Mary Ellen Schneider

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually.

However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually.

However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health. But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually.

However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care. For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year. Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

The stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

The stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

The stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

E-prescribing Controlled Substances

Starting June 1, physicians will have the option of electronically prescribing controlled substances. The U.S. Drug Enforcement Administration said it wants clinicians to take advantage of new technology while maintaining the current control system. The agency also said that e-prescribing could reduce paperwork and forgery. The interim final rule outlines the security precautions, such ashphysician identity confirmationed by an authorized third party.

Topamax Case Settled for $81 Million

Two drug companies owned by Johnson & Johnson will pay more than $81 million to settle criminal and civil charges that they illegally promoted the epilepsy drug Topamax for off-label psychiatric uses. Under the agreement reached with the Department of Justice, Ortho-McNeil Pharmaceutical LLC will plead guilty to a misdemeanor and pay a $6 million criminal fine for promoting Topamax for psychiatric uses through its “Doctor-for-a-Day” program. Another Johnson & Johnson subsidiary, Ortho-McNeil-Janssen Pharmaceuticals, will pay more than $75 million to settle the charge that it caused false claims to be submitted to government health care programs for uses of the drug that were not medically accepted indications. Ortho-McNeil-Janssen denies that it engaged in any wrongful conduct. Health and Human Services Inspector General Daniel R. Levinson said in a statement that the agreement requires Ortho-McNeil-Janssen to avoid future illegal drug promotion.

Gulf War Illnesses Need Attention

The U.S. government has committed more than $400 million for research on Gulf War illnesses, but veterans with symptoms need more, according to a draft report from the Gulf War Veterans' Illnesses Task Force. The task force suggested that the VA do a better job of training primary care physicians, environmental health clinicians, pension examiners, mental health professionals, and social workers about Gulf War illnesses. It also recommended the VA work with the Centers for Disease Control and Prevention to include veteran-specific data collection in its national surveys.

Groups Push FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum (NMQF) and MANA, a national Latina organization, both asked the FDA to push harder on its effort to remove unapproved drugs from the market, which was launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

Chemical Reforms Introduced

After several months of hearings, Sen. Frank Lautenberg (D-N.J.), who chairs a Senate environmental health subcommittee, has introduced a bill that would significantly strengthen federal enforcement powers over potentially toxic chemicals. The “Safe Chemicals Act of 2010” would grant the Environmental Protection Agency new powers to ask chemical manufacturers for safety information, to categorize chemicals by risks they pose, and to remove dangerous chemicals from the market. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S.,” according to advocacy group Health Care Without Harm, which supports strong reforms.

E-prescribing Controlled Substances

Starting June 1, physicians will have the option of electronically prescribing controlled substances. The U.S. Drug Enforcement Administration said it wants clinicians to take advantage of new technology while maintaining the current control system. The agency also said that e-prescribing could reduce paperwork and forgery. The interim final rule outlines the security precautions, such ashphysician identity confirmationed by an authorized third party.

Topamax Case Settled for $81 Million

Two drug companies owned by Johnson & Johnson will pay more than $81 million to settle criminal and civil charges that they illegally promoted the epilepsy drug Topamax for off-label psychiatric uses. Under the agreement reached with the Department of Justice, Ortho-McNeil Pharmaceutical LLC will plead guilty to a misdemeanor and pay a $6 million criminal fine for promoting Topamax for psychiatric uses through its “Doctor-for-a-Day” program. Another Johnson & Johnson subsidiary, Ortho-McNeil-Janssen Pharmaceuticals, will pay more than $75 million to settle the charge that it caused false claims to be submitted to government health care programs for uses of the drug that were not medically accepted indications. Ortho-McNeil-Janssen denies that it engaged in any wrongful conduct. Health and Human Services Inspector General Daniel R. Levinson said in a statement that the agreement requires Ortho-McNeil-Janssen to avoid future illegal drug promotion.

