Jane Anderson

Implementing a single set of payment rules for multiple payers with a single universal claim form and standard set of rules potentially could save $7 billion per year nationwide in fees for physician and clinical services, according to a study at one institution.

Those changes also could save 4 hours of professional time per physician and 5 hours of practice support staff time each week, according to Bonnie B. Blanchfield, a senior research scientist at Massachusetts General Hospital, Boston, and her coauthors (Health Affairs 2010 April 29 [doi:10.1377/hlthaff.2009.0075

“The U.S. health care system has generated byzantine systems of rules and regulations regarding payment for medical services. The result has been a growing and costly bureaucracy, which, in the end, pulls resources from direct patient care,” wrote Ms. Blanchfield and her coauthors, who included other researchers and financial officers from Massachusetts General Hospital and Massachusetts General Physicians Organization in Boston.

The study authors analyzed what they called the “excessive administrative complexity burden” imposed on a large, urban-based, academic teaching hospital's physician organization that contracts with multiple payers, each with different payment requirements.

For 2006, the study found that the cost of excessive administrative complexity, including expenses and lost revenue, was nearly $45 million for this organization, or nearly 12% of net patient revenue. This represented $50,250 per physician.

Out of the total estimated administrative complexity burden, almost three-fourths was attributed to the time costs incurred by practicing physicians and their office staff in preparing paperwork and contacting payers about prescriptions, diagnoses, treatment plans, and referrals. “Many of the subspecialty practices within the physician organization even have full-time staff members dedicated to referral processing,” they wrote.

On the revenue side, the study found that nearly 13% of billed charges for non-Medicare claims were denied on initial submission, and that 81% of these eventually are paid after appeals.

Non-Medicare payers ultimately deny more claims than Medicare does, usually because the physician's office has missed the filing limit date because of the initial rejection, the study found. If these legitimate claims had been paid, they would have been worth $6 million for the physician organization studied.

In addition, 29% of current professional billing staff effort is spent on processing and appealing claim denials that eventually are paid, the authors said.

The federal health reform legislation approved in March directs health plans to implement uniform standards for electronic health information exchange by 2013, but “will not address the larger problems of excessive, different, and changing requirements imposed on the exchange of all health information, including billing information.

“Thus, administrative complexity is likely to remain high and is likely to be a high-value 'target' for finding savings in ongoing incremental reforms.”

The savings from reducing administrative complexity by implementing a single set of rules and a single claim form could translate into decreased health care costs in general, Ms. Blanchfield and her colleagues noted.

“An incremental move to one set of payment rules would yield significant dollar savings as well as work-life and productivity opportunities,” the researchers said. “Administrative simplification could still leave room for a diversity of insurance products and could promote innovation without relying on blunt and opaque administrative processes as a tool.”

Disclosures: Support for the study was provided by the Robert Wood Johnson Foundation and the Commonwealth Fund. The authors reported no financial conflicts of interest.

Implementing a single set of payment rules for multiple payers with a single universal claim form and standard set of rules potentially could save $7 billion per year nationwide in fees for physician and clinical services, according to a study at one institution.

Those changes also could save 4 hours of professional time per physician and 5 hours of practice support staff time each week, according to Bonnie B. Blanchfield, a senior research scientist at Massachusetts General Hospital, Boston, and her coauthors (Health Affairs 2010 April 29 [doi:10.1377/hlthaff.2009.0075

“The U.S. health care system has generated byzantine systems of rules and regulations regarding payment for medical services. The result has been a growing and costly bureaucracy, which, in the end, pulls resources from direct patient care,” wrote Ms. Blanchfield and her coauthors, who included other researchers and financial officers from Massachusetts General Hospital and Massachusetts General Physicians Organization in Boston.

The study authors analyzed what they called the “excessive administrative complexity burden” imposed on a large, urban-based, academic teaching hospital's physician organization that contracts with multiple payers, each with different payment requirements.

For 2006, the study found that the cost of excessive administrative complexity, including expenses and lost revenue, was nearly $45 million for this organization, or nearly 12% of net patient revenue. This represented $50,250 per physician.

Out of the total estimated administrative complexity burden, almost three-fourths was attributed to the time costs incurred by practicing physicians and their office staff in preparing paperwork and contacting payers about prescriptions, diagnoses, treatment plans, and referrals. “Many of the subspecialty practices within the physician organization even have full-time staff members dedicated to referral processing,” they wrote.

On the revenue side, the study found that nearly 13% of billed charges for non-Medicare claims were denied on initial submission, and that 81% of these eventually are paid after appeals.

Non-Medicare payers ultimately deny more claims than Medicare does, usually because the physician's office has missed the filing limit date because of the initial rejection, the study found. If these legitimate claims had been paid, they would have been worth $6 million for the physician organization studied.

In addition, 29% of current professional billing staff effort is spent on processing and appealing claim denials that eventually are paid, the authors said.

The federal health reform legislation approved in March directs health plans to implement uniform standards for electronic health information exchange by 2013, but “will not address the larger problems of excessive, different, and changing requirements imposed on the exchange of all health information, including billing information.

“Thus, administrative complexity is likely to remain high and is likely to be a high-value 'target' for finding savings in ongoing incremental reforms.”

The savings from reducing administrative complexity by implementing a single set of rules and a single claim form could translate into decreased health care costs in general, Ms. Blanchfield and her colleagues noted.

“An incremental move to one set of payment rules would yield significant dollar savings as well as work-life and productivity opportunities,” the researchers said. “Administrative simplification could still leave room for a diversity of insurance products and could promote innovation without relying on blunt and opaque administrative processes as a tool.”

Disclosures: Support for the study was provided by the Robert Wood Johnson Foundation and the Commonwealth Fund. The authors reported no financial conflicts of interest.

Implementing a single set of payment rules for multiple payers with a single universal claim form and standard set of rules potentially could save $7 billion per year nationwide in fees for physician and clinical services, according to a study at one institution.

Those changes also could save 4 hours of professional time per physician and 5 hours of practice support staff time each week, according to Bonnie B. Blanchfield, a senior research scientist at Massachusetts General Hospital, Boston, and her coauthors (Health Affairs 2010 April 29 [doi:10.1377/hlthaff.2009.0075

“The U.S. health care system has generated byzantine systems of rules and regulations regarding payment for medical services. The result has been a growing and costly bureaucracy, which, in the end, pulls resources from direct patient care,” wrote Ms. Blanchfield and her coauthors, who included other researchers and financial officers from Massachusetts General Hospital and Massachusetts General Physicians Organization in Boston.

The study authors analyzed what they called the “excessive administrative complexity burden” imposed on a large, urban-based, academic teaching hospital's physician organization that contracts with multiple payers, each with different payment requirements.

For 2006, the study found that the cost of excessive administrative complexity, including expenses and lost revenue, was nearly $45 million for this organization, or nearly 12% of net patient revenue. This represented $50,250 per physician.

