Jane Anderson

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually–transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013.

The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released earlier this summer. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

The list of preventive services was recommended by an expert panel of the Institute of Medicine.

In a report released July 19, the IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

Dr. E. Albert Reece commented, “The charge of the Preventive Services for Women committee, of which I was a member, was to identify the 'gaps' in coverage that could potentially have a major impact on the health of women in this country. Our other charge was to make recommendations regarding only those preventive services where there was an extremely high level of scientific evidence supporting their health benefits.

“Thus, all of the recommendations we made were based on a very strong scientific evidence of a clear health benefit, as well as evidence from many sources that, if implemented, would fill a significant health care gap in providing optimal preventive care for women. Contraception was just one of a handful of preventive services that emerged from this very rigorous process out of the many services that we considered.”

He continued, “Unintended pregnancies are a major cause of preterm births in this country, and preterm birth is a major contributor to infant mortality and fetal health problems. Despite strong evidence to support the use of contraceptives to ameliorate preterm births, we found a significant gap in access to and availability of this highly effective preventive method.

“As physicians and public health professionals, we on the IOM committee would have been ethically and morally remiss if we had omitted a recommendation to provide a service – without any barriers to access – that can potentially prevent this incredibly costly public health problem,” Dr. Reece, vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine, said in an interview.

In a press briefing, IOM panel chair Linda Rosenstock, dean of the University of California, Los Angeles, noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician.

However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss.

ACOG has pushed for better coverage of preventive services, including many on the IOM's list, for many years, Dr. Martin said in an interview. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said.

Dr. Martin noted that the recommendation for copayment-free contraception should help to reduce the number of unplanned pregnancies in the United States, especially for low- and middle-income women who may have had trouble affording birth control.

“It's amazing to me that a country as advanced as we are is as casual as we are about contraception.”

He also called out the IOM recommendations for better breastfeeding support along with coverage of gestational diabetes and domestic violence screening, saying they will help improve overall women's health.

“All of these are good recommendations,” Dr. Martin said. “I couldn't be happier with this report.

The recommendations also were hailed by Planned Parenthood on its website, which said the recommendations could remove barriers which keep many women from using birth control consistently.

However, Cardinal Daniel DiNardo of Galveston-Houston, Tex., chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, said in a statement that “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”

Cardinal DiNardo urged HHS to block the recommendations on contraception, as did the conservative group Family Research Council, which focused specifically on the recommendations for coverage of emergency contraceptives in the statement on its website.

Dr. Rosenstock noted that many health care plans currently provide coverage for these services and added that “This is just a recommendation for first-dollar coverage.”

The Affordable Care Act of 2010 requires health plans to provide first-dollar coverage for the preventive services listed in HHS' comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the U.S. Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women's health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women.

At the request of HHS officials, an IOM committee made up of women's health experts identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group's charge also required members to consider only services provided in clinical settings, even though “preventive services can be effective when provided in settings outside the physician's office,” she said.

The report backed up each of the committee's recommendations with the science behind it. For example, it noted that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women's preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urged HHS to consider adding the full range of Food and Drug Administration– approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This included emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report went further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

Mary Ellen Schneider, New York Bureau, contributed to this story.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually–transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013.

The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released earlier this summer. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

The list of preventive services was recommended by an expert panel of the Institute of Medicine.

In a report released July 19, the IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

Dr. E. Albert Reece commented, “The charge of the Preventive Services for Women committee, of which I was a member, was to identify the 'gaps' in coverage that could potentially have a major impact on the health of women in this country. Our other charge was to make recommendations regarding only those preventive services where there was an extremely high level of scientific evidence supporting their health benefits.

“Thus, all of the recommendations we made were based on a very strong scientific evidence of a clear health benefit, as well as evidence from many sources that, if implemented, would fill a significant health care gap in providing optimal preventive care for women. Contraception was just one of a handful of preventive services that emerged from this very rigorous process out of the many services that we considered.”

He continued, “Unintended pregnancies are a major cause of preterm births in this country, and preterm birth is a major contributor to infant mortality and fetal health problems. Despite strong evidence to support the use of contraceptives to ameliorate preterm births, we found a significant gap in access to and availability of this highly effective preventive method.

“As physicians and public health professionals, we on the IOM committee would have been ethically and morally remiss if we had omitted a recommendation to provide a service – without any barriers to access – that can potentially prevent this incredibly costly public health problem,” Dr. Reece, vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine, said in an interview.

In a press briefing, IOM panel chair Linda Rosenstock, dean of the University of California, Los Angeles, noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician.

However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss.

ACOG has pushed for better coverage of preventive services, including many on the IOM's list, for many years, Dr. Martin said in an interview. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said.

Dr. Martin noted that the recommendation for copayment-free contraception should help to reduce the number of unplanned pregnancies in the United States, especially for low- and middle-income women who may have had trouble affording birth control.

“It's amazing to me that a country as advanced as we are is as casual as we are about contraception.”

He also called out the IOM recommendations for better breastfeeding support along with coverage of gestational diabetes and domestic violence screening, saying they will help improve overall women's health.

“All of these are good recommendations,” Dr. Martin said. “I couldn't be happier with this report.

The recommendations also were hailed by Planned Parenthood on its website, which said the recommendations could remove barriers which keep many women from using birth control consistently.

However, Cardinal Daniel DiNardo of Galveston-Houston, Tex., chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, said in a statement that “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”

Cardinal DiNardo urged HHS to block the recommendations on contraception, as did the conservative group Family Research Council, which focused specifically on the recommendations for coverage of emergency contraceptives in the statement on its website.

Dr. Rosenstock noted that many health care plans currently provide coverage for these services and added that “This is just a recommendation for first-dollar coverage.”

The Affordable Care Act of 2010 requires health plans to provide first-dollar coverage for the preventive services listed in HHS' comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the U.S. Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women's health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women.

At the request of HHS officials, an IOM committee made up of women's health experts identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group's charge also required members to consider only services provided in clinical settings, even though “preventive services can be effective when provided in settings outside the physician's office,” she said.

The report backed up each of the committee's recommendations with the science behind it. For example, it noted that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women's preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urged HHS to consider adding the full range of Food and Drug Administration– approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This included emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report went further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

Mary Ellen Schneider, New York Bureau, contributed to this story.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually–transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013.

The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released earlier this summer. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

The list of preventive services was recommended by an expert panel of the Institute of Medicine.

In a report released July 19, the IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

Dr. E. Albert Reece commented, “The charge of the Preventive Services for Women committee, of which I was a member, was to identify the 'gaps' in coverage that could potentially have a major impact on the health of women in this country. Our other charge was to make recommendations regarding only those preventive services where there was an extremely high level of scientific evidence supporting their health benefits.

“Thus, all of the recommendations we made were based on a very strong scientific evidence of a clear health benefit, as well as evidence from many sources that, if implemented, would fill a significant health care gap in providing optimal preventive care for women. Contraception was just one of a handful of preventive services that emerged from this very rigorous process out of the many services that we considered.”

He continued, “Unintended pregnancies are a major cause of preterm births in this country, and preterm birth is a major contributor to infant mortality and fetal health problems. Despite strong evidence to support the use of contraceptives to ameliorate preterm births, we found a significant gap in access to and availability of this highly effective preventive method.

“As physicians and public health professionals, we on the IOM committee would have been ethically and morally remiss if we had omitted a recommendation to provide a service – without any barriers to access – that can potentially prevent this incredibly costly public health problem,” Dr. Reece, vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine, said in an interview.

In a press briefing, IOM panel chair Linda Rosenstock, dean of the University of California, Los Angeles, noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician.

However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss.

ACOG has pushed for better coverage of preventive services, including many on the IOM's list, for many years, Dr. Martin said in an interview. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said.

Dr. Martin noted that the recommendation for copayment-free contraception should help to reduce the number of unplanned pregnancies in the United States, especially for low- and middle-income women who may have had trouble affording birth control.

“It's amazing to me that a country as advanced as we are is as casual as we are about contraception.”

He also called out the IOM recommendations for better breastfeeding support along with coverage of gestational diabetes and domestic violence screening, saying they will help improve overall women's health.