Gulf War Illnesses Need Attention

The U.S. government has committed more than $400 million for research on Gulf War illnesses, but veterans with symptoms need more, according to a draft report from the Gulf War Veterans' Illnesses Task Force. The task force suggested that the VA do a better job of training primary care physicians, environmental health clinicians, pension examiners, mental health professionals, and social workers about Gulf War illnesses. It also recommended the VA work with the Centers for Disease Control and Prevention to include veteran-specific data collection in its national surveys.

Groups Push FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum (NMQF) and MANA, a national Latina organization, both asked the FDA to push harder on its effort to remove unapproved drugs from the market, which was launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

Chemical Reforms Introduced

After several months of hearings, Sen. Frank Lautenberg (D-N.J.), who chairs a Senate environmental health subcommittee, has introduced a bill that would significantly strengthen federal enforcement powers over potentially toxic chemicals. The “Safe Chemicals Act of 2010” would grant the Environmental Protection Agency new powers to ask chemical manufacturers for safety information, to categorize chemicals by risks they pose, and to remove dangerous chemicals from the market. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S.,” according to advocacy group Health Care Without Harm, which supports strong reforms.

E-prescribing Controlled Substances

Starting June 1, physicians will have the option of electronically prescribing controlled substances. The U.S. Drug Enforcement Administration said it wants clinicians to take advantage of new technology while maintaining the current control system. The agency also said that e-prescribing could reduce paperwork and forgery. The interim final rule outlines the security precautions, such ashphysician identity confirmationed by an authorized third party.

Topamax Case Settled for $81 Million

Two drug companies owned by Johnson & Johnson will pay more than $81 million to settle criminal and civil charges that they illegally promoted the epilepsy drug Topamax for off-label psychiatric uses. Under the agreement reached with the Department of Justice, Ortho-McNeil Pharmaceutical LLC will plead guilty to a misdemeanor and pay a $6 million criminal fine for promoting Topamax for psychiatric uses through its “Doctor-for-a-Day” program. Another Johnson & Johnson subsidiary, Ortho-McNeil-Janssen Pharmaceuticals, will pay more than $75 million to settle the charge that it caused false claims to be submitted to government health care programs for uses of the drug that were not medically accepted indications. Ortho-McNeil-Janssen denies that it engaged in any wrongful conduct. Health and Human Services Inspector General Daniel R. Levinson said in a statement that the agreement requires Ortho-McNeil-Janssen to avoid future illegal drug promotion.

Gulf War Illnesses Need Attention

The U.S. government has committed more than $400 million for research on Gulf War illnesses, but veterans with symptoms need more, according to a draft report from the Gulf War Veterans' Illnesses Task Force. The task force suggested that the VA do a better job of training primary care physicians, environmental health clinicians, pension examiners, mental health professionals, and social workers about Gulf War illnesses. It also recommended the VA work with the Centers for Disease Control and Prevention to include veteran-specific data collection in its national surveys.

Groups Push FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum (NMQF) and MANA, a national Latina organization, both asked the FDA to push harder on its effort to remove unapproved drugs from the market, which was launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

Chemical Reforms Introduced

After several months of hearings, Sen. Frank Lautenberg (D-N.J.), who chairs a Senate environmental health subcommittee, has introduced a bill that would significantly strengthen federal enforcement powers over potentially toxic chemicals. The “Safe Chemicals Act of 2010” would grant the Environmental Protection Agency new powers to ask chemical manufacturers for safety information, to categorize chemicals by risks they pose, and to remove dangerous chemicals from the market. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S.,” according to advocacy group Health Care Without Harm, which supports strong reforms.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology.

At press time, several regional extension centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, the HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Broad Range of Services

Under the Health Information Technology for Economic and Clinical Health Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The regional extension centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Early Enrollment Encouraged

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to the HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, the HHS is also reaching out to small hospitals. The department plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology.

At press time, several regional extension centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, the HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Broad Range of Services

Under the Health Information Technology for Economic and Clinical Health Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The regional extension centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Early Enrollment Encouraged

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to the HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, the HHS is also reaching out to small hospitals. The department plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology.