Out of the total estimated administrative complexity burden, almost three-fourths was attributed to the time costs incurred by practicing physicians and their office staff in preparing paperwork and contacting payers about prescriptions, diagnoses, treatment plans, and referrals. “Many of the subspecialty practices within the physician organization even have full-time staff members dedicated to referral processing,” they wrote.

On the revenue side, the study found that nearly 13% of billed charges for non-Medicare claims were denied on initial submission, and that 81% of these eventually are paid after appeals.

Non-Medicare payers ultimately deny more claims than Medicare does, usually because the physician's office has missed the filing limit date because of the initial rejection, the study found. If these legitimate claims had been paid, they would have been worth $6 million for the physician organization studied.

In addition, 29% of current professional billing staff effort is spent on processing and appealing claim denials that eventually are paid, the authors said.

The federal health reform legislation approved in March directs health plans to implement uniform standards for electronic health information exchange by 2013, but “will not address the larger problems of excessive, different, and changing requirements imposed on the exchange of all health information, including billing information.

“Thus, administrative complexity is likely to remain high and is likely to be a high-value 'target' for finding savings in ongoing incremental reforms.”

The savings from reducing administrative complexity by implementing a single set of rules and a single claim form could translate into decreased health care costs in general, Ms. Blanchfield and her colleagues noted.

“An incremental move to one set of payment rules would yield significant dollar savings as well as work-life and productivity opportunities,” the researchers said. “Administrative simplification could still leave room for a diversity of insurance products and could promote innovation without relying on blunt and opaque administrative processes as a tool.”

Disclosures: Support for the study was provided by the Robert Wood Johnson Foundation and the Commonwealth Fund. The authors reported no financial conflicts of interest.

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

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 and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, 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 that 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.

CDC Urges State Antismoking Effort

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “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., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

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 and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, 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 that 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.

CDC Urges State Antismoking Effort

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “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., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

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 and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, 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 that 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.

CDC Urges State Antismoking Effort

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “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., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., has announced that sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” that was developed by the advocacy group Health Care Without Harm, said the decision was made to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Diabetic Teens Need Help

Many teenagers who have type 1 diabetes, especially those who are experiencing family conflict concerning their condition, need help as they assume responsibility for their own care, a study has concluded. Published online in the Journal of Adolescent Health, the research measured parent versus child responsibility for care, family conflict over diabetes, hemoglobin A_1c concentrations, and teens' frequency of blood glucose monitoring over 6 months. The Ohio and Texas–based researchers found that the more that disease-management responsibility rested with adolescents, the higher were their hemoglobin A_1c concentrations and the less frequent was their blood glucose monitoring. Teens who reported greater family conflict fared worse on these measures than did others.

Pain Care Adds Up to $7,000

Each case of peripheral-diabetic orpostherpetic neuropathic pain costs an extra $1,600–$7,000 per year for inpatient care, outpatient and professional services, and prescription drugs, a study in the Journal of Pain has found. The researchers compared the health care costs of such patients with those of people who have herpes zoster but no persistent pain or a diagnosis of diabetes without neurological complications. Both pain conditions added to care costs, but the diabetes-associated neuropathy had the more powerful impact, the authors said. They pointed out that the incidence of the pain conditions should rise as the population in the United States continues to age and diabetes increases. Prevention and more treatment of the conditions could reduce health care spending, the authors concluded.

More Diabetics Getting Flu Shots

The proportion of diabetic Americans aged 18–64 who received flu shots rose from 40% in 2000 to more than 50.5% in 2007, according to the Agency for Healthcare Research and Quality. The increase was driven by health insurance, the federal agency found. For example, among the population covered by public insurance, such as Medicaid, the proportion of those getting flu shots surged from 39% to 53%. Meanwhile, the increase among nonelderly diabetic adults with private insurance was from 41% to 53%. The immunization rate for this population without insurance remained at just over 30%. In addition, the proportion of seniors aged 65 and older with diabetes who reported getting a flu shot remained roughly stable at around 70%, the agency reported.

Insurer to Cover Prevention

UnitedHealth Group said it will pay for diabetes prevention and control programs provided by YMCA of the USA and Walgreen Co. In an effort to curb diabetes, prediabetes, and obesity, the health insurer announced that its employer-paid health policies will cover a clinically validated prevention program at YMCA chapters and diabetes-control sessions at Walgreen pharmacies. Programs will be available initially in six cities and will roll out nationally over the next 2 years, the insurer said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it is not overshadowed by other parts of either type of ad. The FDA said it will accept comments on the proposed rule until June 28.

Restaurants Must Post Calories

As part of the newly approved health care reform law, chain restaurants will be required to post the calorie content for their standard menu items along with information on daily suggested calorie intake from the Department of Agriculture. The provision in the Patient Protection and Affordable Care Act, signed into law in March by President Obama, will affect restaurants and other retail food establishments that have 20 or more locations and the same menu items at each location. Restaurants also will be required to have additional nutrition information, such as fat and sodium content, available for their menu items. Vending operators with more than 20 machines will be required to post calorie information on their food items. The law requires the FDA to issue proposed regulations by next March.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., has announced that sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” that was developed by the advocacy group Health Care Without Harm, said the decision was made to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Diabetic Teens Need Help

Many teenagers who have type 1 diabetes, especially those who are experiencing family conflict concerning their condition, need help as they assume responsibility for their own care, a study has concluded. Published online in the Journal of Adolescent Health, the research measured parent versus child responsibility for care, family conflict over diabetes, hemoglobin A_1c concentrations, and teens' frequency of blood glucose monitoring over 6 months. The Ohio and Texas–based researchers found that the more that disease-management responsibility rested with adolescents, the higher were their hemoglobin A_1c concentrations and the less frequent was their blood glucose monitoring. Teens who reported greater family conflict fared worse on these measures than did others.

Pain Care Adds Up to $7,000

Each case of peripheral-diabetic orpostherpetic neuropathic pain costs an extra $1,600–$7,000 per year for inpatient care, outpatient and professional services, and prescription drugs, a study in the Journal of Pain has found. The researchers compared the health care costs of such patients with those of people who have herpes zoster but no persistent pain or a diagnosis of diabetes without neurological complications. Both pain conditions added to care costs, but the diabetes-associated neuropathy had the more powerful impact, the authors said. They pointed out that the incidence of the pain conditions should rise as the population in the United States continues to age and diabetes increases. Prevention and more treatment of the conditions could reduce health care spending, the authors concluded.

More Diabetics Getting Flu Shots

The proportion of diabetic Americans aged 18–64 who received flu shots rose from 40% in 2000 to more than 50.5% in 2007, according to the Agency for Healthcare Research and Quality. The increase was driven by health insurance, the federal agency found. For example, among the population covered by public insurance, such as Medicaid, the proportion of those getting flu shots surged from 39% to 53%. Meanwhile, the increase among nonelderly diabetic adults with private insurance was from 41% to 53%. The immunization rate for this population without insurance remained at just over 30%. In addition, the proportion of seniors aged 65 and older with diabetes who reported getting a flu shot remained roughly stable at around 70%, the agency reported.