“All of these are good recommendations,” Dr. Martin said. “I couldn't be happier with this report.

The recommendations also were hailed by Planned Parenthood on its website, which said the recommendations could remove barriers which keep many women from using birth control consistently.

However, Cardinal Daniel DiNardo of Galveston-Houston, Tex., chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, said in a statement that “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”

Cardinal DiNardo urged HHS to block the recommendations on contraception, as did the conservative group Family Research Council, which focused specifically on the recommendations for coverage of emergency contraceptives in the statement on its website.

Dr. Rosenstock noted that many health care plans currently provide coverage for these services and added that “This is just a recommendation for first-dollar coverage.”

The Affordable Care Act of 2010 requires health plans to provide first-dollar coverage for the preventive services listed in HHS' comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the U.S. Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women's health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women.

At the request of HHS officials, an IOM committee made up of women's health experts identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group's charge also required members to consider only services provided in clinical settings, even though “preventive services can be effective when provided in settings outside the physician's office,” she said.

The report backed up each of the committee's recommendations with the science behind it. For example, it noted that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women's preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urged HHS to consider adding the full range of Food and Drug Administration– approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This included emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report went further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

Mary Ellen Schneider, New York Bureau, contributed to this story.

'Just Say No' to Substitution

The terms “therapeutic substitution” and “therapeutic interchange” refer to two very different practices, and cardiologists should not accept the former but may be comfortable with the latter, according to a policy statement from the American College of Cardiology Foundation. Substitution occurs without a doctor's consent, whereas interchange is when a pharmacy dispenses a similarly acting drug with the physician's permission. If a payer is considering approving a certain interchange, it needs to take into account the strength of the evidence that the two drugs will work similarly, and it needs to consider the patient's specific medical condition. “Cost should be a consideration in this decision but not be the primary factor,” according to the policy statement, which also recommends procedures for health care facilities and payers to follow when they are developing a therapeutic-interchange policy.

Heart Disease Is Most Costly

Heart disease in both women and men was the most expensive condition in the United States in 2008, while hypertension and hyperlipidemia also made the top-10 list, according to the Agency for Healthcare Research and Quality. The analysis found that the cost for inpatient and outpatient care, emergency department visits, home care, and prescriptions for men with heart disease reached $47.3 billion, while payers spent $43.6 billion to treat women for heart disease. Medicare paid more than half of those expenditures for women but only about 38% of the cost for men. In the same year, more men and women suffered from hypertension than from any of the other 10 most costly conditions: 29.5 million women and 25.6 million men were subject to expenditures that were related to hypertension, according to the agency.

FDA Warns on Contrast Generator

The Food and Drug Administration is warning health care professionals to stop using CardioGen-82, a generator of rubidium-82 chloride, for cardiac positron emission tomography scans. The device's manufacturer, Bracco Diagnostics, announced that it will voluntarily recall the product. The FDA had received reports of two patients who were getting more radiation than was expected from CardioGen-82, although the agency said that the individuals' risk of harm was minimal. However, the FDA determined that Bracco Diagnostics's manufacturing procedures are not sufficient to ensure reliable performance of the device. The agency said it also is investigating procedures that are used to detect radiation exposure from the CardioGen-82.

Senators: Stop the Imaging Cuts

A bipartisan group of seven senators has called on President Obama to reject any further cuts to medical-imaging payments under Medicare, saying that the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” the senators wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter, many of whom come from states with strong biotech industries, are John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Cardiologist Convicted of Fraud

A federal jury in Baltimore has convicted Salisbury, Md.–based cardiologist Dr. John McLean of six counts of fraud for implanting unnecessary cardiovascular stents, ordering unnecessary tests, and making false entries in patients' medical records. According to evidence that was presented at his trial, Dr. McLean performed cardiac catheterizations and implanted unnecessary stents in more than 100 patients at the Peninsula Regional Medical Center in Salisbury. He also recorded false evidence or coronary artery blockages in patients' medical records to justify the stents that he implanted, the U.S. attorney's office alleged. Dr. McLean, who is scheduled to be sentenced on Nov. 10, faces a maximum sentence of 35 years in prison and more than $711,000 in forfeited profits.

Another Top Ranking for Harvard

The Harvard Clinical Research Institute received the highest payment from Eli Lilly of all physicians and physician groups in the United States in the first 3 months of 2011 – $767,564 – for its work on the Dual Antiplatelet Therapy study, according to the drug manufacturer's new physician-payment registry. The antiplatelet therapy double-blind randomized controlled trial, which is sponsored by the Harvard Clinical Research Institute and has multiple collaborators, including Eli Lilly, is designed to determine the appropriate combination of aspirin and a second anticlotting therapy. Many of the top 10 payments on Eli Lilly's first quarter 2011 registry went to psychiatrists, neurologists, and rheumatologists. The company, which has started disclosing its payments to physicians under a corporate-integrity agreement with the federal government, indicated that 63% of its payments in the first quarter were related to research projects.

'Just Say No' to Substitution

The terms “therapeutic substitution” and “therapeutic interchange” refer to two very different practices, and cardiologists should not accept the former but may be comfortable with the latter, according to a policy statement from the American College of Cardiology Foundation. Substitution occurs without a doctor's consent, whereas interchange is when a pharmacy dispenses a similarly acting drug with the physician's permission. If a payer is considering approving a certain interchange, it needs to take into account the strength of the evidence that the two drugs will work similarly, and it needs to consider the patient's specific medical condition. “Cost should be a consideration in this decision but not be the primary factor,” according to the policy statement, which also recommends procedures for health care facilities and payers to follow when they are developing a therapeutic-interchange policy.

Heart Disease Is Most Costly

Heart disease in both women and men was the most expensive condition in the United States in 2008, while hypertension and hyperlipidemia also made the top-10 list, according to the Agency for Healthcare Research and Quality. The analysis found that the cost for inpatient and outpatient care, emergency department visits, home care, and prescriptions for men with heart disease reached $47.3 billion, while payers spent $43.6 billion to treat women for heart disease. Medicare paid more than half of those expenditures for women but only about 38% of the cost for men. In the same year, more men and women suffered from hypertension than from any of the other 10 most costly conditions: 29.5 million women and 25.6 million men were subject to expenditures that were related to hypertension, according to the agency.

FDA Warns on Contrast Generator

The Food and Drug Administration is warning health care professionals to stop using CardioGen-82, a generator of rubidium-82 chloride, for cardiac positron emission tomography scans. The device's manufacturer, Bracco Diagnostics, announced that it will voluntarily recall the product. The FDA had received reports of two patients who were getting more radiation than was expected from CardioGen-82, although the agency said that the individuals' risk of harm was minimal. However, the FDA determined that Bracco Diagnostics's manufacturing procedures are not sufficient to ensure reliable performance of the device. The agency said it also is investigating procedures that are used to detect radiation exposure from the CardioGen-82.

Senators: Stop the Imaging Cuts

A bipartisan group of seven senators has called on President Obama to reject any further cuts to medical-imaging payments under Medicare, saying that the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” the senators wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter, many of whom come from states with strong biotech industries, are John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Cardiologist Convicted of Fraud

A federal jury in Baltimore has convicted Salisbury, Md.–based cardiologist Dr. John McLean of six counts of fraud for implanting unnecessary cardiovascular stents, ordering unnecessary tests, and making false entries in patients' medical records. According to evidence that was presented at his trial, Dr. McLean performed cardiac catheterizations and implanted unnecessary stents in more than 100 patients at the Peninsula Regional Medical Center in Salisbury. He also recorded false evidence or coronary artery blockages in patients' medical records to justify the stents that he implanted, the U.S. attorney's office alleged. Dr. McLean, who is scheduled to be sentenced on Nov. 10, faces a maximum sentence of 35 years in prison and more than $711,000 in forfeited profits.