At press time, several regional extension centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, the HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Broad Range of Services

Under the Health Information Technology for Economic and Clinical Health Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products.

The regional extension centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Early Enrollment Encouraged

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years.

Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to the HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, the HHS is also reaching out to small hospitals. The department plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

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

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

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

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

A survey of 944 primary care physicians that was 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 that they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor [who] will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion.

“Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years,” he said.

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

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

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

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

A survey of 944 primary care physicians that was 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 that they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor [who] will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion.

“Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years,” he said.

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

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

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

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

A survey of 944 primary care physicians that was 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 that they would be willing to take on new Medicaid patients.

“Having a Medicaid insurance card is not the same as having a primary care doctor [who] will treat you,” Simon Stevens, executive vice president of UnitedHealth Group and chairman of the UnitedHealth Center for Health Reform and Modernization, said during a news conference to discuss Medicaid expansion.

“Unfortunately, that disconnect between Medicaid benefits and health care access has in some places been growing in recent years,” he said.

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.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS asked states to respond with their plans by the end of April.

States that don't currently operate a high-risk insurance pool could establish one with federal help. Those with a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To qualify for the high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS asked states to respond with their plans by the end of April.

States that don't currently operate a high-risk insurance pool could establish one with federal help. Those with a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To qualify for the high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced in early April.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014. At that time, the new state-based health insurance exchanges would open and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS asked states to respond with their plans by the end of April.

States that don't currently operate a high-risk insurance pool could establish one with federal help. Those with a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

To qualify for the high-risk pools, individuals must be citizens of the United States or lawfully present here, have been uninsured for the previous 6 months, and have a preexisting condition.

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 Medicaid that states can receive federal funds for providing coverage for adults based solely on income levels.

States that begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular rate. Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to the Centers for Medicare and Medicaid Services. The agency plans to issue separate guidance on this issue later.

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

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients. Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

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

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

UnitedHealth 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.

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 Medicaid that states can receive federal funds for providing coverage for adults based solely on income levels.

States that begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular rate. Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to the Centers for Medicare and Medicaid Services. The agency plans to issue separate guidance on this issue later.

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

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients. Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

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

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

UnitedHealth 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.

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 Medicaid that states can receive federal funds for providing coverage for adults based solely on income levels.

States that begin enrolling these newly eligible adults before 2014 will receive federal matching payments at the regular rate. Starting in 2014, they will receive an increased matching rate for certain people in the new eligibility group, according to the Centers for Medicare and Medicaid Services. The agency plans to issue separate guidance on this issue later.

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

Another question is how the expansion of the Medicaid program will impact access to care. In many states, Medicaid pays physicians at rates well below Medicare levels, and some estimates suggest that, around the country, only about half of primary care physicians even accept new Medicaid patients. Under the Health Care and Education Reconciliation Act passed as part of health reform, Congress raised Medicaid payments up to Medicare levels for primary care providers starting in 2013 and 2014.

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

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

UnitedHealth 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.

Aim Is to Cut Lupus Disparities

The Department of the Health and Human Services and the American College of Rheumatology are teaming up to ensure that minority women, who are the most likely to be affected by lupus, receive early diagnosis and treatment for the autoimmune disease. As part of the effort, a group of international experts on lupus is recrafting lupus curricula to suggest to medical, nursing, and health professional schools. The ACR also will develop tools to help practicing clinicians provide early diagnoses in at-risk groups. Women are 6-10 times as likely as men to have lupus, and minority women are 2-3 times as likely as white women to have the diseases. Dr. Elena Rios of the National Hispanic Medical Association commented in a statement, “To reach the people who need it most, we must work to educate health care teams and be sensitive to cultural differences, ensuring that appropriate messages about lupus are delivered in the most effective way.”