Insurer to Cover Prevention

UnitedHealth Group said it will pay for diabetes prevention and control programs provided by YMCA of the USA and Walgreen Co. In an effort to curb diabetes, prediabetes, and obesity, the health insurer announced that its employer-paid health policies will cover a clinically validated prevention program at YMCA chapters and diabetes-control sessions at Walgreen pharmacies. Programs will be available initially in six cities and will roll out nationally over the next 2 years, the insurer said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it is not overshadowed by other parts of either type of ad. The FDA said it will accept comments on the proposed rule until June 28.

Restaurants Must Post Calories

As part of the newly approved health care reform law, chain restaurants will be required to post the calorie content for their standard menu items along with information on daily suggested calorie intake from the Department of Agriculture. The provision in the Patient Protection and Affordable Care Act, signed into law in March by President Obama, will affect restaurants and other retail food establishments that have 20 or more locations and the same menu items at each location. Restaurants also will be required to have additional nutrition information, such as fat and sodium content, available for their menu items. Vending operators with more than 20 machines will be required to post calorie information on their food items. The law requires the FDA to issue proposed regulations by next March.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., has announced that sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” that was developed by the advocacy group Health Care Without Harm, said the decision was made to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Diabetic Teens Need Help

Many teenagers who have type 1 diabetes, especially those who are experiencing family conflict concerning their condition, need help as they assume responsibility for their own care, a study has concluded. Published online in the Journal of Adolescent Health, the research measured parent versus child responsibility for care, family conflict over diabetes, hemoglobin A_1c concentrations, and teens' frequency of blood glucose monitoring over 6 months. The Ohio and Texas–based researchers found that the more that disease-management responsibility rested with adolescents, the higher were their hemoglobin A_1c concentrations and the less frequent was their blood glucose monitoring. Teens who reported greater family conflict fared worse on these measures than did others.

Pain Care Adds Up to $7,000

Each case of peripheral-diabetic orpostherpetic neuropathic pain costs an extra $1,600–$7,000 per year for inpatient care, outpatient and professional services, and prescription drugs, a study in the Journal of Pain has found. The researchers compared the health care costs of such patients with those of people who have herpes zoster but no persistent pain or a diagnosis of diabetes without neurological complications. Both pain conditions added to care costs, but the diabetes-associated neuropathy had the more powerful impact, the authors said. They pointed out that the incidence of the pain conditions should rise as the population in the United States continues to age and diabetes increases. Prevention and more treatment of the conditions could reduce health care spending, the authors concluded.

More Diabetics Getting Flu Shots

The proportion of diabetic Americans aged 18–64 who received flu shots rose from 40% in 2000 to more than 50.5% in 2007, according to the Agency for Healthcare Research and Quality. The increase was driven by health insurance, the federal agency found. For example, among the population covered by public insurance, such as Medicaid, the proportion of those getting flu shots surged from 39% to 53%. Meanwhile, the increase among nonelderly diabetic adults with private insurance was from 41% to 53%. The immunization rate for this population without insurance remained at just over 30%. In addition, the proportion of seniors aged 65 and older with diabetes who reported getting a flu shot remained roughly stable at around 70%, the agency reported.

Insurer to Cover Prevention

UnitedHealth Group said it will pay for diabetes prevention and control programs provided by YMCA of the USA and Walgreen Co. In an effort to curb diabetes, prediabetes, and obesity, the health insurer announced that its employer-paid health policies will cover a clinically validated prevention program at YMCA chapters and diabetes-control sessions at Walgreen pharmacies. Programs will be available initially in six cities and will roll out nationally over the next 2 years, the insurer said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it is not overshadowed by other parts of either type of ad. The FDA said it will accept comments on the proposed rule until June 28.

Restaurants Must Post Calories

As part of the newly approved health care reform law, chain restaurants will be required to post the calorie content for their standard menu items along with information on daily suggested calorie intake from the Department of Agriculture. The provision in the Patient Protection and Affordable Care Act, signed into law in March by President Obama, will affect restaurants and other retail food establishments that have 20 or more locations and the same menu items at each location. Restaurants also will be required to have additional nutrition information, such as fat and sodium content, available for their menu items. Vending operators with more than 20 machines will be required to post calorie information on their food items. The law requires the FDA to issue proposed regulations by next March.

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public Webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data. “HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a Webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.”

He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the Webcast.

And, CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and also will release never-before-published national, state, regional, and potentially county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard, which when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA programs on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the Webcast.

The public will be able to use the dashboard (www.fda.gov/fdatrack

“Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress,” Dr. Sharfstein concluded.

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public Webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data. “HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a Webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.”

He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the Webcast.

And, CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and also will release never-before-published national, state, regional, and potentially county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard, which when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA programs on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the Webcast.

The public will be able to use the dashboard (www.fda.gov/fdatrack

“Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress,” Dr. Sharfstein concluded.

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public Webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data. “HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a Webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.”

He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the Webcast.

And, CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and also will release never-before-published national, state, regional, and potentially county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard, which when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA programs on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the Webcast.

The public will be able to use the dashboard (www.fda.gov/fdatrack

“Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress,” Dr. Sharfstein concluded.

EPA Implements Lead Protections

Contractors renovating homes and apartments built before 1978 must now employ practices to protect children and pregnant women from exposure to lead-based paint, the U.S. Environmental Protection Agency announced. The enforcement of an existing rule comes nearly 2 decades after Congress directed the EPA to regulate housing renovations and after environmental groups filed a lawsuit to force action. The EPA Lead Renovation, Repair, and Painting Rule requires contractors to be trained and certified in lead-safe work practices. To date, the EPA said it has certified 204 trainers who have already taught the practices to about 160,000 people in the construction and remodeling industries.

Male Teens Miss Sex Counseling

Despite national efforts to improve sexual health services for teenagers, even teenage boys who report high-risk sexual behaviors generally don't get counseling about HIV and other sexually transmitted infections, a study from the Johns Hopkins Children's Center found. Published online in the Journal of Adolescent Health, the research found that only one-third of male teens who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners received counseling in 2002. Only 26% of males reporting high-risk sex, which the authors defined as sex with a prostitute, sex with a person infected with HIV, or sex while high, received counseling. The researchers recommended evidence-based, uniform guidelines to reduce confusion among providers about sexual counseling, and they said pediatricians with male teenage patients need to “ACT”: ask, counsel, and test.

NCQA Adds Obesity Measure

The National Committee for Quality Assurance (NCQA) said it is adding a new childhood obesity measurement to its health plan data set. The committee said it has been collecting data on the measurement, “Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents,” which in 2009 became the only gauge of childhood obesity adopted by health plans nationwide. Now, there are enough data available for comparisons between plans. The NCQA will include the childhood obesity measurement in the August release of its online database of health plans' quality indicators so purchasers, consumers, and others may compare the plans' performances in this area. The measurement adjusts body mass index data for age and sex, distinguishing between desirable growth and unhealthy weight gain.

