Payment Advisory Board (IPAB) created by the law, making permanent the boost in primary care payment rates under Medicare and Medicaid, and eliminating newly created penalties for failing to report quality data to Medicare.

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

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. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

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

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

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

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures. Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012–2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it 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.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work. The campaign will include practical information on issues such as the Medicare doughnut hole.

'Health care reform is an ongoing journey. It's not a destination.'

Source: Robert B. Doherty

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

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

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

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. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

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

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

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

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures. Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012–2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it 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.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work. The campaign will include practical information on issues such as the Medicare doughnut hole.

'Health care reform is an ongoing journey. It's not a destination.'

Source: Robert B. Doherty

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

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

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

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. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.

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

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

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

The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures. Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012–2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.

One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it 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.

The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work. The campaign will include practical information on issues such as the Medicare doughnut hole.

'Health care reform is an ongoing journey. It's not a destination.'

Source: Robert B. Doherty

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 at the annual meeting. These recommendations, which will be issued in the next few months, could include evaluations of the appropriateness of certain preoperative screening tests, for example. Additional recommendations will follow over the next several months.

“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.

Another part of the problem is that 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. “All the things in America point toward doing more, and yet 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. While 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 Knowledge Self-Assessment Program (MKSAP). The upcoming MKSAP edition 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.

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 at the annual meeting. These recommendations, which will be issued in the next few months, could include evaluations of the appropriateness of certain preoperative screening tests, for example. Additional recommendations will follow over the next several months.

“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.

Another part of the problem is that 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. “All the things in America point toward doing more, and yet 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. While 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 Knowledge Self-Assessment Program (MKSAP). The upcoming MKSAP edition 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.

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 at the annual meeting. These recommendations, which will be issued in the next few months, could include evaluations of the appropriateness of certain preoperative screening tests, for example. Additional recommendations will follow over the next several months.

“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.

Another part of the problem is that 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. “All the things in America point toward doing more, and yet 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. While 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 Knowledge Self-Assessment Program (MKSAP). The upcoming MKSAP edition 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.

Cost is the major stumbling block in passing a permanent fix for the formula that determines physician reimbursement under Medicare. The Congressional Budget Office recently estimated that the price tag for replacing the Sustainable Growth Rate (SGR) formula would be more than $200 billion. But now physicians are making the case that the government can’t afford not to fix the problem.

The American Medical Association is running a new print ad in Capitol Hill newspapers all this month urging Congress to enact a permanent repeal of the SGR before the price goes up. The ad notes that in 3 years, the cost will rise to $396 billion and to $513 billion in 5 years.

Physicians are looking for action from lawmakers before Congress recesses for Memorial Day weekend. The current formula calls for Medicare payments to physicians to be cut by 21% starting on June 1.

Do you think Congress will replace the SGR permanently or continue to pass short-term fixes that delay the payment cuts?

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

Cost is the major stumbling block in passing a permanent fix for the formula that determines physician reimbursement under Medicare. The Congressional Budget Office recently estimated that the price tag for replacing the Sustainable Growth Rate (SGR) formula would be more than $200 billion. But now physicians are making the case that the government can’t afford not to fix the problem.

The American Medical Association is running a new print ad in Capitol Hill newspapers all this month urging Congress to enact a permanent repeal of the SGR before the price goes up. The ad notes that in 3 years, the cost will rise to $396 billion and to $513 billion in 5 years.

Physicians are looking for action from lawmakers before Congress recesses for Memorial Day weekend. The current formula calls for Medicare payments to physicians to be cut by 21% starting on June 1.

Do you think Congress will replace the SGR permanently or continue to pass short-term fixes that delay the payment cuts?

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

Cost is the major stumbling block in passing a permanent fix for the formula that determines physician reimbursement under Medicare. The Congressional Budget Office recently estimated that the price tag for replacing the Sustainable Growth Rate (SGR) formula would be more than $200 billion. But now physicians are making the case that the government can’t afford not to fix the problem.

The American Medical Association is running a new print ad in Capitol Hill newspapers all this month urging Congress to enact a permanent repeal of the SGR before the price goes up. The ad notes that in 3 years, the cost will rise to $396 billion and to $513 billion in 5 years.