FDA Issues Warning on Gel Ads

The Food and Drug Administration has warned the drugmaker Novartis that a promotional e-mail directed at consumers overstated the efficacy of Voltaren Gel (diclofenac sodium topical gel). In its April 14 letter, the FDA said that the promotional e-mail also minimized the risks of Voltaren Gel and implied that it had a broader indication than the FDA had approved. Specifically, the e-mail told consumers that the gel could keep osteoarthritis joint pain from “interrupting your days ahead.” But the FDA said there isn't evidence that Voltaren Gel improves activities of daily living. The FDA letter also takes the company to task for putting the efficacy claims in large print and easy-to-understand language, while the risk information is at the bottom of the e-mail in small type and complex medical terms. A Novartis Consumer Health spokeswoman said the company is reviewing the letter and plans to work with the FDA to address the concerns.

State Medical Board Actions Up

State medical boards took 5,721 actions against physicians in 2009, an increase of 342 (or more than 6%) over 2008, according to a report from the Federation of State Medical Boards. Meanwhile, an analysis by the advocacy group Public Citizen found that the rate of serious disciplinary actions rose slightly in 2009 but still sits about 18% lower than the peak rate of 2004. Minnesota ranked last in disciplining physicians, Public Citizen said, and Maryland, South Carolina, and Wisconsin also consistently rank among the bottom 10 states. Arizona, Alaska, Kentucky, North Dakota, and Ohio discipline the most physicians, the group said. “There is considerable evidence that most boards are under-disciplining physicians,” Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a statement. “Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner.”

Pfizer Paid $35M in 6 Months

Pfizer Inc., the latest drug manufacturer to disclose physician payments, said it paid approximately $20 million to 4,500 physicians and other health care professionals for consulting and speaking services between July and December 2009. Pfizer also said it paid $15.3 million to 250 academic medical centers and other researchers to fund clinical trials in the last 6 months of 2009. The Pfizer disclosures were required by an integrity agreement the company signed last year to settle a federal investigation into promotion of off-label uses of drugs. Pfizer is the first major pharmaceutical company to disclose clinical trial payments, although drug maker GlaxoSmithKline has said it will begin publishing payments made to researchers in 2011.

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Report Urges Relaxed E-Rules

The federal government could better foster use of electronic medical records if it relaxed its “meaningful use” standards, according to a market analysis firm. That standard requires physicians, hospitals, and other health professionals to meet 25 wide-ranging criteria for how they use EMRs in order to be eligible for Medicare and Medicaid incentive payments. The report by Kalorama Information said that the stringent requirements could limit sales of new EMR systems. “Getting physicians used to these systems is the challenge to a totally paperless health care system in the United States, and we think gradual, achievable goals would be preferable,” Bruce Carlson of Kalorama Information said in a statement. Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

Aim Is to Cut Lupus Disparities

The Department of the Health and Human Services and the American College of Rheumatology are teaming up to ensure that minority women, who are the most likely to be affected by lupus, receive early diagnosis and treatment for the autoimmune disease. As part of the effort, a group of international experts on lupus is recrafting lupus curricula to suggest to medical, nursing, and health professional schools. The ACR also will develop tools to help practicing clinicians provide early diagnoses in at-risk groups. Women are 6-10 times as likely as men to have lupus, and minority women are 2-3 times as likely as white women to have the diseases. Dr. Elena Rios of the National Hispanic Medical Association commented in a statement, “To reach the people who need it most, we must work to educate health care teams and be sensitive to cultural differences, ensuring that appropriate messages about lupus are delivered in the most effective way.”

FDA Issues Warning on Gel Ads

The Food and Drug Administration has warned the drugmaker Novartis that a promotional e-mail directed at consumers overstated the efficacy of Voltaren Gel (diclofenac sodium topical gel). In its April 14 letter, the FDA said that the promotional e-mail also minimized the risks of Voltaren Gel and implied that it had a broader indication than the FDA had approved. Specifically, the e-mail told consumers that the gel could keep osteoarthritis joint pain from “interrupting your days ahead.” But the FDA said there isn't evidence that Voltaren Gel improves activities of daily living. The FDA letter also takes the company to task for putting the efficacy claims in large print and easy-to-understand language, while the risk information is at the bottom of the e-mail in small type and complex medical terms. A Novartis Consumer Health spokeswoman said the company is reviewing the letter and plans to work with the FDA to address the concerns.