Grandparents Help Autistic Children

Grandparents play a key role in the lives of children with autism; one-third say they were the first to raise concerns about their grandchild's development, according to a survey from the Interactive Autism Network at the Kennedy Krieger Institute. The survey of more than 2,600 grandparents found that nearly 11% live in the same household as their autistic grandchildren, and another 46% live within 24 miles. Many had moved closer to help the grandchild's family manage the disorder. More than 70% said they played some role in treatment decisions, and about one-third said they provided some direct child care at least once per week. Many grandparents also said they contributed financially to treatment.

House Approves Child Fitness Bill

School districts would be required, under a bill approved by the House, to post information on their Internet sites detailing the strengths and weaknesses of their physical education programs. The legislation, now referred to the Senate, also would require direct reports to parents on physical education for their children. The information would have to include the amount of time students spend in physical education classes, whether those classes follow a curriculum adhering to national Centers for Disease Control and Prevention guidelines or state guidelines, and descriptions of the facilities available for exercise. The reports also would need to include information on the importance of a healthy lifestyle in the learning environment.

Reducing Minority Teen Pregnancy

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

EPA Implements Lead Protections

Contractors renovating homes and apartments built before 1978 must now employ practices to protect children and pregnant women from exposure to lead-based paint, the U.S. Environmental Protection Agency announced. The enforcement of an existing rule comes nearly 2 decades after Congress directed the EPA to regulate housing renovations and after environmental groups filed a lawsuit to force action. The EPA Lead Renovation, Repair, and Painting Rule requires contractors to be trained and certified in lead-safe work practices. To date, the EPA said it has certified 204 trainers who have already taught the practices to about 160,000 people in the construction and remodeling industries.

Male Teens Miss Sex Counseling

Despite national efforts to improve sexual health services for teenagers, even teenage boys who report high-risk sexual behaviors generally don't get counseling about HIV and other sexually transmitted infections, a study from the Johns Hopkins Children's Center found. Published online in the Journal of Adolescent Health, the research found that only one-third of male teens who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners received counseling in 2002. Only 26% of males reporting high-risk sex, which the authors defined as sex with a prostitute, sex with a person infected with HIV, or sex while high, received counseling. The researchers recommended evidence-based, uniform guidelines to reduce confusion among providers about sexual counseling, and they said pediatricians with male teenage patients need to “ACT”: ask, counsel, and test.

NCQA Adds Obesity Measure

The National Committee for Quality Assurance (NCQA) said it is adding a new childhood obesity measurement to its health plan data set. The committee said it has been collecting data on the measurement, “Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents,” which in 2009 became the only gauge of childhood obesity adopted by health plans nationwide. Now, there are enough data available for comparisons between plans. The NCQA will include the childhood obesity measurement in the August release of its online database of health plans' quality indicators so purchasers, consumers, and others may compare the plans' performances in this area. The measurement adjusts body mass index data for age and sex, distinguishing between desirable growth and unhealthy weight gain.

Grandparents Help Autistic Children

Grandparents play a key role in the lives of children with autism; one-third say they were the first to raise concerns about their grandchild's development, according to a survey from the Interactive Autism Network at the Kennedy Krieger Institute. The survey of more than 2,600 grandparents found that nearly 11% live in the same household as their autistic grandchildren, and another 46% live within 24 miles. Many had moved closer to help the grandchild's family manage the disorder. More than 70% said they played some role in treatment decisions, and about one-third said they provided some direct child care at least once per week. Many grandparents also said they contributed financially to treatment.

House Approves Child Fitness Bill

School districts would be required, under a bill approved by the House, to post information on their Internet sites detailing the strengths and weaknesses of their physical education programs. The legislation, now referred to the Senate, also would require direct reports to parents on physical education for their children. The information would have to include the amount of time students spend in physical education classes, whether those classes follow a curriculum adhering to national Centers for Disease Control and Prevention guidelines or state guidelines, and descriptions of the facilities available for exercise. The reports also would need to include information on the importance of a healthy lifestyle in the learning environment.

Reducing Minority Teen Pregnancy

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

EPA Implements Lead Protections

Contractors renovating homes and apartments built before 1978 must now employ practices to protect children and pregnant women from exposure to lead-based paint, the U.S. Environmental Protection Agency announced. The enforcement of an existing rule comes nearly 2 decades after Congress directed the EPA to regulate housing renovations and after environmental groups filed a lawsuit to force action. The EPA Lead Renovation, Repair, and Painting Rule requires contractors to be trained and certified in lead-safe work practices. To date, the EPA said it has certified 204 trainers who have already taught the practices to about 160,000 people in the construction and remodeling industries.

Male Teens Miss Sex Counseling

Despite national efforts to improve sexual health services for teenagers, even teenage boys who report high-risk sexual behaviors generally don't get counseling about HIV and other sexually transmitted infections, a study from the Johns Hopkins Children's Center found. Published online in the Journal of Adolescent Health, the research found that only one-third of male teens who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners received counseling in 2002. Only 26% of males reporting high-risk sex, which the authors defined as sex with a prostitute, sex with a person infected with HIV, or sex while high, received counseling. The researchers recommended evidence-based, uniform guidelines to reduce confusion among providers about sexual counseling, and they said pediatricians with male teenage patients need to “ACT”: ask, counsel, and test.

NCQA Adds Obesity Measure

The National Committee for Quality Assurance (NCQA) said it is adding a new childhood obesity measurement to its health plan data set. The committee said it has been collecting data on the measurement, “Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents,” which in 2009 became the only gauge of childhood obesity adopted by health plans nationwide. Now, there are enough data available for comparisons between plans. The NCQA will include the childhood obesity measurement in the August release of its online database of health plans' quality indicators so purchasers, consumers, and others may compare the plans' performances in this area. The measurement adjusts body mass index data for age and sex, distinguishing between desirable growth and unhealthy weight gain.

Grandparents Help Autistic Children

Grandparents play a key role in the lives of children with autism; one-third say they were the first to raise concerns about their grandchild's development, according to a survey from the Interactive Autism Network at the Kennedy Krieger Institute. The survey of more than 2,600 grandparents found that nearly 11% live in the same household as their autistic grandchildren, and another 46% live within 24 miles. Many had moved closer to help the grandchild's family manage the disorder. More than 70% said they played some role in treatment decisions, and about one-third said they provided some direct child care at least once per week. Many grandparents also said they contributed financially to treatment.

House Approves Child Fitness Bill

School districts would be required, under a bill approved by the House, to post information on their Internet sites detailing the strengths and weaknesses of their physical education programs. The legislation, now referred to the Senate, also would require direct reports to parents on physical education for their children. The information would have to include the amount of time students spend in physical education classes, whether those classes follow a curriculum adhering to national Centers for Disease Control and Prevention guidelines or state guidelines, and descriptions of the facilities available for exercise. The reports also would need to include information on the importance of a healthy lifestyle in the learning environment.

Reducing Minority Teen Pregnancy

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

Attendees at the American Academy of Pediatrics annual Leadership Forum urged the academy's leadership to support a national vaccine registry or information clearinghouse that would allow access to patient vaccine histories across state lines.

In addition, meeting attendees approved resolutions asking the AAP to form a new council on obesity to better focus antiobesity efforts in childhood and encourage increased knowledge on concussion and head injury prevention, AAP President Judith Palfrey said in an interview.

Immunization policy, especially regarding state registries, was the No. 1 topic at the forum, she said.

“The general public probably thinks we have [immunization] data on all children, but the fact of the matter is, we don't,” Dr. Palfrey said. For example, she said her home state of Massachusetts is working to create a permanent immunization registry.

The forum attendees adopted a resolution urging the AAP to create a mechanism allowing pediatricians “ready access to existing vaccine registries in all states” and to “support the establishment of, and consider the feasibility of sponsorship of, a national vaccine registry/clearinghouse with common electronic gateways to state registries, allowing ready access to vaccine histories of patients.”

Attendees also adopted a second immunization-centered resolution urging the AAP to “provide all appropriate, reasonable, legal, and fiscally sound support possible to any AAP chapter that requests assistance in its efforts to combat legislative or electoral attempts to roll back immunization efforts in its state.”

That resolution noted that several organizations actively advocate against routine universal immunization, and said that “one or more of these groups is considering a state-by-state legislative and electoral campaign to roll back current laws and regulations promoting immunization.”

However, attendees defeated a resolution that asked the academy to support the inclusion of a standardized document, signed by a child's pediatrician, indicating that a well-considered discussion of vaccine-preventable diseases and immunizations between the parent and the child's medical home has occurred before that parent can obtain a personal belief exemption (in states that allow such regulations).

Childhood obesity issues, which gained new prominence on the national level with the launch of First Lady Michelle Obama's “Let's Move” antiobesity campaign in February, also generated significant excitement at the meeting, Dr. Palfrey said.”

“As you can imagine, there's tremendous support for the First Lady's goals,” she said. “There was a great deal of discussion on the First Lady's initiative, Let's Move, and how we can be involved.”

The AAP, which joined the White House for the Let's Move launch, has pledged to urge pediatricians to measure body mass index (BMI) at well-child visits to determine if an intervention is necessary. The academy also has created materials for pediatricians to share with patients and their families if an obesity intervention is necessary, said Dr. Palfrey, the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School, Boston.

“All pediatricians should do a BMI [calculation] at each well-child visit so that becomes a routine part of our health maintenance,” she said. “We've also created a 'prescription' about healthy eating and fitness choices so that the pediatrician can have a conversation with the family and patient.”

At the forum, delegates approved a resolution urging the AAP to form an official obesity council to position the academy “to move forward in a stronger, broader, and more organized fashion to address the pediatric obesity epidemic.”

The forum attendees also spent some time debating measures intended to increase the use of guidelines for concussion that might occur in sports and other activities, Dr. Palfrey said. “The sports medicine group is concerned about everyone using good guidelines for concussions in youth,” she said. “It's important to do a good work-up and make sure they don't go back on the field until they've had a good period of healing.”

The forum adopted a resolution urging the AAP to “work to encourage increased knowledge in the area of concussion and head injury prevention and return to play guidelines through education of coaches, parents, athletic trainers, and health care providers.”

The resolution also calls on the AAP to “advocate for ongoing athletic team trainer education along with parental notification so that consistent evaluation occurs with community health care providers and [there is] appropriate utilization of the referral services for postconcussive evaluation.”

About 480 pediatricians attended the meeting. Resolutions approved at the leadership forum go to the AAP board of directors, which considers them as advice on the future direction of academy policies and procedures.

Dr. Judith Palfrey said, “The general public probably thinks we have [immunization] data on all children, but … we don't.”

Source Courtesy American Academy of Pediatrics

Attendees at the American Academy of Pediatrics annual Leadership Forum urged the academy's leadership to support a national vaccine registry or information clearinghouse that would allow access to patient vaccine histories across state lines.

In addition, meeting attendees approved resolutions asking the AAP to form a new council on obesity to better focus antiobesity efforts in childhood and encourage increased knowledge on concussion and head injury prevention, AAP President Judith Palfrey said in an interview.

Immunization policy, especially regarding state registries, was the No. 1 topic at the forum, she said.

“The general public probably thinks we have [immunization] data on all children, but the fact of the matter is, we don't,” Dr. Palfrey said. For example, she said her home state of Massachusetts is working to create a permanent immunization registry.

The forum attendees adopted a resolution urging the AAP to create a mechanism allowing pediatricians “ready access to existing vaccine registries in all states” and to “support the establishment of, and consider the feasibility of sponsorship of, a national vaccine registry/clearinghouse with common electronic gateways to state registries, allowing ready access to vaccine histories of patients.”

Attendees also adopted a second immunization-centered resolution urging the AAP to “provide all appropriate, reasonable, legal, and fiscally sound support possible to any AAP chapter that requests assistance in its efforts to combat legislative or electoral attempts to roll back immunization efforts in its state.”

That resolution noted that several organizations actively advocate against routine universal immunization, and said that “one or more of these groups is considering a state-by-state legislative and electoral campaign to roll back current laws and regulations promoting immunization.”

However, attendees defeated a resolution that asked the academy to support the inclusion of a standardized document, signed by a child's pediatrician, indicating that a well-considered discussion of vaccine-preventable diseases and immunizations between the parent and the child's medical home has occurred before that parent can obtain a personal belief exemption (in states that allow such regulations).

Childhood obesity issues, which gained new prominence on the national level with the launch of First Lady Michelle Obama's “Let's Move” antiobesity campaign in February, also generated significant excitement at the meeting, Dr. Palfrey said.”

“As you can imagine, there's tremendous support for the First Lady's goals,” she said. “There was a great deal of discussion on the First Lady's initiative, Let's Move, and how we can be involved.”

The AAP, which joined the White House for the Let's Move launch, has pledged to urge pediatricians to measure body mass index (BMI) at well-child visits to determine if an intervention is necessary. The academy also has created materials for pediatricians to share with patients and their families if an obesity intervention is necessary, said Dr. Palfrey, the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School, Boston.

“All pediatricians should do a BMI [calculation] at each well-child visit so that becomes a routine part of our health maintenance,” she said. “We've also created a 'prescription' about healthy eating and fitness choices so that the pediatrician can have a conversation with the family and patient.”

At the forum, delegates approved a resolution urging the AAP to form an official obesity council to position the academy “to move forward in a stronger, broader, and more organized fashion to address the pediatric obesity epidemic.”

The forum attendees also spent some time debating measures intended to increase the use of guidelines for concussion that might occur in sports and other activities, Dr. Palfrey said. “The sports medicine group is concerned about everyone using good guidelines for concussions in youth,” she said. “It's important to do a good work-up and make sure they don't go back on the field until they've had a good period of healing.”

The forum adopted a resolution urging the AAP to “work to encourage increased knowledge in the area of concussion and head injury prevention and return to play guidelines through education of coaches, parents, athletic trainers, and health care providers.”

The resolution also calls on the AAP to “advocate for ongoing athletic team trainer education along with parental notification so that consistent evaluation occurs with community health care providers and [there is] appropriate utilization of the referral services for postconcussive evaluation.”

About 480 pediatricians attended the meeting. Resolutions approved at the leadership forum go to the AAP board of directors, which considers them as advice on the future direction of academy policies and procedures.

Dr. Judith Palfrey said, “The general public probably thinks we have [immunization] data on all children, but … we don't.”

Source Courtesy American Academy of Pediatrics

Attendees at the American Academy of Pediatrics annual Leadership Forum urged the academy's leadership to support a national vaccine registry or information clearinghouse that would allow access to patient vaccine histories across state lines.

In addition, meeting attendees approved resolutions asking the AAP to form a new council on obesity to better focus antiobesity efforts in childhood and encourage increased knowledge on concussion and head injury prevention, AAP President Judith Palfrey said in an interview.

Immunization policy, especially regarding state registries, was the No. 1 topic at the forum, she said.

“The general public probably thinks we have [immunization] data on all children, but the fact of the matter is, we don't,” Dr. Palfrey said. For example, she said her home state of Massachusetts is working to create a permanent immunization registry.

The forum attendees adopted a resolution urging the AAP to create a mechanism allowing pediatricians “ready access to existing vaccine registries in all states” and to “support the establishment of, and consider the feasibility of sponsorship of, a national vaccine registry/clearinghouse with common electronic gateways to state registries, allowing ready access to vaccine histories of patients.”

Attendees also adopted a second immunization-centered resolution urging the AAP to “provide all appropriate, reasonable, legal, and fiscally sound support possible to any AAP chapter that requests assistance in its efforts to combat legislative or electoral attempts to roll back immunization efforts in its state.”

That resolution noted that several organizations actively advocate against routine universal immunization, and said that “one or more of these groups is considering a state-by-state legislative and electoral campaign to roll back current laws and regulations promoting immunization.”

However, attendees defeated a resolution that asked the academy to support the inclusion of a standardized document, signed by a child's pediatrician, indicating that a well-considered discussion of vaccine-preventable diseases and immunizations between the parent and the child's medical home has occurred before that parent can obtain a personal belief exemption (in states that allow such regulations).

Childhood obesity issues, which gained new prominence on the national level with the launch of First Lady Michelle Obama's “Let's Move” antiobesity campaign in February, also generated significant excitement at the meeting, Dr. Palfrey said.”

“As you can imagine, there's tremendous support for the First Lady's goals,” she said. “There was a great deal of discussion on the First Lady's initiative, Let's Move, and how we can be involved.”

The AAP, which joined the White House for the Let's Move launch, has pledged to urge pediatricians to measure body mass index (BMI) at well-child visits to determine if an intervention is necessary. The academy also has created materials for pediatricians to share with patients and their families if an obesity intervention is necessary, said Dr. Palfrey, the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School, Boston.

“All pediatricians should do a BMI [calculation] at each well-child visit so that becomes a routine part of our health maintenance,” she said. “We've also created a 'prescription' about healthy eating and fitness choices so that the pediatrician can have a conversation with the family and patient.”

At the forum, delegates approved a resolution urging the AAP to form an official obesity council to position the academy “to move forward in a stronger, broader, and more organized fashion to address the pediatric obesity epidemic.”

The forum attendees also spent some time debating measures intended to increase the use of guidelines for concussion that might occur in sports and other activities, Dr. Palfrey said. “The sports medicine group is concerned about everyone using good guidelines for concussions in youth,” she said. “It's important to do a good work-up and make sure they don't go back on the field until they've had a good period of healing.”

The forum adopted a resolution urging the AAP to “work to encourage increased knowledge in the area of concussion and head injury prevention and return to play guidelines through education of coaches, parents, athletic trainers, and health care providers.”

The resolution also calls on the AAP to “advocate for ongoing athletic team trainer education along with parental notification so that consistent evaluation occurs with community health care providers and [there is] appropriate utilization of the referral services for postconcussive evaluation.”

About 480 pediatricians attended the meeting. Resolutions approved at the leadership forum go to the AAP board of directors, which considers them as advice on the future direction of academy policies and procedures.

Dr. Judith Palfrey said, “The general public probably thinks we have [immunization] data on all children, but … we don't.”

Source Courtesy American Academy of Pediatrics

Stricter EPA Water Standards

The Environmental Protection Agency is developing broader and stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, said EPA Administrator Lisa Jackson in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said the agency also will foster development of new drinking water treatment technologies to address health risks.

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.”

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009; family practitioners' incomes rose less than 0.5%. Geographic location and productivity contributed to changes in compensation. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash on Faith

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

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. The public expects retail, entertainment, and consumer-technology companies to be involved in ways that go well beyond the health of their employees, the firm reported. For example, survey respondents said that businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said that business is doing a fair or poor job on health, and just over a third said they trust business to address health issues.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Stricter EPA Water Standards

The Environmental Protection Agency is developing broader and stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, said EPA Administrator Lisa Jackson in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said the agency also will foster development of new drinking water treatment technologies to address health risks.

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.”

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009; family practitioners' incomes rose less than 0.5%. Geographic location and productivity contributed to changes in compensation. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash on Faith

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

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. The public expects retail, entertainment, and consumer-technology companies to be involved in ways that go well beyond the health of their employees, the firm reported. For example, survey respondents said that businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said that business is doing a fair or poor job on health, and just over a third said they trust business to address health issues.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Stricter EPA Water Standards

The Environmental Protection Agency is developing broader and stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, said EPA Administrator Lisa Jackson in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said the agency also will foster development of new drinking water treatment technologies to address health risks.

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.”

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009; family practitioners' incomes rose less than 0.5%. Geographic location and productivity contributed to changes in compensation. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash on Faith

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

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. The public expects retail, entertainment, and consumer-technology companies to be involved in ways that go well beyond the health of their employees, the firm reported. For example, survey respondents said that businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said that business is doing a fair or poor job on health, and just over a third said they trust business to address health issues.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data.

“HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.” He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

The CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the webcast.

The CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and will release previously unpublished national, state, regional, and possibly county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard that, when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA program offices on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the webcast.

The public will be able to use the dashboard, located at www.fda.gov/fdatrack

“In the past, agencies had been measured by some broad overall measures,” Dr. Sharfstein said. “Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress.”

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data.

“HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.” He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

The CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the webcast.

The CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and will release previously unpublished national, state, regional, and possibly county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard that, when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA program offices on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the webcast.

The public will be able to use the dashboard, located at www.fda.gov/fdatrack

“In the past, agencies had been measured by some broad overall measures,” Dr. Sharfstein said. “Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress.”

A new Open Government initiative unveiled by the Health and Human Services department April 7 aims to create more transparency at the giant federal health agency, improve accountability, and make large quantities of raw Medicare and public health data available to the public.

A separate transparency project at the Food and Drug Administration was announced during the same public webcast, as was a beta-test version of a new data dashboard for the Centers for Medicare and Medicaid Services (www.cms/gov.Dashboard

One of the biggest components of the HHS plan is the release of raw public health data.

“HHS's vast stores of data are a remarkable national resource which can be utilized to help citizens understand what we do and hold us accountable, help the public hold the private sector accountable, increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people,” HHS officials wrote in the plan.

The project will make various data sets public so that state and local governments, researchers, and others can use it to analyze public health trends and create novel applications, said Todd Park, HHS chief technology officer.

“We have a lot of data showing how we're doing on obesity, smoking, access to healthy foods,” Mr. Park said during a webcast launching the project. “We're going to take all that data, make sure it doesn't compromise patient privacy, and then release it.”

Mr. Park said he is “100% confident” that users outside government will take the data and “come up with better ideas than we would ever have for it.”

For example, he said he could envision “social networking games to help advise a lot of folks on what's going on in community health and how to improve it.” He added that the agency is sponsoring the HHS Apps Challenge, which is a public competition for the best applications built using the data.

The CMS already has uploaded an improved user interface and analytical tool for viewing existing CMS COMPARE data on quality performance for hospitals, nursing homes, home health agencies, and dialysis centers, HHS officials said during the webcast.

The CMS plans to publish detailed Medicaid State Plan documents and amendments online at the CMS Web site by the end of 2010, and will release previously unpublished national, state, regional, and possibly county-level data on Medicare prevalence of disease, quality, costs, and service utilization as part of HHS's Community Health Data Initiative.

As part of the overall Open Government initiative, the FDA also launched a new dashboard that, when fully implemented, will allow the public to track some 300 performance measures and 80 key projects across more than 90 FDA program offices on an ongoing basis, Dr. Joshua Sharfstein, FDA principal deputy commissioner, said during the webcast.

The public will be able to use the dashboard, located at www.fda.gov/fdatrack

“In the past, agencies had been measured by some broad overall measures,” Dr. Sharfstein said. “Our measures are monthly, there are many more of them, and they're really targeted. People will be able to go online and see our progress.”

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.” Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. “We are committed to creating a healthier community and will set the pace by influencing healthier lifestyle choices,” said hospital president Eugene Dellea in a statement. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009, family physicians' incomes rose less than 0.5%, invasive cardiologists' pay was hiked by 7%, ophthalmologists gained by more than 9%, and neurologists' compensation fell by more than 2%. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash Over Faith

Nearly 1 in 10 primary care physicians has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found.

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. Survey respondents said businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said business is doing a fair or poor job on health, and about a third said they trust business to address health issues.

Stricter EPA Water Standards

The Environmental Protection Agency is developing stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, EPA Administrator Lisa Jackson said in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said that the agency also will foster development of new drinking water treatment technologies to address health risks.

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.” Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. “We are committed to creating a healthier community and will set the pace by influencing healthier lifestyle choices,” said hospital president Eugene Dellea in a statement. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009, family physicians' incomes rose less than 0.5%, invasive cardiologists' pay was hiked by 7%, ophthalmologists gained by more than 9%, and neurologists' compensation fell by more than 2%. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash Over Faith

Nearly 1 in 10 primary care physicians has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found.

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. Survey respondents said businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said business is doing a fair or poor job on health, and about a third said they trust business to address health issues.

Stricter EPA Water Standards

The Environmental Protection Agency is developing stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, EPA Administrator Lisa Jackson said in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said that the agency also will foster development of new drinking water treatment technologies to address health risks.

Report Urges Relaxed E-Rules

The federal government could better foster electronic medical record keeping 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 electronic medical records 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. The mandates “may not be effective, given the kind of real-world usage among physicians we see today,” Bruce Carlson of Kalorama Information said in a statement. “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.” Some members of Congress also have backed less-stringent meaningful use requirements for both physicians and hospitals.

Hospital Sours on Sweet Drinks

In an effort to combat obesity, Fairview Hospital, a 24-bed acute care hospital in Great Barrington, Mass., said sodas and sugar-sweetened sports drinks no longer will be available on hospital grounds. Fairview, which has signed a “Healthy Food in Healthcare Pledge” developed by the advocacy group Health Care Without Harm, said it decided to eliminate sugary drinks after the state's House of Representatives voted to ban their sale in schools. “We are committed to creating a healthier community and will set the pace by influencing healthier lifestyle choices,” said hospital president Eugene Dellea in a statement. According to Health Care Without Harm, many hospitals make money by negotiating agreements with beverage companies to limit sales to single brands of soft drinks.

Academic Pay Growth Slows

Annual compensation for primary care and specialty physicians in academic settings slowed between 2008 and 2009, increasing less than 3% last year for both primary care physicians and specialists whose roles include teaching, research, and administration, according to the Medical Group Management Association. Primary care physicians in academic practice reported 2009 compensation of $158,218, while specialty care physicians had earnings of $238,587, the report said. Other differences emerged across specialties: Internists in academic practice saw their compensation rise more than 4% between 2008 and 2009, family physicians' incomes rose less than 0.5%, invasive cardiologists' pay was hiked by 7%, ophthalmologists gained by more than 9%, and neurologists' compensation fell by more than 2%. Income for physicians in academic practice continues to trail earnings of physicians in private practices, the report said.

Doctors, Hospitals Clash Over Faith

Nearly 1 in 10 primary care physicians has experienced a conflict over patient care policies with a hospital or practice affiliated with a religion, researchers from the University of Chicago reported online in the Journal of General Internal Medicine. Such entities hold about one-fifth of all U.S. hospital beds, according to the report. About 43% of primary care physicians have practiced in religion-affiliated hospitals, and about 19% of them experienced conflicts stemming from policies that, for instance, prohibit certain reproductive and end-of-life treatments, the researchers' cross-sectional survey found.

'Health' Is New Biz Buzzword

“Health” is joining “green” as a business strategy, according to a worldwide survey by the public relations firm Edelman. Survey respondents said businesses should support the health of their local communities, create new products that maintain and improve health, and educate the public on health topics related to products and services. More than two-thirds said that businesses should help to address obesity. Nearly three-quarters said they trust a company more that is effectively engaged in health, and two-thirds said they would either recommend or buy products from such a company. But half of respondents said business is doing a fair or poor job on health, and about a third said they trust business to address health issues.

Stricter EPA Water Standards

The Environmental Protection Agency is developing stronger standards for contaminants in drinking water. First, the agency will seek to address contaminants as groups, rather than individually, for the sake of efficiency, EPA Administrator Lisa Jackson said in a speech. And within the next year, the agency will revise standards for the carcinogenic contaminants tetrachloroethylene and trichloroethylene, which are used in industrial processes and get into ground and surface water. Then the EPA will turn to the carcinogens acrylamide and epichlorohydrin, impurities that can be introduced into drinking water during its treatment. Ms. Jackson said that the agency also will foster development of new drinking water treatment technologies to address health risks.

Physicians, patients, and research participants believe researchers’ financial ties to industry decrease the quality of research evidence, and patients believe that financial ties influence professional behavior and should be disclosed, a review of studies looking at views on financial ties to pharmaceutical and medical device companies found.

For some patients, knowledge of the researchers’ financial ties to industry would affect their willingness to participate in research studies, Dr. Cary Gross of Yale University, New Haven, Conn., and his colleagues wrote in the Apr. 26 issue of Archives of Internal Medicine.

“When any financial tie was disclosed, there was a reduction in the perceived quality of research among research participants and physicians,” they reported.

They noted that in clinical care, patients believed that financial ties also decreased the quality of care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of patients’, research participants’, and journal readers’ views about financial ties and perceptions of quality.

In studies considering patient perception of cost, a range of 26%-76% said they believed that gifts to physicians increase the cost of care, although fewer patients thought professional gifts were a problem.

“For instance, in a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote (Arch. Intern. Med. 2010;170:675-82).

In other studies, when respondents were asked to rate study disclosure statements, they deemed researchers with financial tie statements to be less trustworthy and less important than those who did not have them, they noted.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” according to Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

The literature review “suggests that a sizeable portion of the public wants to know about physician financial ties,” and that patients and research participants can distinguish between different types of financial ties and determine the relative importance of disclosure of each, the investigators concluded.

In an accompanying editorial, Eric Campbell, Ph.D., of Harvard University, Boston, noted that patients and research participants want access to data on conflicts of interest to make decisions about the potential impacts of industry relationships on the care they receive (Arch. Intern. Med. 2010;170:667).

“For example, they want to be able to ascertain if, and to what extent, their prescriptions could be inappropriately influenced by the financial relationships between their physician and pharmaceutical companies,” Dr. Campbell wrote.

However, collecting and presenting industry data in a useful way will not be easy, and “for consumers to use the data, it is clear that the quality of the data that is reported by companies must be improved,” he said.

Public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships, Dr. Campbell wrote. “This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy.”

However, “this transparency will help prevent the further erosion of public trust in the medical profession,” he argued.

The literature review was supported in part by a Doris Duke Clinical Research Fellowship. Dr. Gross disclosed having served as an expert witness, and another author disclosed serving as a paid data and safety committee member for Genzyme Corp. Dr. Campbell did not report any financial disclosures.

Physicians, patients, and research participants believe researchers’ financial ties to industry decrease the quality of research evidence, and patients believe that financial ties influence professional behavior and should be disclosed, a review of studies looking at views on financial ties to pharmaceutical and medical device companies found.

For some patients, knowledge of the researchers’ financial ties to industry would affect their willingness to participate in research studies, Dr. Cary Gross of Yale University, New Haven, Conn., and his colleagues wrote in the Apr. 26 issue of Archives of Internal Medicine.

“When any financial tie was disclosed, there was a reduction in the perceived quality of research among research participants and physicians,” they reported.

They noted that in clinical care, patients believed that financial ties also decreased the quality of care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of patients’, research participants’, and journal readers’ views about financial ties and perceptions of quality.

In studies considering patient perception of cost, a range of 26%-76% said they believed that gifts to physicians increase the cost of care, although fewer patients thought professional gifts were a problem.

“For instance, in a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote (Arch. Intern. Med. 2010;170:675-82).

In other studies, when respondents were asked to rate study disclosure statements, they deemed researchers with financial tie statements to be less trustworthy and less important than those who did not have them, they noted.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” according to Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

The literature review “suggests that a sizeable portion of the public wants to know about physician financial ties,” and that patients and research participants can distinguish between different types of financial ties and determine the relative importance of disclosure of each, the investigators concluded.

In an accompanying editorial, Eric Campbell, Ph.D., of Harvard University, Boston, noted that patients and research participants want access to data on conflicts of interest to make decisions about the potential impacts of industry relationships on the care they receive (Arch. Intern. Med. 2010;170:667).

“For example, they want to be able to ascertain if, and to what extent, their prescriptions could be inappropriately influenced by the financial relationships between their physician and pharmaceutical companies,” Dr. Campbell wrote.

However, collecting and presenting industry data in a useful way will not be easy, and “for consumers to use the data, it is clear that the quality of the data that is reported by companies must be improved,” he said.

Public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships, Dr. Campbell wrote. “This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy.”

However, “this transparency will help prevent the further erosion of public trust in the medical profession,” he argued.

The literature review was supported in part by a Doris Duke Clinical Research Fellowship. Dr. Gross disclosed having served as an expert witness, and another author disclosed serving as a paid data and safety committee member for Genzyme Corp. Dr. Campbell did not report any financial disclosures.

Physicians, patients, and research participants believe researchers’ financial ties to industry decrease the quality of research evidence, and patients believe that financial ties influence professional behavior and should be disclosed, a review of studies looking at views on financial ties to pharmaceutical and medical device companies found.

For some patients, knowledge of the researchers’ financial ties to industry would affect their willingness to participate in research studies, Dr. Cary Gross of Yale University, New Haven, Conn., and his colleagues wrote in the Apr. 26 issue of Archives of Internal Medicine.

“When any financial tie was disclosed, there was a reduction in the perceived quality of research among research participants and physicians,” they reported.

They noted that in clinical care, patients believed that financial ties also decreased the quality of care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of patients’, research participants’, and journal readers’ views about financial ties and perceptions of quality.

In studies considering patient perception of cost, a range of 26%-76% said they believed that gifts to physicians increase the cost of care, although fewer patients thought professional gifts were a problem.

“For instance, in a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote (Arch. Intern. Med. 2010;170:675-82).

In other studies, when respondents were asked to rate study disclosure statements, they deemed researchers with financial tie statements to be less trustworthy and less important than those who did not have them, they noted.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” according to Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

The literature review “suggests that a sizeable portion of the public wants to know about physician financial ties,” and that patients and research participants can distinguish between different types of financial ties and determine the relative importance of disclosure of each, the investigators concluded.

In an accompanying editorial, Eric Campbell, Ph.D., of Harvard University, Boston, noted that patients and research participants want access to data on conflicts of interest to make decisions about the potential impacts of industry relationships on the care they receive (Arch. Intern. Med. 2010;170:667).

“For example, they want to be able to ascertain if, and to what extent, their prescriptions could be inappropriately influenced by the financial relationships between their physician and pharmaceutical companies,” Dr. Campbell wrote.

However, collecting and presenting industry data in a useful way will not be easy, and “for consumers to use the data, it is clear that the quality of the data that is reported by companies must be improved,” he said.

Public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships, Dr. Campbell wrote. “This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy.”

However, “this transparency will help prevent the further erosion of public trust in the medical profession,” he argued.

The literature review was supported in part by a Doris Duke Clinical Research Fellowship. Dr. Gross disclosed having served as an expert witness, and another author disclosed serving as a paid data and safety committee member for Genzyme Corp. Dr. Campbell did not report any financial disclosures.