Physicians are looking for action from lawmakers before Congress recesses for Memorial Day weekend. The current formula calls for Medicare payments to physicians to be cut by 21% starting on June 1.

Do you think Congress will replace the SGR permanently or continue to pass short-term fixes that delay the payment cuts?

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

TORONTO - For electronic health records to have real value, physicians need to use them to improve quality, and not just to improve documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. Released in April during the ACP's annual meeting, the paper outlines several objectives to maximize the use of EHRs for reporting quality measures. For example, EHR-based quality reporting should use only those measures that are clinically relevant and that help improve outcomes.

The ACP also advised that any EHR-based measurement should be based on information that is routinely collected during a visit, including data provided by patients themselves. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

It's critical that the collection of information does not create another administrative burden for physicians, said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement. "If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them the way we're talking about," he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This type of functionality would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. Dr. Stubbs said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and didn't receive any feedback until October 2009.

"That kind of feedback 1 year later on something that happened the year before is not a very helpful thing in terms of helping me to figure out how to improve the population of patients that I manage," Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

The other hurdle for implementing widespread use of EHRs for quality reporting is the physician payment system. The current volume-based payment system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. "Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record," he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program, a Web site that will provide comparisons of EHR products, information on physician experiences with the technology, and opportunities for online social networking.

The resources will be free and open to all physicians, not just ACP members. AmericanEHR Partners is expected to be live by early June.

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes "meaningful use" of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. "That would do more to destroy the effort than anything," Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch, medical director for ambulatory, EHR, and health IT policy at MedStar Health in the Baltimore-Washington area. The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain "unintended trip wires" that even advanced users of EHRs probably can't overcome, he said.

But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

"These are dollars they do want to pay out," he said. "They do want to make this reasonable for doctors to do."

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, Dr. Basch said.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, he said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. "Most of us tend to undercode, and EHRs can help us with coding," Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. "As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people," he said.

TORONTO - For electronic health records to have real value, physicians need to use them to improve quality, and not just to improve documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. Released in April during the ACP's annual meeting, the paper outlines several objectives to maximize the use of EHRs for reporting quality measures. For example, EHR-based quality reporting should use only those measures that are clinically relevant and that help improve outcomes.

The ACP also advised that any EHR-based measurement should be based on information that is routinely collected during a visit, including data provided by patients themselves. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

It's critical that the collection of information does not create another administrative burden for physicians, said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement. "If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them the way we're talking about," he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This type of functionality would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. Dr. Stubbs said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and didn't receive any feedback until October 2009.

"That kind of feedback 1 year later on something that happened the year before is not a very helpful thing in terms of helping me to figure out how to improve the population of patients that I manage," Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

The other hurdle for implementing widespread use of EHRs for quality reporting is the physician payment system. The current volume-based payment system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. "Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record," he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program, a Web site that will provide comparisons of EHR products, information on physician experiences with the technology, and opportunities for online social networking.

The resources will be free and open to all physicians, not just ACP members. AmericanEHR Partners is expected to be live by early June.

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes "meaningful use" of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. "That would do more to destroy the effort than anything," Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch, medical director for ambulatory, EHR, and health IT policy at MedStar Health in the Baltimore-Washington area. The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain "unintended trip wires" that even advanced users of EHRs probably can't overcome, he said.

But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

"These are dollars they do want to pay out," he said. "They do want to make this reasonable for doctors to do."

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, Dr. Basch said.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, he said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. "Most of us tend to undercode, and EHRs can help us with coding," Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. "As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people," he said.

TORONTO - For electronic health records to have real value, physicians need to use them to improve quality, and not just to improve documentation and coding.

That's the message the American College of Physicians is sending to doctors, policy makers, and the health information technology industry with the release of a position paper on EHR-based quality measurement and reporting. Released in April during the ACP's annual meeting, the paper outlines several objectives to maximize the use of EHRs for reporting quality measures. For example, EHR-based quality reporting should use only those measures that are clinically relevant and that help improve outcomes.

The ACP also advised that any EHR-based measurement should be based on information that is routinely collected during a visit, including data provided by patients themselves. This will likely require EHR systems to include new functionalities that are not part of today's standard systems, such as practice-based registries that allow reporting on a population of patients, as well as connections to patient portals.

It's critical that the collection of information does not create another administrative burden for physicians, said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement. "If we layer additional processes onto the daily workload of doctors, especially without taking away other responsibilities, we won't get the potential of EHRs because physicians will not implement them the way we're talking about," he said.

The paper also emphasizes the need for EHRs to provide real-time clinical decision support systems that are linked to quality reporting. This type of functionality would allow physicians to get patient-specific recommendations after entering routine clinical information into the system.

This kind of real-time feedback has been lacking in current quality reporting programs such as Medicare's Physician Quality Reporting Initiative (PQRI), said Dr. Joseph W. Stubbs, ACP president. Dr. Stubbs said there is often a long lag time between when physicians report on measures and when they receive reports on their performance under PQRI. For example, he submitted his final 2008 quality measures in December 2008 and didn't receive any feedback until October 2009.

"That kind of feedback 1 year later on something that happened the year before is not a very helpful thing in terms of helping me to figure out how to improve the population of patients that I manage," Dr. Stubbs said.

Most current EHR systems can't provide the level of functionality described in the ACP's policy paper. But technology is not the major obstacle, Dr. Barr said. A bigger barrier is the cultural change required of each member of the clinical team in rethinking the office workflow as part of EHR implementation, he said.

The other hurdle for implementing widespread use of EHRs for quality reporting is the physician payment system. The current volume-based payment system doesn't allow physicians to be paid for actually improving quality, Dr. Stubbs said. "Without the business model for practicing better quality of care, it's an extraordinarily expensive prospect for physicians, particularly in small groups, to think about putting in an electronic health record," he said.

Despite these obstacles, the ACP is encouraging its members to adopt EHRs, and is launching new resources for evaluating the technology. At the annual meeting, the ACP demonstrated its new AmericanEHR Partners program, a Web site that will provide comparisons of EHR products, information on physician experiences with the technology, and opportunities for online social networking.

The resources will be free and open to all physicians, not just ACP members. AmericanEHR Partners is expected to be live by early June.

The focus on using EHRs for quality comes as the federal government is finalizing regulations on what constitutes "meaningful use" of EHRs, the standard for qualifying for Medicare and Medicaid incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Physicians who demonstrate meaningful use of certified EHR technology can earn up to $44,000 in bonus payments under Medicare starting in 2011. A similar program under Medicaid allows eligible physicians to earn nearly $64,000 in incentive payments.

Dr. Stubbs said the federal incentives could be a big boost for physicians looking to purchase EHR systems. But the success of the program depends on whether the meaningful use criteria can actually be achieved. The worst thing would be for physicians to invest money up front to purchase EHRs, but find out later that they fell short of meaningful use by one measure and thus won't get any incentive dollars. "That would do more to destroy the effort than anything," Dr. Stubbs said.

As written, the proposed rule on meaningful use is not achievable, said Dr. Peter Basch, medical director for ambulatory, EHR, and health IT policy at MedStar Health in the Baltimore-Washington area. The overall goals of meaningful use are reasonable, he said, but the details in the proposed rule raise concerns. Some of the metrics and thresholds in the rule contain "unintended trip wires" that even advanced users of EHRs probably can't overcome, he said.

But Dr. Basch, who also is a member of the ACP's Medical Informatics Subcommittee, said he is hopeful that the Centers for Medicare and Medicaid Services will modify the requirements in the final rule expected later this year, so that the average physician can achieve meaningful use in 2011 or 2012.

"These are dollars they do want to pay out," he said. "They do want to make this reasonable for doctors to do."

The return on investment that physicians can expect to see after implementing an electronic health record is likely to differ greatly based on the size of their practice, Dr. Basch said.

In large practices, physicians can anticipate significant cost reductions from elimination of chart pulls and improved intra-office communication. And such practices are likely to achieve savings from improvements in process throughput, coding, elimination of transcription, reductions in physician-to-staff ratios, and increased productivity, he said.

But the return on investment equation is quite different for small practices, Dr. Basch said. For example, small practices can't bank on saving much by reducing or eliminating chart pulls, because they typically keep charts right in the office and don't pay $8-$15 per chart pull the way large practices do. Small practices have the potential to reduce some staff following EHR adoption, but that won't happen immediately. Also, if the practice is already fairly lean there may not be much trimming of staff costs, he said.

The greatest potential for savings comes from better coding and the elimination of transcription. "Most of us tend to undercode, and EHRs can help us with coding," Dr. Basch said.

Small practices have additional obstacles when implementing an EHR, he noted. They generally don't have sufficient capital to invest in an expensive system, so they have to borrow money or take a reduction in income during the initial start-up period. Practices that aren't interested in taking out loans or reducing their income can consider an application service provider model, which essentially allows them to lease an EHR system. This isn't a good fit for every practice, Dr. Basch said, but it is attractive because it doesn't involve a large cash outlay upfront.

For practices considering the leasing approach, the monthly cost will be important. Those costs have typically ranged from $500 to $1,000 per month, but they appear to be coming down, Dr. Basch said. "As those monthly figures begin to move down because of market pressure, this could certainly make an EHR investment a lot more affordable for many, many people," he said.

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

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims are being mailed this month.

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, 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.

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

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims are being mailed this month.

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, 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.

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

The American Medical Association estimates that thousands of physicians will be eligible to be paid under the settlement. Notices with instructions for filing claims are being mailed this month.

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, 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 Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

The Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

The Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference on April 12.

HHS is seeking comment from states and health plans on issues including what types of methods states use to determine whether to approve a rate increase as well as whether special consideration should be given for certain types of plans such as HMOs or high-deductible plans.

Egg Donation $ Exceeds Limits

Despite guidelines that egg donor compensation not generally exceed $5,000, many agencies and private couples are advertising payouts of $10,000 and more. For one thing, the couples are willing to pay the highest prices for eggs from women with good SAT scores, according to a study published in the March-April issue of the Hastings Center Report. Aaron D. Levine of the Georgia Institute of Technology, Atlanta, analyzed 105 advertisements for egg donation from 63 different college newspapers. He found that about half offered compensation of $5,000 or less, in line with the guidelines from the American Society for Reproductive Medicine. The remaining ads, 52, promoted payments of more than $5,000. Under the society's guidelines, amounts between $5,000 and $10,000 require justification, and payments of more than $10,000 are not considered appropriate. The study noted that nearly a quarter of the ads offered compensation above $10,000, with one ad offering $50,000 for an “extraordinary egg donor.”

Clash Over Religion-Based Policies

Nearly 1 in 10 primary care physicians in the United States has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found. Younger and less religious physicians are more likely to experience conflicts than are older or more religious peers, the researchers reported. Most primary care physicians said that the best way to handle conflicts between clinical judgment and religious policy is to refer patients to another hospital.

Reducing Minority Teen Pregnancy

New federal legislation would aim pregnancy prevention programs at teenagers in minority communities. The need there is great, according to Rep. Lucille Roybal-Allard (D-Calif.), who sponsored the legislation. More than half of Hispanic and African American teen girls will become pregnant at least once before age 20, she said. The Communities of Color Teen Pregnancy Prevention Act of 2010 (H.R. 5033) would expand the number of competitive federal grants available for teen pregnancy programs in minority communities. It would also offer grants for research into the prevalence and social causes of pregnancy and births among minority teens. “While addressing teen sexual behavior is complex, we know that an effective strategy to reduce teen pregnancy in minority communities involves sexual health education that takes into consideration cultural and linguistic differences,” Rep. Roybal-Allard said in a statement.

What Is Sex?

Adults in their 20s have narrowed their definition of what it means to have sex, with only 20% of college students surveyed defining oral-genital contact as sex. That's compared with about 40% in similar surveys conducted in 1991 and 1999. These latest findings are based on online responses from 477 students at a large state university. The survey asked students about their views on whether they would say they “had sex” if they engaged in certain behaviors. While 98% defined penile-vaginal intercourse as sex, 78% defined penile-anal intercourse as sex. Those views are similar to the results in the earlier surveys. The attitude toward oral sex is significant, according to the study authors, because it carries significant risk for transmission of sexually transmitted diseases. Sex education programs need to give increased attention to oral-genital contact and provide preventive measures, the authors wrote. The study is available online and will be published in the June issue of Perspectives on Sexual and Reproductive Health.

U.N.: Maternal Health a Priority

The United Nations is working to create a plan to improve maternal and newborn health. The Joint Action Plan calls on governments, foundations, corporations, and U.N. agencies to address preventable deaths during childbirth. The U.N. estimates that each year hundreds of thousands of women and girls die during pregnancy and childbirth. An additional 10 million to 15 million of these women face illnesses or disabilities caused by pregnancy complications. “No woman should die bringing life into the world,” U.N. Secretary-General Ban Ki-moon said in a statement. “We must create a seamless continuum of care that helps to improve the health of women from pregnancy though childbirth and builds the foundation for a healthy society.” The secretary-general called on developed nations to increase their financial commitment to maternal and child health and for developing nations to make this area a real priority. The issue will be addressed at a U.N.-sponsored meeting in September.

Egg Donation $ Exceeds Limits

Despite guidelines that egg donor compensation not generally exceed $5,000, many agencies and private couples are advertising payouts of $10,000 and more. For one thing, the couples are willing to pay the highest prices for eggs from women with good SAT scores, according to a study published in the March-April issue of the Hastings Center Report. Aaron D. Levine of the Georgia Institute of Technology, Atlanta, analyzed 105 advertisements for egg donation from 63 different college newspapers. He found that about half offered compensation of $5,000 or less, in line with the guidelines from the American Society for Reproductive Medicine. The remaining ads, 52, promoted payments of more than $5,000. Under the society's guidelines, amounts between $5,000 and $10,000 require justification, and payments of more than $10,000 are not considered appropriate. The study noted that nearly a quarter of the ads offered compensation above $10,000, with one ad offering $50,000 for an “extraordinary egg donor.”

Clash Over Religion-Based Policies

Nearly 1 in 10 primary care physicians in the United States has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found. Younger and less religious physicians are more likely to experience conflicts than are older or more religious peers, the researchers reported. Most primary care physicians said that the best way to handle conflicts between clinical judgment and religious policy is to refer patients to another hospital.

Reducing Minority Teen Pregnancy

New federal legislation would aim pregnancy prevention programs at teenagers in minority communities. The need there is great, according to Rep. Lucille Roybal-Allard (D-Calif.), who sponsored the legislation. More than half of Hispanic and African American teen girls will become pregnant at least once before age 20, she said. The Communities of Color Teen Pregnancy Prevention Act of 2010 (H.R. 5033) would expand the number of competitive federal grants available for teen pregnancy programs in minority communities. It would also offer grants for research into the prevalence and social causes of pregnancy and births among minority teens. “While addressing teen sexual behavior is complex, we know that an effective strategy to reduce teen pregnancy in minority communities involves sexual health education that takes into consideration cultural and linguistic differences,” Rep. Roybal-Allard said in a statement.

What Is Sex?

Adults in their 20s have narrowed their definition of what it means to have sex, with only 20% of college students surveyed defining oral-genital contact as sex. That's compared with about 40% in similar surveys conducted in 1991 and 1999. These latest findings are based on online responses from 477 students at a large state university. The survey asked students about their views on whether they would say they “had sex” if they engaged in certain behaviors. While 98% defined penile-vaginal intercourse as sex, 78% defined penile-anal intercourse as sex. Those views are similar to the results in the earlier surveys. The attitude toward oral sex is significant, according to the study authors, because it carries significant risk for transmission of sexually transmitted diseases. Sex education programs need to give increased attention to oral-genital contact and provide preventive measures, the authors wrote. The study is available online and will be published in the June issue of Perspectives on Sexual and Reproductive Health.

U.N.: Maternal Health a Priority

The United Nations is working to create a plan to improve maternal and newborn health. The Joint Action Plan calls on governments, foundations, corporations, and U.N. agencies to address preventable deaths during childbirth. The U.N. estimates that each year hundreds of thousands of women and girls die during pregnancy and childbirth. An additional 10 million to 15 million of these women face illnesses or disabilities caused by pregnancy complications. “No woman should die bringing life into the world,” U.N. Secretary-General Ban Ki-moon said in a statement. “We must create a seamless continuum of care that helps to improve the health of women from pregnancy though childbirth and builds the foundation for a healthy society.” The secretary-general called on developed nations to increase their financial commitment to maternal and child health and for developing nations to make this area a real priority. The issue will be addressed at a U.N.-sponsored meeting in September.

Egg Donation $ Exceeds Limits

Despite guidelines that egg donor compensation not generally exceed $5,000, many agencies and private couples are advertising payouts of $10,000 and more. For one thing, the couples are willing to pay the highest prices for eggs from women with good SAT scores, according to a study published in the March-April issue of the Hastings Center Report. Aaron D. Levine of the Georgia Institute of Technology, Atlanta, analyzed 105 advertisements for egg donation from 63 different college newspapers. He found that about half offered compensation of $5,000 or less, in line with the guidelines from the American Society for Reproductive Medicine. The remaining ads, 52, promoted payments of more than $5,000. Under the society's guidelines, amounts between $5,000 and $10,000 require justification, and payments of more than $10,000 are not considered appropriate. The study noted that nearly a quarter of the ads offered compensation above $10,000, with one ad offering $50,000 for an “extraordinary egg donor.”

Clash Over Religion-Based Policies

Nearly 1 in 10 primary care physicians in the United States has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found. Younger and less religious physicians are more likely to experience conflicts than are older or more religious peers, the researchers reported. Most primary care physicians said that the best way to handle conflicts between clinical judgment and religious policy is to refer patients to another hospital.

Reducing Minority Teen Pregnancy

New federal legislation would aim pregnancy prevention programs at teenagers in minority communities. The need there is great, according to Rep. Lucille Roybal-Allard (D-Calif.), who sponsored the legislation. More than half of Hispanic and African American teen girls will become pregnant at least once before age 20, she said. The Communities of Color Teen Pregnancy Prevention Act of 2010 (H.R. 5033) would expand the number of competitive federal grants available for teen pregnancy programs in minority communities. It would also offer grants for research into the prevalence and social causes of pregnancy and births among minority teens. “While addressing teen sexual behavior is complex, we know that an effective strategy to reduce teen pregnancy in minority communities involves sexual health education that takes into consideration cultural and linguistic differences,” Rep. Roybal-Allard said in a statement.

What Is Sex?

Adults in their 20s have narrowed their definition of what it means to have sex, with only 20% of college students surveyed defining oral-genital contact as sex. That's compared with about 40% in similar surveys conducted in 1991 and 1999. These latest findings are based on online responses from 477 students at a large state university. The survey asked students about their views on whether they would say they “had sex” if they engaged in certain behaviors. While 98% defined penile-vaginal intercourse as sex, 78% defined penile-anal intercourse as sex. Those views are similar to the results in the earlier surveys. The attitude toward oral sex is significant, according to the study authors, because it carries significant risk for transmission of sexually transmitted diseases. Sex education programs need to give increased attention to oral-genital contact and provide preventive measures, the authors wrote. The study is available online and will be published in the June issue of Perspectives on Sexual and Reproductive Health.

U.N.: Maternal Health a Priority

The United Nations is working to create a plan to improve maternal and newborn health. The Joint Action Plan calls on governments, foundations, corporations, and U.N. agencies to address preventable deaths during childbirth. The U.N. estimates that each year hundreds of thousands of women and girls die during pregnancy and childbirth. An additional 10 million to 15 million of these women face illnesses or disabilities caused by pregnancy complications. “No woman should die bringing life into the world,” U.N. Secretary-General Ban Ki-moon said in a statement. “We must create a seamless continuum of care that helps to improve the health of women from pregnancy though childbirth and builds the foundation for a healthy society.” The secretary-general called on developed nations to increase their financial commitment to maternal and child health and for developing nations to make this area a real priority. The issue will be addressed at a U.N.-sponsored meeting in September.

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 federal Health IT Policy Committee, which makes recommendations to the 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 and security and privacy protocols, as well different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, 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 work group 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 on the scope of safety issues, the work group 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. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

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 federal Health IT Policy Committee, which makes recommendations to the 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 and security and privacy protocols, as well different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, 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 work group 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 on the scope of safety issues, the work group 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. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

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 federal Health IT Policy Committee, which makes recommendations to the 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 and security and privacy protocols, as well different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, 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 work group 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 on the scope of safety issues, the work group 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. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.