State Medical Board Actions Up

State medical boards took 5,721 actions against physicians in 2009, an increase of 342 (or more than 6%) over 2008, according to a report from the Federation of State Medical Boards. Meanwhile, an analysis by the advocacy group Public Citizen found that the rate of serious disciplinary actions rose slightly in 2009 but still sits about 18% lower than the peak rate of 2004. Minnesota ranked last in disciplining physicians, Public Citizen said, and Maryland, South Carolina, and Wisconsin also consistently rank among the bottom 10 states. Arizona, Alaska, Kentucky, North Dakota, and Ohio discipline the most physicians, the group said. “There is considerable evidence that most boards are under-disciplining physicians,” Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a statement. “Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner.”

Pfizer Paid $35M in 6 Months

Pfizer Inc., the latest drug manufacturer to disclose physician payments, said it paid approximately $20 million to 4,500 physicians and other health care professionals for consulting and speaking services between July and December 2009. Pfizer also said it paid $15.3 million to 250 academic medical centers and other researchers to fund clinical trials in the last 6 months of 2009. The Pfizer disclosures were required by an integrity agreement the company signed last year to settle a federal investigation into promotion of off-label uses of drugs. Pfizer is the first major pharmaceutical company to disclose clinical trial payments, although drug maker GlaxoSmithKline has said it will begin publishing payments made to researchers in 2011.

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Report Urges Relaxed E-Rules

The federal government could better foster use of electronic medical records if it relaxed its “meaningful use” standards, according to a market analysis firm. That standard requires physicians, hospitals, and other health professionals to meet 25 wide-ranging criteria for how they use EMRs in order to be eligible for Medicare and Medicaid incentive payments. The report by Kalorama Information said that the stringent requirements could limit sales of new EMR systems. “Getting physicians used to these systems is the challenge to a totally paperless health care system in the United States, and we think gradual, achievable goals would be preferable,” Bruce Carlson of Kalorama Information said in a statement. Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

Aim Is to Cut Lupus Disparities

The Department of the Health and Human Services and the American College of Rheumatology are teaming up to ensure that minority women, who are the most likely to be affected by lupus, receive early diagnosis and treatment for the autoimmune disease. As part of the effort, a group of international experts on lupus is recrafting lupus curricula to suggest to medical, nursing, and health professional schools. The ACR also will develop tools to help practicing clinicians provide early diagnoses in at-risk groups. Women are 6-10 times as likely as men to have lupus, and minority women are 2-3 times as likely as white women to have the diseases. Dr. Elena Rios of the National Hispanic Medical Association commented in a statement, “To reach the people who need it most, we must work to educate health care teams and be sensitive to cultural differences, ensuring that appropriate messages about lupus are delivered in the most effective way.”

FDA Issues Warning on Gel Ads

The Food and Drug Administration has warned the drugmaker Novartis that a promotional e-mail directed at consumers overstated the efficacy of Voltaren Gel (diclofenac sodium topical gel). In its April 14 letter, the FDA said that the promotional e-mail also minimized the risks of Voltaren Gel and implied that it had a broader indication than the FDA had approved. Specifically, the e-mail told consumers that the gel could keep osteoarthritis joint pain from “interrupting your days ahead.” But the FDA said there isn't evidence that Voltaren Gel improves activities of daily living. The FDA letter also takes the company to task for putting the efficacy claims in large print and easy-to-understand language, while the risk information is at the bottom of the e-mail in small type and complex medical terms. A Novartis Consumer Health spokeswoman said the company is reviewing the letter and plans to work with the FDA to address the concerns.