Another Top Ranking for Harvard

The Harvard Clinical Research Institute received the highest payment from Eli Lilly of all physicians and physician groups in the United States in the first 3 months of 2011 – $767,564 – for its work on the Dual Antiplatelet Therapy study, according to the drug manufacturer's new physician-payment registry. The antiplatelet therapy double-blind randomized controlled trial, which is sponsored by the Harvard Clinical Research Institute and has multiple collaborators, including Eli Lilly, is designed to determine the appropriate combination of aspirin and a second anticlotting therapy. Many of the top 10 payments on Eli Lilly's first quarter 2011 registry went to psychiatrists, neurologists, and rheumatologists. The company, which has started disclosing its payments to physicians under a corporate-integrity agreement with the federal government, indicated that 63% of its payments in the first quarter were related to research projects.

'Just Say No' to Substitution

The terms “therapeutic substitution” and “therapeutic interchange” refer to two very different practices, and cardiologists should not accept the former but may be comfortable with the latter, according to a policy statement from the American College of Cardiology Foundation. Substitution occurs without a doctor's consent, whereas interchange is when a pharmacy dispenses a similarly acting drug with the physician's permission. If a payer is considering approving a certain interchange, it needs to take into account the strength of the evidence that the two drugs will work similarly, and it needs to consider the patient's specific medical condition. “Cost should be a consideration in this decision but not be the primary factor,” according to the policy statement, which also recommends procedures for health care facilities and payers to follow when they are developing a therapeutic-interchange policy.

Heart Disease Is Most Costly

Heart disease in both women and men was the most expensive condition in the United States in 2008, while hypertension and hyperlipidemia also made the top-10 list, according to the Agency for Healthcare Research and Quality. The analysis found that the cost for inpatient and outpatient care, emergency department visits, home care, and prescriptions for men with heart disease reached $47.3 billion, while payers spent $43.6 billion to treat women for heart disease. Medicare paid more than half of those expenditures for women but only about 38% of the cost for men. In the same year, more men and women suffered from hypertension than from any of the other 10 most costly conditions: 29.5 million women and 25.6 million men were subject to expenditures that were related to hypertension, according to the agency.

FDA Warns on Contrast Generator

The Food and Drug Administration is warning health care professionals to stop using CardioGen-82, a generator of rubidium-82 chloride, for cardiac positron emission tomography scans. The device's manufacturer, Bracco Diagnostics, announced that it will voluntarily recall the product. The FDA had received reports of two patients who were getting more radiation than was expected from CardioGen-82, although the agency said that the individuals' risk of harm was minimal. However, the FDA determined that Bracco Diagnostics's manufacturing procedures are not sufficient to ensure reliable performance of the device. The agency said it also is investigating procedures that are used to detect radiation exposure from the CardioGen-82.

Senators: Stop the Imaging Cuts

A bipartisan group of seven senators has called on President Obama to reject any further cuts to medical-imaging payments under Medicare, saying that the cuts already in place are harming both patients and the developers of these technologies. “As a result of these cuts, physicians are holding onto their old equipment longer, which means fewer patients have access to the newest technologies that are better at finding early-stage disease and guiding life-saving treatment,” the senators wrote. Instead of cutting imaging payments, the group said, Medicare should implement clinical decision-support systems that will help doctors determine when imaging is necessary. The senators signing the letter, many of whom come from states with strong biotech industries, are John Kerry (D-Mass.), David Vitter (R-La.), Scott Brown (R-Mass.), Ron Wyden (D-Ore.), Herb Kohl (D-Wis.), Lamar Alexander (R-Tenn.), and Maria Cantwell (D-Wash.).

Cardiologist Convicted of Fraud

A federal jury in Baltimore has convicted Salisbury, Md.–based cardiologist Dr. John McLean of six counts of fraud for implanting unnecessary cardiovascular stents, ordering unnecessary tests, and making false entries in patients' medical records. According to evidence that was presented at his trial, Dr. McLean performed cardiac catheterizations and implanted unnecessary stents in more than 100 patients at the Peninsula Regional Medical Center in Salisbury. He also recorded false evidence or coronary artery blockages in patients' medical records to justify the stents that he implanted, the U.S. attorney's office alleged. Dr. McLean, who is scheduled to be sentenced on Nov. 10, faces a maximum sentence of 35 years in prison and more than $711,000 in forfeited profits.

Another Top Ranking for Harvard

The Harvard Clinical Research Institute received the highest payment from Eli Lilly of all physicians and physician groups in the United States in the first 3 months of 2011 – $767,564 – for its work on the Dual Antiplatelet Therapy study, according to the drug manufacturer's new physician-payment registry. The antiplatelet therapy double-blind randomized controlled trial, which is sponsored by the Harvard Clinical Research Institute and has multiple collaborators, including Eli Lilly, is designed to determine the appropriate combination of aspirin and a second anticlotting therapy. Many of the top 10 payments on Eli Lilly's first quarter 2011 registry went to psychiatrists, neurologists, and rheumatologists. The company, which has started disclosing its payments to physicians under a corporate-integrity agreement with the federal government, indicated that 63% of its payments in the first quarter were related to research projects.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10.1377/hlthaff.2010.0893].

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and his colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

“The price of inefficiencies is not only the cost measured in this study,” according to the authors. “When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced,” they wrote.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members were found to work 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

“The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing,” Dr. Morra said in a statement.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10.1377/hlthaff.2010.0893].

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and his colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

“The price of inefficiencies is not only the cost measured in this study,” according to the authors. “When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced,” they wrote.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members were found to work 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

“The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing,” Dr. Morra said in a statement.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10.1377/hlthaff.2010.0893].

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and his colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

“The price of inefficiencies is not only the cost measured in this study,” according to the authors. “When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced,” they wrote.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members were found to work 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

“The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing,” Dr. Morra said in a statement.

The Center for Medicare and Medicaid Services' final rule to update Medicare's inpatient prospective payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted too quickly.

Hospitals are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when those pay cuts will start to take effect.

“We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions,” said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. “What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous.”

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying “it's a condition that's hard to prevent.”

But for hospitals, the most important provisions in the new rule are those asking them to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

The CMS defines readmission as “occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization.”

The CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

“As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge,” the agency said in a statement. “A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care.”

The American College of Cardiology has advocated use of registries to report on performance measures, however no registries were included in the final rule.

Nuts and Bolts of the Final Rule

The CMS's final rule to update Medicare's inpatient prospective payment system rates includes the following:

▸ Reporting measures for the rates of MRSA bacteremia, stroke, and venous thromboembolism.

▸ No adoption of its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments.

▸ A directive that hospitals should begin measuring readmission rates for three conditions (acute MI, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates.

▸ Methodology to calculate those excessive readmission rates.

▸ More than 20 new procedure codes, including codes for atherectomy and for endovascular and transapical heart valve procedures.

▸ A Medicare spending-per-beneficiary measure to assess Part A and Part B beneficiary spending from 3 days before a hospital admission through 30 days after a patient is discharged, in an effort to encourage hospitals to provide high-quality care to Medicare beneficiaries at a lower cost.

The Center for Medicare and Medicaid Services' final rule to update Medicare's inpatient prospective payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted too quickly.

Hospitals are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when those pay cuts will start to take effect.

“We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions,” said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. “What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous.”

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying “it's a condition that's hard to prevent.”

But for hospitals, the most important provisions in the new rule are those asking them to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

The CMS defines readmission as “occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization.”

The CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

“As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge,” the agency said in a statement. “A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care.”

The American College of Cardiology has advocated use of registries to report on performance measures, however no registries were included in the final rule.

Nuts and Bolts of the Final Rule

The CMS's final rule to update Medicare's inpatient prospective payment system rates includes the following:

▸ Reporting measures for the rates of MRSA bacteremia, stroke, and venous thromboembolism.

▸ No adoption of its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments.

▸ A directive that hospitals should begin measuring readmission rates for three conditions (acute MI, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates.

▸ Methodology to calculate those excessive readmission rates.

▸ More than 20 new procedure codes, including codes for atherectomy and for endovascular and transapical heart valve procedures.

▸ A Medicare spending-per-beneficiary measure to assess Part A and Part B beneficiary spending from 3 days before a hospital admission through 30 days after a patient is discharged, in an effort to encourage hospitals to provide high-quality care to Medicare beneficiaries at a lower cost.

The Center for Medicare and Medicaid Services' final rule to update Medicare's inpatient prospective payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted too quickly.

Hospitals are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when those pay cuts will start to take effect.

“We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions,” said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. “What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous.”

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying “it's a condition that's hard to prevent.”

But for hospitals, the most important provisions in the new rule are those asking them to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

The CMS defines readmission as “occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization.”

The CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

“As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge,” the agency said in a statement. “A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care.”

The American College of Cardiology has advocated use of registries to report on performance measures, however no registries were included in the final rule.

Nuts and Bolts of the Final Rule

The CMS's final rule to update Medicare's inpatient prospective payment system rates includes the following:

▸ Reporting measures for the rates of MRSA bacteremia, stroke, and venous thromboembolism.

▸ No adoption of its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments.

▸ A directive that hospitals should begin measuring readmission rates for three conditions (acute MI, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for “excessive” all-cause readmission rates.

▸ Methodology to calculate those excessive readmission rates.

▸ More than 20 new procedure codes, including codes for atherectomy and for endovascular and transapical heart valve procedures.

▸ A Medicare spending-per-beneficiary measure to assess Part A and Part B beneficiary spending from 3 days before a hospital admission through 30 days after a patient is discharged, in an effort to encourage hospitals to provide high-quality care to Medicare beneficiaries at a lower cost.

Hospitalists are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when pay cuts from revisions of Medicare’s inpatient prospective payment system start to take effect.

The Center for Medicare and Medicaid Services’ final rule to update the payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted in fewer than 30 days.

"We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions," said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. "What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous."

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying "it’s a condition that’s hard to prevent."

But for hospitalists, the most important provisions in the new rule are those asking hospitals to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for "excessive" all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

CMS defines readmission as "occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization."

CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

"As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge," the agency said in a statement. "A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care."

Dr. Doctoroff noted that hospitalists and the Society for Hospital Medicine have been working for several years to decrease readmissions in an effort to improve patient care.

The society, where Dr. Doctoroff sits on the Public Policy Committee, initiated Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), which works to help hospitalists to identify high-risk patients upon discharge and to facilitate information flow between inpatient and outpatient providers.

Project BOOST mentor sites now number more than 60, and the group wants to see 100 sites by the end of 2011. Early data from six sites show readmission rates falling from 14.2% to 11.2%, and those six sites also saw a 21% reduction in 30-day all-cause readmission rates, according to the society.

At Beth Israel, the entire group of more than 40 hospitalists has focused on how to improve communication and transition of care to primary care physicians, Dr. Doctoroff said.

For example, the hospitalists are trying to provide continuity of care by working with home health agencies on improved communications once a patient leaves the hospital, Dr. Doctoroff said. In addition, "we’ve put in place easier ways to set up posthospitalization appointments" using an administrative service that can contact patients, she said.

Finally, Beth Israel’s hospitalists have set up a postdischarge clinic in the hospital’s primary care facility where patients can receive follow-up care immediately following their discharge from the hospital.

All of these measures "improve the likelihood that the patient gets back to their primary care clinic," she said. "It also gives me and the other hospitalists an interesting view on outpatient medicine."

Still, it’s not possible to prevent all readmissions, Dr. Doctoroff said. "Our hospital is one of the high-readmission hospitals," she said, and could be looking at reductions in payments in October 2012 as a result of this new rule, unless hospitalists and other hospital staff can bring readmissions down.

Decreasing readmissions represents "such a multifactorial problem," she said. "There’s a group of patients it’s possible to keep out of the hospital completely. But there’s another group where, if you can stretch [readmissions] out to every 6 weeks instead of every month, you’re improving."

To improve care and prevent payment cuts relating to that second group of patients, hospitals may need to implement strategies aimed at delaying, rather than preventing, readmission, Dr. Doctoroff said. Those patients also tend to fall lower on the socioeconomic scale, but the new Medicare rules don’t account for socioeconomic status, she said, adding, "I worry very much about the safety-net hospitals."

Hospitalists are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when pay cuts from revisions of Medicare’s inpatient prospective payment system start to take effect.

The Center for Medicare and Medicaid Services’ final rule to update the payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted in fewer than 30 days.

"We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions," said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. "What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous."

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying "it’s a condition that’s hard to prevent."

But for hospitalists, the most important provisions in the new rule are those asking hospitals to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for "excessive" all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

CMS defines readmission as "occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization."

CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

"As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge," the agency said in a statement. "A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care."

Dr. Doctoroff noted that hospitalists and the Society for Hospital Medicine have been working for several years to decrease readmissions in an effort to improve patient care.

The society, where Dr. Doctoroff sits on the Public Policy Committee, initiated Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), which works to help hospitalists to identify high-risk patients upon discharge and to facilitate information flow between inpatient and outpatient providers.

Project BOOST mentor sites now number more than 60, and the group wants to see 100 sites by the end of 2011. Early data from six sites show readmission rates falling from 14.2% to 11.2%, and those six sites also saw a 21% reduction in 30-day all-cause readmission rates, according to the society.

At Beth Israel, the entire group of more than 40 hospitalists has focused on how to improve communication and transition of care to primary care physicians, Dr. Doctoroff said.

For example, the hospitalists are trying to provide continuity of care by working with home health agencies on improved communications once a patient leaves the hospital, Dr. Doctoroff said. In addition, "we’ve put in place easier ways to set up posthospitalization appointments" using an administrative service that can contact patients, she said.

Finally, Beth Israel’s hospitalists have set up a postdischarge clinic in the hospital’s primary care facility where patients can receive follow-up care immediately following their discharge from the hospital.

All of these measures "improve the likelihood that the patient gets back to their primary care clinic," she said. "It also gives me and the other hospitalists an interesting view on outpatient medicine."

Still, it’s not possible to prevent all readmissions, Dr. Doctoroff said. "Our hospital is one of the high-readmission hospitals," she said, and could be looking at reductions in payments in October 2012 as a result of this new rule, unless hospitalists and other hospital staff can bring readmissions down.

Decreasing readmissions represents "such a multifactorial problem," she said. "There’s a group of patients it’s possible to keep out of the hospital completely. But there’s another group where, if you can stretch [readmissions] out to every 6 weeks instead of every month, you’re improving."

To improve care and prevent payment cuts relating to that second group of patients, hospitals may need to implement strategies aimed at delaying, rather than preventing, readmission, Dr. Doctoroff said. Those patients also tend to fall lower on the socioeconomic scale, but the new Medicare rules don’t account for socioeconomic status, she said, adding, "I worry very much about the safety-net hospitals."

Hospitalists are ramping up quality improvement initiatives that they hope will decrease readmission rates by October 2012, when pay cuts from revisions of Medicare’s inpatient prospective payment system start to take effect.

The Center for Medicare and Medicaid Services’ final rule to update the payment system rates for hospitals beginning Oct. 1 will increase overall payments to hospitals by 1.1%, but also will begin implementing policies that ultimately will cut hospital reimbursement if patients are readmitted in fewer than 30 days.

"We see preventable readmissions, but we also see a whole large group of nonpreventable readmissions," said Dr. Lauren Doctoroff, a hospitalist at Beth Israel Deaconess Medical Center, Boston. "What the payment system is trying to do is measure all-cause readmissions, and this makes most hospitalists nervous."

The final Medicare Inpatient Prospective Payment System rule estimates that total payments to acute care hospitals for inpatient services occurring in fiscal year 2012 (which begins Oct. 1) will increase by about $1.1 billion to total approximately $100 billion. Each year, the rule spells out recalculated payments for individual codes, leading to a mixed bag of increases and decreases for specific procedures.

This year, the CMS rule also expanded the Hospital Inpatient Quality Reporting Program, with a greater focus on patient outcomes and experiences. The agency added a reporting measure involving the rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, along with reporting measures for stroke and venous thromboembolism.

However, the agency said that it is not adopting its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments. In an interview, Dr. Doctoroff welcomed that news, saying "it’s a condition that’s hard to prevent."

But for hospitalists, the most important provisions in the new rule are those asking hospitals to begin measuring readmission rates for three conditions (acute myocardial infarction, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for "excessive" all-cause readmission rates. The rule also outlines a methodology to calculate those excessive readmission rates.

CMS defines readmission as "occurring when a patient is discharged from the applicable hospital and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization."

CMS has set 30 days as the time period it will use to determine if a patient was readmitted unnecessarily. Beginning in 2012, it will begin cutting overall payments for hospitals that have numbers the agency deems excessive.

"As many as one in three Medicare patients who leave the hospital will be readmitted within 30 days of discharge," the agency said in a statement. "A large portion of these readmissions can be avoided through well-coordinated, high-quality hospital care."

Dr. Doctoroff noted that hospitalists and the Society for Hospital Medicine have been working for several years to decrease readmissions in an effort to improve patient care.

The society, where Dr. Doctoroff sits on the Public Policy Committee, initiated Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), which works to help hospitalists to identify high-risk patients upon discharge and to facilitate information flow between inpatient and outpatient providers.

Project BOOST mentor sites now number more than 60, and the group wants to see 100 sites by the end of 2011. Early data from six sites show readmission rates falling from 14.2% to 11.2%, and those six sites also saw a 21% reduction in 30-day all-cause readmission rates, according to the society.

At Beth Israel, the entire group of more than 40 hospitalists has focused on how to improve communication and transition of care to primary care physicians, Dr. Doctoroff said.

For example, the hospitalists are trying to provide continuity of care by working with home health agencies on improved communications once a patient leaves the hospital, Dr. Doctoroff said. In addition, "we’ve put in place easier ways to set up posthospitalization appointments" using an administrative service that can contact patients, she said.

Finally, Beth Israel’s hospitalists have set up a postdischarge clinic in the hospital’s primary care facility where patients can receive follow-up care immediately following their discharge from the hospital.

All of these measures "improve the likelihood that the patient gets back to their primary care clinic," she said. "It also gives me and the other hospitalists an interesting view on outpatient medicine."

Still, it’s not possible to prevent all readmissions, Dr. Doctoroff said. "Our hospital is one of the high-readmission hospitals," she said, and could be looking at reductions in payments in October 2012 as a result of this new rule, unless hospitalists and other hospital staff can bring readmissions down.

Decreasing readmissions represents "such a multifactorial problem," she said. "There’s a group of patients it’s possible to keep out of the hospital completely. But there’s another group where, if you can stretch [readmissions] out to every 6 weeks instead of every month, you’re improving."

To improve care and prevent payment cuts relating to that second group of patients, hospitals may need to implement strategies aimed at delaying, rather than preventing, readmission, Dr. Doctoroff said. Those patients also tend to fall lower on the socioeconomic scale, but the new Medicare rules don’t account for socioeconomic status, she said, adding, "I worry very much about the safety-net hospitals."

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study published Aug. 4.

The study, which appears in the journal Health Affairs (doi:10.1377/hlthaff.2010.0893), found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada’s single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

"If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year," wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues.

Most of the problems U.S. physicians face relate to the fact that they’re trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

"The price of inefficiencies is not only the cost measured in this study," the authors said. "When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced."

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country’s single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences "striking." U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

"The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing," Dr. Morra said in a statement.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded. For example, the authors backed creating common, possibly mandatory standards for billing, claims payment, and prior authorization; requiring payers and physicians to communicate electronically; implementing automated verification of insurance benefits at the point of care; and using standard credentialing and quality measurement processes.

The authors reported no financial conflicts of interest for the study, which was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study published Aug. 4.

The study, which appears in the journal Health Affairs (doi:10.1377/hlthaff.2010.0893), found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada’s single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

"If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year," wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues.

Most of the problems U.S. physicians face relate to the fact that they’re trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

"The price of inefficiencies is not only the cost measured in this study," the authors said. "When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced."

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country’s single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences "striking." U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

"The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing," Dr. Morra said in a statement.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded. For example, the authors backed creating common, possibly mandatory standards for billing, claims payment, and prior authorization; requiring payers and physicians to communicate electronically; implementing automated verification of insurance benefits at the point of care; and using standard credentialing and quality measurement processes.

The authors reported no financial conflicts of interest for the study, which was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study published Aug. 4.

The study, which appears in the journal Health Affairs (doi:10.1377/hlthaff.2010.0893), found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada’s single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

"If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year," wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues.

Most of the problems U.S. physicians face relate to the fact that they’re trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

"The price of inefficiencies is not only the cost measured in this study," the authors said. "When these inefficiencies result in frequent interruptions in the work of physicians and their staff, they are likely to interfere with patient care. Everyone – health plans, physicians and their staff, and patients – will be better off if inefficiencies in transactions between physicians and health plans can be reduced."

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country’s single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences "striking." U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

"The major difference between the United States and Ontario is that nonphysician staff members in the United States spend large amounts of time obtaining prior authorizations and on billing," Dr. Morra said in a statement.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded. For example, the authors backed creating common, possibly mandatory standards for billing, claims payment, and prior authorization; requiring payers and physicians to communicate electronically; implementing automated verification of insurance benefits at the point of care; and using standard credentialing and quality measurement processes.

The authors reported no financial conflicts of interest for the study, which was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.

The health care reform law passed in 2010 offers the potential to reduce socioeconomic disparities in cancer care and outcomes, but it does not go far enough, according to an American Society of Clinical Oncology policy statement published online August 1.

The statement in the Journal of Clinical Oncology calls for numerous measures, including creation of oncology-based medical homes, automatic qualification of Medicaid-eligible cancer patients for Medicare, an end to Medicare reimbursement cuts for cancer care, requiring insurers to pay for follow-up testing when abnormalities are discovered, and rethinking of penalties for higher readmission rates of vulnerable cancer patients (J. Clin. Oncol. 2011 Aug. 1 [doi: 10.1200/JCO.2011.35.8903]).

"We think it’s time to move beyond documenting disparity in cancer outcomes and start moving toward solutions," oncologist Dr. Blase N. Polite, chair-elect of the American Society of Clinical Oncology (ASCO) Health Disparities Advisory Group, said in an interview.

"When a patient has a cancer diagnosis, time is of the essence," said Dr. Polite of the University of Chicago. "When they have no insurance or poor insurance, it means people are going to die, and we know that."

The statement is not a blanket endorsement of the Patient Protection and Affordable Care Act (PPACA), the authors note. ASCO’s members have differing opinions, but providing quality care to all cancer patients "regardless of racial, socioeconomic, or geographic group, is a priority for all if its members."

Create Oncology Medical Homes

One approach that could help is creating oncology-specific, patient-centered medical homes, according to ASCO’s policy statement.

As written, the health care reform legislation calls for grants to develop and study community-based health teams and patient-centered medical homes that would allow a team of medical professionals, directed by a primary care physician, to provide comprehensive medical services and care coordination to patients.

The approach offers a "tremendous opportunity to develop a comprehensive coordinated strategy to reduce cancer incidence" by improving screening and helping patients implement lifestyle changes to reduce their risk, the society says.

But the approach "does less to ensure the coordination of care once a cancer diagnosis is made," and the legislation does not make it clear whether a cancer-specific community health team under the guidance of an oncologist would be allowed, the authors note.

"Given the unique care requirements for patients with cancer, ASCO believes that any form of integrated community care should allow for cancer-centered services under the direction of oncology professionals," the policy statement says.

Dr. Polite noted that the group wants to work with Congress to develop this concept of an oncology-specific patient-centered medical home.

"Once a patient gets diagnosed with cancer, the oncologist manages their care for a 3- to 4-year period," he said. "These patients require a diverse set of services, and right now they’re provided piecemeal. If we had this, then we could focus on providing the right set of services under one umbrella."

Health care reform also places more resources into federally qualified community health centers, Dr. Polite noted, but those centers don’t always offer good coordination of specialty care. "It does no good to diagnose the patient with cancer if you can’t put them into a qualified treatment center," he said. Therefore, ASCO wants to see community health center–based cancer care programs with oncologists at the helm, he said.

Change Reimbursement Policies

The ASCO policy statement also urges changes in reimbursement for oncologists treating Medicaid patients. It notes that increased Medicaid eligibility in the health care reform legislation has the potential to reduce the number of uninsured by 59%.

However, in part due to the low reimbursement rates that Medicaid offers, "there is convincing evidence that adult patients with cancer who are covered by Medicaid have poor clinical outcomes similar to those of uninsured patients," according to the group’s statement.

Therefore, ASCO is asking federal lawmakers to provide Medicaid patients diagnosed with cancer with immediate, presumptive eligibility for Medicare. In addition, states should reimburse doctors who treat cancer patients on Medicaid at Medicare rates, and there should be no more cuts to Medicare reimbursement rates.

Cover Follow-up Tests

Reforms also are needed in insurance coverage of cancer prevention and screening follow-ups, and on quality of care measures, according to the policy statement.

The health care reform legislation mandates coverage for certain screenings, but it does not expressly require insurers to cover follow-up tests if an abnormality is discovered, according to ASCO. For example, insurers don’t need to cover follow-up diagnostic exams and biopsies if a polyp is discovered during a colonoscopy.

ASCO wants Congress to require insurers to specifically cover appropriate follow-up testing without patient deductibles or copayments.

On quality of care, the health care reform law authorizes development of a strategy to develop and test measures to improve quality of care to reduce health care disparities. However, the society’s policy statement cautions that the strategy "must not further weaken the efforts of providers who are struggling to care for these patients in a strained resource environment unless the tools are provided for them to improve their quality."

For example, penalties for increased readmission rates should take into account the reduced social support and high rates of comorbidities found in impoverished patients, the group said. "ASCO recommends that quality improvement efforts be conducted in such a way that providers caring for underserved patients are not penalized."

Dr. Polite said that ASCO already is working with "a very resource-constrained public hospital" in an effort to help the hospital improve quality with its scant resources. "We get that quality’s important," he said, but "we also get that it’s hard for people who don’t have the resources."

Clinical Trials and Data Collection

The statement also calls for greater efforts to ensure access to clinical trials for racial, ethnic, and low-income groups. And it seeks more attention to issues surrounding the capture of data on race and ethnicity as they relate to cancer disparities.

Overall, when considering cancer care and outcome disparities, patients in specific vulnerable population groups suffer disproportionately, the policy statement observes.

"We have a fragmented system," Dr. Polite said. "Most people are able to get through it because they put a lot of the burden on themselves," but the most vulnerable don’t have the resources to do that, he added.

"If at the end of the day we were able to achieve seamless integration of care for cancer patients – diagnosis through survivorship – and also include a medical home, that would be a tremendous benefit for cancer patients," he said.

The authors indicated no potential conflicts of interest.

The health care reform law passed in 2010 offers the potential to reduce socioeconomic disparities in cancer care and outcomes, but it does not go far enough, according to an American Society of Clinical Oncology policy statement published online August 1.

The statement in the Journal of Clinical Oncology calls for numerous measures, including creation of oncology-based medical homes, automatic qualification of Medicaid-eligible cancer patients for Medicare, an end to Medicare reimbursement cuts for cancer care, requiring insurers to pay for follow-up testing when abnormalities are discovered, and rethinking of penalties for higher readmission rates of vulnerable cancer patients (J. Clin. Oncol. 2011 Aug. 1 [doi: 10.1200/JCO.2011.35.8903]).

"We think it’s time to move beyond documenting disparity in cancer outcomes and start moving toward solutions," oncologist Dr. Blase N. Polite, chair-elect of the American Society of Clinical Oncology (ASCO) Health Disparities Advisory Group, said in an interview.

"When a patient has a cancer diagnosis, time is of the essence," said Dr. Polite of the University of Chicago. "When they have no insurance or poor insurance, it means people are going to die, and we know that."

The statement is not a blanket endorsement of the Patient Protection and Affordable Care Act (PPACA), the authors note. ASCO’s members have differing opinions, but providing quality care to all cancer patients "regardless of racial, socioeconomic, or geographic group, is a priority for all if its members."

Create Oncology Medical Homes

One approach that could help is creating oncology-specific, patient-centered medical homes, according to ASCO’s policy statement.

As written, the health care reform legislation calls for grants to develop and study community-based health teams and patient-centered medical homes that would allow a team of medical professionals, directed by a primary care physician, to provide comprehensive medical services and care coordination to patients.

The approach offers a "tremendous opportunity to develop a comprehensive coordinated strategy to reduce cancer incidence" by improving screening and helping patients implement lifestyle changes to reduce their risk, the society says.

But the approach "does less to ensure the coordination of care once a cancer diagnosis is made," and the legislation does not make it clear whether a cancer-specific community health team under the guidance of an oncologist would be allowed, the authors note.

"Given the unique care requirements for patients with cancer, ASCO believes that any form of integrated community care should allow for cancer-centered services under the direction of oncology professionals," the policy statement says.

Dr. Polite noted that the group wants to work with Congress to develop this concept of an oncology-specific patient-centered medical home.

"Once a patient gets diagnosed with cancer, the oncologist manages their care for a 3- to 4-year period," he said. "These patients require a diverse set of services, and right now they’re provided piecemeal. If we had this, then we could focus on providing the right set of services under one umbrella."

Health care reform also places more resources into federally qualified community health centers, Dr. Polite noted, but those centers don’t always offer good coordination of specialty care. "It does no good to diagnose the patient with cancer if you can’t put them into a qualified treatment center," he said. Therefore, ASCO wants to see community health center–based cancer care programs with oncologists at the helm, he said.

Change Reimbursement Policies

The ASCO policy statement also urges changes in reimbursement for oncologists treating Medicaid patients. It notes that increased Medicaid eligibility in the health care reform legislation has the potential to reduce the number of uninsured by 59%.

However, in part due to the low reimbursement rates that Medicaid offers, "there is convincing evidence that adult patients with cancer who are covered by Medicaid have poor clinical outcomes similar to those of uninsured patients," according to the group’s statement.

Therefore, ASCO is asking federal lawmakers to provide Medicaid patients diagnosed with cancer with immediate, presumptive eligibility for Medicare. In addition, states should reimburse doctors who treat cancer patients on Medicaid at Medicare rates, and there should be no more cuts to Medicare reimbursement rates.

Cover Follow-up Tests

Reforms also are needed in insurance coverage of cancer prevention and screening follow-ups, and on quality of care measures, according to the policy statement.

The health care reform legislation mandates coverage for certain screenings, but it does not expressly require insurers to cover follow-up tests if an abnormality is discovered, according to ASCO. For example, insurers don’t need to cover follow-up diagnostic exams and biopsies if a polyp is discovered during a colonoscopy.

ASCO wants Congress to require insurers to specifically cover appropriate follow-up testing without patient deductibles or copayments.

On quality of care, the health care reform law authorizes development of a strategy to develop and test measures to improve quality of care to reduce health care disparities. However, the society’s policy statement cautions that the strategy "must not further weaken the efforts of providers who are struggling to care for these patients in a strained resource environment unless the tools are provided for them to improve their quality."

For example, penalties for increased readmission rates should take into account the reduced social support and high rates of comorbidities found in impoverished patients, the group said. "ASCO recommends that quality improvement efforts be conducted in such a way that providers caring for underserved patients are not penalized."

Dr. Polite said that ASCO already is working with "a very resource-constrained public hospital" in an effort to help the hospital improve quality with its scant resources. "We get that quality’s important," he said, but "we also get that it’s hard for people who don’t have the resources."

Clinical Trials and Data Collection

The statement also calls for greater efforts to ensure access to clinical trials for racial, ethnic, and low-income groups. And it seeks more attention to issues surrounding the capture of data on race and ethnicity as they relate to cancer disparities.

Overall, when considering cancer care and outcome disparities, patients in specific vulnerable population groups suffer disproportionately, the policy statement observes.

"We have a fragmented system," Dr. Polite said. "Most people are able to get through it because they put a lot of the burden on themselves," but the most vulnerable don’t have the resources to do that, he added.

"If at the end of the day we were able to achieve seamless integration of care for cancer patients – diagnosis through survivorship – and also include a medical home, that would be a tremendous benefit for cancer patients," he said.

The authors indicated no potential conflicts of interest.

The health care reform law passed in 2010 offers the potential to reduce socioeconomic disparities in cancer care and outcomes, but it does not go far enough, according to an American Society of Clinical Oncology policy statement published online August 1.

The statement in the Journal of Clinical Oncology calls for numerous measures, including creation of oncology-based medical homes, automatic qualification of Medicaid-eligible cancer patients for Medicare, an end to Medicare reimbursement cuts for cancer care, requiring insurers to pay for follow-up testing when abnormalities are discovered, and rethinking of penalties for higher readmission rates of vulnerable cancer patients (J. Clin. Oncol. 2011 Aug. 1 [doi: 10.1200/JCO.2011.35.8903]).

"We think it’s time to move beyond documenting disparity in cancer outcomes and start moving toward solutions," oncologist Dr. Blase N. Polite, chair-elect of the American Society of Clinical Oncology (ASCO) Health Disparities Advisory Group, said in an interview.

"When a patient has a cancer diagnosis, time is of the essence," said Dr. Polite of the University of Chicago. "When they have no insurance or poor insurance, it means people are going to die, and we know that."

The statement is not a blanket endorsement of the Patient Protection and Affordable Care Act (PPACA), the authors note. ASCO’s members have differing opinions, but providing quality care to all cancer patients "regardless of racial, socioeconomic, or geographic group, is a priority for all if its members."

Create Oncology Medical Homes

One approach that could help is creating oncology-specific, patient-centered medical homes, according to ASCO’s policy statement.

As written, the health care reform legislation calls for grants to develop and study community-based health teams and patient-centered medical homes that would allow a team of medical professionals, directed by a primary care physician, to provide comprehensive medical services and care coordination to patients.

The approach offers a "tremendous opportunity to develop a comprehensive coordinated strategy to reduce cancer incidence" by improving screening and helping patients implement lifestyle changes to reduce their risk, the society says.

But the approach "does less to ensure the coordination of care once a cancer diagnosis is made," and the legislation does not make it clear whether a cancer-specific community health team under the guidance of an oncologist would be allowed, the authors note.

"Given the unique care requirements for patients with cancer, ASCO believes that any form of integrated community care should allow for cancer-centered services under the direction of oncology professionals," the policy statement says.

Dr. Polite noted that the group wants to work with Congress to develop this concept of an oncology-specific patient-centered medical home.

"Once a patient gets diagnosed with cancer, the oncologist manages their care for a 3- to 4-year period," he said. "These patients require a diverse set of services, and right now they’re provided piecemeal. If we had this, then we could focus on providing the right set of services under one umbrella."

Health care reform also places more resources into federally qualified community health centers, Dr. Polite noted, but those centers don’t always offer good coordination of specialty care. "It does no good to diagnose the patient with cancer if you can’t put them into a qualified treatment center," he said. Therefore, ASCO wants to see community health center–based cancer care programs with oncologists at the helm, he said.

Change Reimbursement Policies

The ASCO policy statement also urges changes in reimbursement for oncologists treating Medicaid patients. It notes that increased Medicaid eligibility in the health care reform legislation has the potential to reduce the number of uninsured by 59%.

However, in part due to the low reimbursement rates that Medicaid offers, "there is convincing evidence that adult patients with cancer who are covered by Medicaid have poor clinical outcomes similar to those of uninsured patients," according to the group’s statement.

Therefore, ASCO is asking federal lawmakers to provide Medicaid patients diagnosed with cancer with immediate, presumptive eligibility for Medicare. In addition, states should reimburse doctors who treat cancer patients on Medicaid at Medicare rates, and there should be no more cuts to Medicare reimbursement rates.

Cover Follow-up Tests

Reforms also are needed in insurance coverage of cancer prevention and screening follow-ups, and on quality of care measures, according to the policy statement.

The health care reform legislation mandates coverage for certain screenings, but it does not expressly require insurers to cover follow-up tests if an abnormality is discovered, according to ASCO. For example, insurers don’t need to cover follow-up diagnostic exams and biopsies if a polyp is discovered during a colonoscopy.

ASCO wants Congress to require insurers to specifically cover appropriate follow-up testing without patient deductibles or copayments.

On quality of care, the health care reform law authorizes development of a strategy to develop and test measures to improve quality of care to reduce health care disparities. However, the society’s policy statement cautions that the strategy "must not further weaken the efforts of providers who are struggling to care for these patients in a strained resource environment unless the tools are provided for them to improve their quality."

For example, penalties for increased readmission rates should take into account the reduced social support and high rates of comorbidities found in impoverished patients, the group said. "ASCO recommends that quality improvement efforts be conducted in such a way that providers caring for underserved patients are not penalized."

Dr. Polite said that ASCO already is working with "a very resource-constrained public hospital" in an effort to help the hospital improve quality with its scant resources. "We get that quality’s important," he said, but "we also get that it’s hard for people who don’t have the resources."

Clinical Trials and Data Collection

The statement also calls for greater efforts to ensure access to clinical trials for racial, ethnic, and low-income groups. And it seeks more attention to issues surrounding the capture of data on race and ethnicity as they relate to cancer disparities.

Overall, when considering cancer care and outcome disparities, patients in specific vulnerable population groups suffer disproportionately, the policy statement observes.

"We have a fragmented system," Dr. Polite said. "Most people are able to get through it because they put a lot of the burden on themselves," but the most vulnerable don’t have the resources to do that, he added.

"If at the end of the day we were able to achieve seamless integration of care for cancer patients – diagnosis through survivorship – and also include a medical home, that would be a tremendous benefit for cancer patients," he said.

The authors indicated no potential conflicts of interest.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. 2011 [doi:10.1377/hlthaff. 2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. 2011 [doi:10.1377/hlthaff. 2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded.

Major Finding: Medical practices in the United States spend nearly $83,000 per year per physician to deal with health insurance plans; practices in Ontario spend about $22,200 per physician per year to interact with Canada's single-payer health care system.

Data Source: Surveys of physician practices in Ontario and in the United States, as well as 37 interviews with physicians, health plan executives, and practice administrators.

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

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that medical practices in the United States spend nearly $83,000 per year per physician to deal with health plans. In contrast, physician practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system. The report adjusted the figures slightly to account for exchange rates and specialty mix.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra, assistant professor of medicine at the University of Toronto, and his colleagues (Health Aff. 2011 [doi:10.1377/hlthaff. 2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

The differences in staff time spent on insurance issues started with the physicians themselves. U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study, which called the differences “striking.” U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

Standardizing transactions and conducting them electronically holds the potential for reducing some of these administrative costs in the United States, the study concluded.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually transmitted infections; HIV screening and counseling; Food and Drug Administration–approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013. The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released July 19. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing on Aug. 1.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception.

The list of preventive services was recommended by an expert panel of the Institute of Medicine. The IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

“Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay,” said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles. In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said in an interview.

Mary Ellen Schneider, New York Bureau, contributed to this story.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually transmitted infections; HIV screening and counseling; Food and Drug Administration–approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013. The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released July 19. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing on Aug. 1.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception.

The list of preventive services was recommended by an expert panel of the Institute of Medicine. The IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

“Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay,” said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles. In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said in an interview.

Mary Ellen Schneider, New York Bureau, contributed to this story.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women's preventive services, including contraception, the Health and Human Services department announced.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually transmitted infections; HIV screening and counseling; Food and Drug Administration–approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New private health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012. HHS estimates that about 34 million women ages 18-64 years will be in new private health plans by 2013. The new requirements do not apply to so-called “grandfathered” plans – those in existence today.

The list of women's preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM's recommendations, which were released July 19. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius said in a statement.

The decision to provide copayment-free contraceptives was a controversial one, but also “common sense,” Ms. Sebelius said during a news briefing on Aug. 1.

“Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it,” she said. “Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day.”

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group's beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception.

The list of preventive services was recommended by an expert panel of the Institute of Medicine. The IOM said that each of the services identified by IOM committee members is critical to ensure “women's optimal health and well-being.” Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

“Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay,” said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles. In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, “It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures.”

The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said in an interview.

Mary Ellen Schneider, New York Bureau, contributed to this story.

Oral Care Found Lacking

The Institute of Medicine warned that millions of Americans – especially children – lack access to critical dental services because there are too few dentists in some areas and not all families can afford dental care. One way to address the problem, in addition to improving reimbursement for dental professionals, is to train doctors and nurses to recognize potential oral diseases, according to the report. “As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health,” IOM committee chairman Dr. Frederick Rivara, professor of pediatrics at the University of Washington in Seattle, said in a statement. Children and adults who lack regular oral care risk diabetes and respiratory and cardiovascular diseases, the report emphasized.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the [Food and Drug Administration] and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

Training Support Urged

Despite what it calls a “challenging” budgetary climate, the American Academy of Pediatrics has urged federal lawmakers to fund three training programs for pediatricians that are intended, in part, to improve access to care for vulnerable pediatric populations. The academy labeled “instrumental” the Children's Hospital Graduate Medical Education program, the Medicare Graduate Medical Education program, and a new loan-repayment plan that is part of the health care reform act. The Children's Hospital program funds training for more than 40% of general pediatricians and pediatric medical and surgical specialists, according to the academy. The loan repayment program, which has not yet been funded, would provide financial support for pediatricians who enter subspecialty care, the group said.

The Smoke Clears in Movies

Motion pictures dramatically decreased depictions of tobacco from 2005 to 2010, according to the Centers for Disease Control and Prevention. The change could prevent some adolescents from starting the habit, the CDC said. The number of scenes with a tobacco product shown or its use implied dropped 56% in top-grossing movies (from 4,152 “incidents” to 1,825). In G- or PG-rated movies the drop was 94% (472 to 30), in PG-13 movies it was 65% (from 1,621 to 2010), and in R-rated movies tobacco use decreased 40% (2,059 to 1,226). Three of the six major motion picture companies have implemented policies to reduce tobacco use in their movies, the CDC reported, but films from the companies without such policies also left more tobacco on the cutting room floor.

School Health Centers Get Bonus

A total of 278 school-based health centers across the United States will split grants of $95 million to greatly expand their services, the Department of Health and Human Services said. The clinics currently serve approximately 790,000 patients, and the awards are intended to hike capacity by 440,000. The centers provide health screenings, disease prevention activities, and services that enable children with chronic illnesses to attend school. The new grants come from the health care reform act, which promised $200 million for school-based health centers through 2013.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The April proposal from the Federal Trade Commission said that only foods that contribute to a healthful diet should be marketed to children, and offered target levels for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers now argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association also called for the voluntary standards to be withdrawn because they could become mandatory.

Oral Care Found Lacking

The Institute of Medicine warned that millions of Americans – especially children – lack access to critical dental services because there are too few dentists in some areas and not all families can afford dental care. One way to address the problem, in addition to improving reimbursement for dental professionals, is to train doctors and nurses to recognize potential oral diseases, according to the report. “As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health,” IOM committee chairman Dr. Frederick Rivara, professor of pediatrics at the University of Washington in Seattle, said in a statement. Children and adults who lack regular oral care risk diabetes and respiratory and cardiovascular diseases, the report emphasized.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the [Food and Drug Administration] and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

Training Support Urged

Despite what it calls a “challenging” budgetary climate, the American Academy of Pediatrics has urged federal lawmakers to fund three training programs for pediatricians that are intended, in part, to improve access to care for vulnerable pediatric populations. The academy labeled “instrumental” the Children's Hospital Graduate Medical Education program, the Medicare Graduate Medical Education program, and a new loan-repayment plan that is part of the health care reform act. The Children's Hospital program funds training for more than 40% of general pediatricians and pediatric medical and surgical specialists, according to the academy. The loan repayment program, which has not yet been funded, would provide financial support for pediatricians who enter subspecialty care, the group said.

The Smoke Clears in Movies

Motion pictures dramatically decreased depictions of tobacco from 2005 to 2010, according to the Centers for Disease Control and Prevention. The change could prevent some adolescents from starting the habit, the CDC said. The number of scenes with a tobacco product shown or its use implied dropped 56% in top-grossing movies (from 4,152 “incidents” to 1,825). In G- or PG-rated movies the drop was 94% (472 to 30), in PG-13 movies it was 65% (from 1,621 to 2010), and in R-rated movies tobacco use decreased 40% (2,059 to 1,226). Three of the six major motion picture companies have implemented policies to reduce tobacco use in their movies, the CDC reported, but films from the companies without such policies also left more tobacco on the cutting room floor.

School Health Centers Get Bonus

A total of 278 school-based health centers across the United States will split grants of $95 million to greatly expand their services, the Department of Health and Human Services said. The clinics currently serve approximately 790,000 patients, and the awards are intended to hike capacity by 440,000. The centers provide health screenings, disease prevention activities, and services that enable children with chronic illnesses to attend school. The new grants come from the health care reform act, which promised $200 million for school-based health centers through 2013.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The April proposal from the Federal Trade Commission said that only foods that contribute to a healthful diet should be marketed to children, and offered target levels for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers now argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association also called for the voluntary standards to be withdrawn because they could become mandatory.

Oral Care Found Lacking

The Institute of Medicine warned that millions of Americans – especially children – lack access to critical dental services because there are too few dentists in some areas and not all families can afford dental care. One way to address the problem, in addition to improving reimbursement for dental professionals, is to train doctors and nurses to recognize potential oral diseases, according to the report. “As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health,” IOM committee chairman Dr. Frederick Rivara, professor of pediatrics at the University of Washington in Seattle, said in a statement. Children and adults who lack regular oral care risk diabetes and respiratory and cardiovascular diseases, the report emphasized.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the [Food and Drug Administration] and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

Training Support Urged

Despite what it calls a “challenging” budgetary climate, the American Academy of Pediatrics has urged federal lawmakers to fund three training programs for pediatricians that are intended, in part, to improve access to care for vulnerable pediatric populations. The academy labeled “instrumental” the Children's Hospital Graduate Medical Education program, the Medicare Graduate Medical Education program, and a new loan-repayment plan that is part of the health care reform act. The Children's Hospital program funds training for more than 40% of general pediatricians and pediatric medical and surgical specialists, according to the academy. The loan repayment program, which has not yet been funded, would provide financial support for pediatricians who enter subspecialty care, the group said.

The Smoke Clears in Movies

Motion pictures dramatically decreased depictions of tobacco from 2005 to 2010, according to the Centers for Disease Control and Prevention. The change could prevent some adolescents from starting the habit, the CDC said. The number of scenes with a tobacco product shown or its use implied dropped 56% in top-grossing movies (from 4,152 “incidents” to 1,825). In G- or PG-rated movies the drop was 94% (472 to 30), in PG-13 movies it was 65% (from 1,621 to 2010), and in R-rated movies tobacco use decreased 40% (2,059 to 1,226). Three of the six major motion picture companies have implemented policies to reduce tobacco use in their movies, the CDC reported, but films from the companies without such policies also left more tobacco on the cutting room floor.

School Health Centers Get Bonus

A total of 278 school-based health centers across the United States will split grants of $95 million to greatly expand their services, the Department of Health and Human Services said. The clinics currently serve approximately 790,000 patients, and the awards are intended to hike capacity by 440,000. The centers provide health screenings, disease prevention activities, and services that enable children with chronic illnesses to attend school. The new grants come from the health care reform act, which promised $200 million for school-based health centers through 2013.

Food Makers Pan Guidelines

Food manufacturers charged that voluntary guidelines proposed by the federal government ignore the industry's progress on responsible marketing of food to children. The April proposal from the Federal Trade Commission said that only foods that contribute to a healthful diet should be marketed to children, and offered target levels for saturated fat, trans fat, added sugars, and sodium in such food. In a letter to the FTC, the FDA, and other agencies, 150 state, regional, and national food groups and manufacturers now argue that there's no evidence the proposed restrictions would contribute to long-term changes in eating behavior or solve childhood obesity. Separately, the National Restaurant Association also called for the voluntary standards to be withdrawn because they could become mandatory.