State Medical Board Actions Up

State medical boards took 5,721 actions against physicians in 2009, an increase of 342 (or more than 6%) over 2008, according to a report from the Federation of State Medical Boards. Meanwhile, an analysis by the advocacy group Public Citizen found that the rate of serious disciplinary actions rose slightly in 2009 but still sits about 18% lower than the peak rate of 2004. Minnesota ranked last in disciplining physicians, Public Citizen said, and Maryland, South Carolina, and Wisconsin also consistently rank among the bottom 10 states. Arizona, Alaska, Kentucky, North Dakota, and Ohio discipline the most physicians, the group said. “There is considerable evidence that most boards are under-disciplining physicians,” Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a statement. “Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner.”

Pfizer Paid $35M in 6 Months

Pfizer Inc., the latest drug manufacturer to disclose physician payments, said it paid approximately $20 million to 4,500 physicians and other health care professionals for consulting and speaking services between July and December 2009. Pfizer also said it paid $15.3 million to 250 academic medical centers and other researchers to fund clinical trials in the last 6 months of 2009. The Pfizer disclosures were required by an integrity agreement the company signed last year to settle a federal investigation into promotion of off-label uses of drugs. Pfizer is the first major pharmaceutical company to disclose clinical trial payments, although drug maker GlaxoSmithKline has said it will begin publishing payments made to researchers in 2011.

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Report Urges Relaxed E-Rules

The federal government could better foster use of electronic medical records if it relaxed its “meaningful use” standards, according to a market analysis firm. That standard requires physicians, hospitals, and other health professionals to meet 25 wide-ranging criteria for how they use EMRs in order to be eligible for Medicare and Medicaid incentive payments. The report by Kalorama Information said that the stringent requirements could limit sales of new EMR systems. “Getting physicians used to these systems is the challenge to a totally paperless health care system in the United States, and we think gradual, achievable goals would be preferable,” Bruce Carlson of Kalorama Information said in a statement. Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced April 2.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014.

At that time, the new state-based health insurance exchanges would open, and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced April 2.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014.

At that time, the new state-based health insurance exchanges would open, and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

State-based high-risk health insurance pools are among the first programs to be implemented under health reform, Health and Human Service department officials announced April 2.

These state-based pools, designed to provide coverage to uninsured adults with preexisting conditions, are scheduled to be up and running within 90 days and will operate until Jan. 1, 2014.

At that time, the new state-based health insurance exchanges would open, and coverage would be available to all individuals regardless of preexisting conditions.

“When it's up and running, the new high-risk pool program provides immediate relief to potentially millions of Americans with preexisting conditions like diabetes or high blood pressure who have been shut out of the insurance system,” HHS Secretary Kathleen Sebelius said during a news conference.

The same day, Ms. Sebelius sent a letter to governors and state insurance commissioners asking how they plan to participate in the temporary high-risk pool program. Under the law, HHS has $5 billion in federal funds to set up pools on its own or collaborate with states. HHS is asking states to respond with their plans by the end of April.

States will have a number of options for participation. For example, states that don't currently operate a high-risk insurance pool could establish one with federal help. Those that do have a pool in place could set up a companion high-risk pool that meets the new federal standards. States also could contract with an insurer to provide subsidized coverage for eligible residents. In states that choose to do nothing, HHS will operate the program on their behalf.

More than 30 states currently have high-risk insurance pools, according to HHS, with premiums 25%–100% higher than standard rates. Under the health reform law, the federal government would require new high-risk pools to set premiums at a standard rate, which would vary by state. The standard rate should be equivalent to what a typical person shopping on the individual market would be offered, according to HHS.

The quality of health care in the United States is improving slowly, with the least progress occurring in prevention and chronic disease management, according to the latest government data.

The nation continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports. Specifically, the health care reform laws will expand data collection and research efforts on health care disparities. In addition, they will increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. The speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the least progress occurring in prevention and chronic disease management, according to the latest government data.

The nation continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports. Specifically, the health care reform laws will expand data collection and research efforts on health care disparities. In addition, they will increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. The speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the least progress occurring in prevention and chronic disease management, according to the latest government data.

The nation continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Service department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports. Specifically, the health care reform laws will expand data collection and research efforts on health care disparities. In addition, they will increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most importantly, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. The speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing.

“Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time. For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm