Archives: September 2005
Thu Sep 29, 2005
Durbin Removes Block on Risk Pool Legislation
Reportedly, Senator Dick Durbin (D. Ill.) has removed a block that has stalled legislation in the Senate intended to help fund state high risk medical insurance pools. Durbin had cited that legislation's favoring small states over large states as reason for his block. Apparently, the legislation now has been modified to treat large states equally.
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Wed Sep 28, 2005
Survey: 2006 Employee Health Care Costs to Raise 8 Percent
According to the 2006 Towers Perrin Health Care Cost Survey, U.S. employers are facing an 8% increase in their 2006 health care costs. Moreover, the cumulative effect of years of double-digit increases has produced a record high for employer-sponsored health care costs in America. In flat dollar terms, next year�s gross health care expenditure is expected to rise by an average of $597 per employee, to an average total cost of $8,424 -- representing a 140% increase over the last 10 years.
Employers continue to shoulder the majority of the burden. Employees on average will pay $155 more in 2006, representing a 10% increase from the year before. Employers, on the other hand, will see an increase of $442 per employee, absorbing 74% of the total cost increase. Overall, employers will pay 80% of premium costs and employees will pay 20%.
Notably, while the average cost of health care coverage will increase by $597 per employee in 2006, this figure would have been close to $750 were it not for employer efforts to aggressively manage program performance through vendor selection and performance management, prescription drug expenditures, care management, employee engagement and other initiatives.
These observations are drawn from top-line results of the annual survey, now in its 17th year, conducted by Towers Perrin�s HR Services Business. This year�s survey includes data on the health benefit programs provided by more than 200 of the nation�s largest employers, covering over five million U.S. employees, retirees and dependents.
�The health care cost crisis has become a chronic problem for U.S. employers and employees alike,� said David Guilmette, Managing Director of Health and Welfare for Towers Perrin. �There is a fundamental tension between managing costs and managing people that constrains how much of the cost can be shifted to employees. Given the huge cost base built up over the years and continuing inflation at rates well above CPI, employers simply have to take a longer-term view. With this perspective as a platform, some employers are moving toward a model that increases employees� responsibility and accountability -- engaging them in a long-term solution to a problem that is not going away. And these companies are beginning to see positive outcomes and a significant difference in program performance.�
A Crisis Turns Chronic
A historical view highlights the magnitude of the health care cost problem and why cost inflation -- whether at single- or double-digit rates -- now produces significant additional burdens for both employers and employees. Employees are paying 64% more in health care costs today than they spent five years ago. Employers, meanwhile, are paying 78% more in health care costs today than five years ago.
Employers continue to bear the lion�s share of the cost, and although cost-shifting in past years has increased employees� relative share, the 2006 survey suggests that employers recognize the need to look beyond stopgap �fixes� that simply shift costs and may have negative consequences for effective workforce management over the longer term.
For example, this year�s survey shows that the average employee share of premium costs will increase 10% in 2006, while the employer share will increase by 7%. In the 2005 survey, the cost increases experienced by employees and employers were 12% and 8%, respectively. In the 2006 survey, the bulk of the increase in the dollar amounts contributed by employees is due to inflation on their share of the premium, with less impact coming from cost shifting (increasing the employees� percentage of the cost).
Active Employee and Retiree Medical Costs Continue to Climb
The average reported 2006 cost of medical coverage for all types of health plans combined is $355 per month ($4,260 annually) for active employee-only coverage; $715 per month ($8,580 annually) for employee-plus-one-dependent coverage and $1,033 per month ($12,396 annually) for family coverage.
The total cost for retirees under age 65 is the highest in our survey -- $562 per month for retiree-only coverage ($6,744 annually) and more for coverage that includes dependents. Notably, the rate of cost increase for this group is higher than for active employees -- 10% versus 8% for active employees -- a trend that has persisted in employer-sponsored plans since 1999. This is of particular concern for employers who have large postretirement medical obligations.
Meanwhile, the Medicare Modernization Act is changing the landscape for employer-sponsored retiree medical programs. With a 2006 effective date for Medicare Part D on the horizon, the vast majority (83%) of the survey respondents who offer retiree medical say they will provide prescription drug coverage at least as rich as Medicare�s new program and take the federal subsidy offered to employers who provide this benefit.
For many companies, however, the 2006 approach could be an interim step toward a new strategy for the longer term as the impact of rising costs, changing demographics and the new Medicare law combine. Notably, over half (53%) of responding companies offering retiree medical say the Medicare changes will prompt them to rethink their commitments to all retirement programs, including both medical and retirement income benefits.
Employees Have More at Stake
Despite what appears to be a slowdown in costshifting, the data suggest that the trend toward greater sharing of costs between employers and employees is still under way. And in flat dollar terms, the employee share represents a significant cost by any standard. Employees will contribute 18% of the premium cost for employee-only coverage and 21% for dependent coverage (20% overall) -- an average of $63 a month ($756 annually) for employee-only coverage and $217 a month ($2,604 annually) for family coverage in 2006.
Retirees, meanwhile, will contribute approximately 43% of the total cost of their coverage. Retirees under 65 will pay an average of $244 a month ($2,928 annually) for retiree-only coverage, while retirees age 65 and older will pay an average of $108 a month ($1,296 annually) for retiree-only coverage.
�As health care costs continue to rise faster than the rate of general inflation, it�s more important than ever for employees to actively participate in controlling the overall spend and realize that increasing costs will affect them in both direct and indirect ways,� said Guilmette. �Clearly, as the company�s health care costs increase, the employee�s cost goes up as well. Continuing high inflation rates mean that employees� out-of-pocket health care expenses will also rise. And, at the end of the day, employees need to recognize that a larger piece of the total compensation pie is being taken up by health care costs.�
�The money has to come from somewhere, and increasingly we�re seeing it come from resources set aside to reward employee performance,� adds Ron Fontanetta, Principal in the Towers Perrin Health and Welfare practice. �Health care has become a tremendous financial burden on employers, and unless health care cost increases moderate, the funds available for compensation and rewards will be reduced. Moreover, as employees plan for retirement, they need to factor in health care premium costs because future retirees will often have to pay the entire amount.�
Beyond the Averages: Creative Actions Can Drive Positive Results
The survey data overall tell a sobering story, but the averages don�t give the complete picture -- i.e., the data also show significant variations in both the flat dollar and percentage cost increases experienced by U.S. companies and their employees. And the survey results suggest that companies with lower-than-average costs are doing some creative things -- notably, taking a comprehensive, longer-term approach to cost management and actively engaging employees in the process.
To better understand the factors that contribute to lower costs, the Towers Perrin analysis divides the survey group into three categories -- low-cost companies (companies in the lower third, with the lowest premium level per employee), average cost (the middle third) and high cost (the upper third, experiencing the highest cost per employee).
The cost variation across these groups is significant, with companies in the upper third facing a total cost of $10,022 per employee in 2006, against a $6,866 per employee cost for companies in the lower third. The rate of cost increases for the two groups -- 9% versus 6%, respectively -- is also notable. �While some variations in health care costs can be explained by differences in geography or employee demographics, many companies are experiencing better cost containment as a direct result of proactive steps they have taken,� said Guilmette.
Looking more closely at what distinguishes these groups, a number of key findings come to light. First, the low-cost companies seem to be looking at all aspects of their vendor relationships for quality of care, efficiency and cost-saving opportunities. For example, these companies are more likely than their high-cost counterparts to have consolidated vendors or implemented enhanced vendor performance standards/service levels. They are also much more likely to have implemented processes to monitor the results of their care management initiatives.
Aggressive vendor management does appear to yield results that go beyond the impact of geographic and demographic differences. And, while the average increase for HMOs in this year�s survey is 9% (compared with 7% for other plans overall), for the �low cost� companies, the average HMO increase is only 7%. �Smart employers are managing their HMOs using tactics that have been successful with PPOs, such as terminating poor-performing vendors and using self-insured arrangements,� noted Fontanetta.
�The gains achieved through aggressive program management allow these employers to minimize any cost shift to employees, as shown in the contrast between the rate of cost increases for employees at high-cost versus low-cost companies,� added Fontanetta.
Relief from cost shifting does not mean, however, reduced responsibility for employees at the low-cost companies. In fact, companies with the lowest health care costs are more likely to be sharing more of the costs as a percentage of the total with employees -- i.e., employees at low-cost companies pay on average 22% of the total, while employees at high-cost companies pay 17%.
The companies with lower costs are also more likely to have put other cost-sharing elements into place that encourage employees to take responsibility for their decisions at the point of care. For example, the differential between the copay amount for brand-name drugs compared with that for generic drugs is greater for employees at low-cost companies than for those at high-cost companies, creating a stronger incentive to use the less expensive alternative. Other incentives aimed at increasing employee accountability include meaningful differentials between primary care and specialist copays, along with a move away from copays altogether to coinsurance -- a trend much more prevalent among the low-cost companies.
Perhaps most important, companies with the lowest costs are not only requiring employees to take more responsibility for their health care decisions, but are also equipping them to do just that by communicating more effectively about health care costs, providing decision support tools and encouraging them to understand and manage their health risks.
�Most of the companies in the survey say they see their role and responsibility as employers continuing as it is or even growing over the next five years,� said Guilmette. �In other words, they see themselves in the game for the foreseeable future. But it�s interesting to note that companies with lower costs also seem to have more of a long-term philosophy and are taking actions that minimize the need to shift costs to employees.
�For employees who work at these more proactive companies, there is a quid pro quo. They must actively share responsibility, understand and accept the financial consequences of their decisions, and protect and invest in their own health,� added Guilmette. �Overall, we call this a culture of health -- employers and employees together managing the money, managing the vendors and providers, and sharing a commitment to the value of employee health.�
About the Survey
The Towers Perrin 2006 Health Care Cost Survey was conducted during August and September 2005. Participants were asked to report their 2006 per capita premium costs for insured health and dental plans, and premium equivalents (i.e., estimated benefit and administrative costs) for self-insured plans. Survey respondents represent primarily Fortune 1000 companies with operations in numerous locations nationwide. Health benefits for the 204 participating companies cost more than $24 billion annually.
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Tue Sep 27, 2005
ER Docs: The U.S. Health Care System is Collapsing, and Nowhere is That More Apparent Than in Our Nations Emergency Departments
America�s hospital emergency departments are under-funded, over-crowded, and suffer from staffing challenges caused by rising costs of medical liability insurance, according to a report released today by the American College of Emergency Physicians.
More than 3,500 emergency physicians and nurses came to the steps of the U.S. Capitol, urging Congress to �save emergency care� and to make sure their patients continue to have access to lifesaving emergency medicine. The emergency medicine professionals lauded the Access to Emergency Medical Services Act of 2005 (H.R. 3875), introduced last week by Rep. Bart Gordon (D-TN) and Rep. Pete Sessions (R-TX) and urged Congress to pass it quickly.
�The U.S. health care system is collapsing, and nowhere is that more apparent than in our nation�s emergency departments,� said Frederick C. Blum, MD, FACEP, president of the American College of Emergency Physicians. �Hurricane Katrina also made it clear � we must expand the �surge� capacity of our nation�s hospitals.
�Soaring health care costs, reduced hospital budgets, and an increasing dependence on emergency care mean that patients line the halls, waiting hours � sometimes days � to be transferred to inpatient hospital beds. This is a daily occurrence in many hospitals, and our patients can�t wait any longer for Congress to act. That�s why we applaud Rep. Sessions and Rep. Gordon for taking action and introducing much-needed legislation.�
The Emergency Nurses Association added their voices and concern. �We are here on behalf of emergency nurses across the country who fight daily to provide optimal care in emergency departments that are overflowing with patients,� said ENA President Patricia Kunz Howard, PhD, RN, CEN. �Today, we are moving to protect the rights of our patients and colleagues by urging our legislators to partner with us to secure the future of emergency patient care by endorsing initiatives that alleviate crowding and support emergency care as an essential public service.�
�For the 14 million readers of Ladies' Home Journal, who are the gatekeepers of their family's health, few safety issues are as urgent as the need to keep their community emergency rooms open, functioning and vital," says Diane Salvatore, Editor in Chief. �Our readers are a powerful force in advocating for positive public health changes, and we know they will put the full weight of their support behind this initiative to help save America's endangered ERs.�
A report released today by ACEP � State of Emergency: America�s Emergency Departments in Critical Condition � shows the number of patients seeking emergency care increased 27 percent in the past decade, while the number of emergency departments decreased by 15 percent, resulting in dramatic increases in patient volumes and waiting times at the remaining facilities. The majority of the nation�s 4,000 hospital emergency departments report that they are operating �at� or �over� critical capacity.
Thousands of physicians, nurses, and other health professionals assembled on Capitol Hill today to express their support for the bipartisan Access to Emergency Medical Services Act, which recognizes emergency medical care as providing essential public services that should receive public funding, just as police and fire departments do. Specifically, the Act would:
* Recognize hospital emergency departments as the backbone of our nation�s health care safety net.
* Provide hospitals with incentives to end boarding of admitted patients in emergency departments � to help end gridlock and save lives during natural disasters and acts of terrorism.
* Extend liability protection to on-call specialists and emergency physicians who provide EMTALA-mandated care.
ACEP also supports legislation that would provide limitations on non-economic damages awarded in medical liability lawsuits, which are driving record increases in insurance rates and forcing good doctors out of practice in many states.
�When you need the emergency room, you don�t want to worry about it being crowded or under-funded or not having the staff it needs, but sadly, the challenges facing emergency departments mean that all of us might not be able to receive the care we need when we need it,� said Rep. Bart Gordon (D-TN- 6th District). �ER doctors are the heroes in America�s hospitals, working under incredibly difficult conditions on patients who need critical attention Congress needs to step up and take action.�
�More patients are seeking emergency care than ever before, but fewer emergency department resources are available,� said Pete Sessions (R-TX, 32nd District). �A national investment is urgently needed to ensure that emergency departments can meet increasing demands. I think this legislation goes a long way toward that goal.�
Joining congressional representatives and health care professionals at the event is Emmy nominated actress Maura Tierney, who stars as emergency physician Abby Lockhart in the award-winning television series �ER.�
�For six years I have played a character who treats patients in a busy emergency room,� said Tierney. �If lending my voice today gets one more person to listen up and support America�s emergency departments, then I am proud to do it. I may not be a real doctor, but I can tell you that no matter how real we strive to depict emergency medicine on ER, it does not compare to what these doctors and nurses do every day. They�re heroes to millions of Americans.�
More information about the report on emergency care, the Access to Emergency Care Act, and the Capitol Hill rally is available at www.acep.org
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Mon Sep 26, 2005
Detroit News: Family Doctors Are Becoming A Dying Breed
Rising costs and increasing job pressures are driving family doctors, who provide the broadest and most basic health care, from the field, according to the Detroit News.
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Health Affairs: Curing any one disease will make the elderly live longer and in better health but it also means they accumulate more health care spending over a lifetime. That offsets the savings of being healthier. Exception: Eliminating Obesity
What impact will advances in biomedicine and technology have on health and spending for the elderly in the future? New data, released today by the journal Health Affairs, reveal that many of the most promising medical innovations will result in better health and longer life, but they will increase, not decrease, Medicare spending. Researchers also predict that curing any one particular disease won�t save Medicare much money, with one important exception: Eliminating obesity could potentially lower costs.
�Curing any one disease will make the elderly live longer and in better health�and this has great value to society�but it also means they accumulate more health care spending over a lifetime. That offsets the savings of being healthier,� said Dana P. Goldman, PhD, corporate chair and director of health economics at RAND in Santa Monica, California.
Under current projections, Medicare spending will rise from 2.6 percent of gross domestic product (GDP) today to 9.2 percent in 2050. Demographics will have a large impact as the first wave of baby boomers turns 65 in 2010. Goldman led a team of economists and physicians from RAND, Stanford University, and the VA [Department of Veterans Affairs] Greater Los Angeles Healthcare System to explore beyond the established, current projections, and to see how changes in medical technology, disease, and disability would affect future health spending for the elderly. The researchers developed the Future Elderly Model (FEM), a demographic and economic simulation model, to help them predict future costs and health status for the elderly. The data were published today in a series of six articles and seven accompanying Perspectives in a Health Affairs Web Exclusive.
�The challenge for policymakers is to understand and manage future Medicare spending. This in-depth analysis will help them chart direction for the future,� said John K. Iglehart, founding editor of Health Affairs.
In the lead article, �Consequences of Health Trends and Medical Innovation for the Future Elderly,� Goldman and colleagues looked at advances in cardiovascular disease, cancer and the biology of aging, and neurological disease to assess how innovations affected spending and life years saved over the period 2002�2030. Some technologies would be extremely expensive. For example, expanding the use of implantable cardioverter defibrillators (ICDs) to half of elderly patients with new cases of heart failure or heart attack would result in approximately 550,000 procedures annually in 2030, with total treatment costs of $27 billion measured in 2005 dollars.
Other technologies could have modest costs per additional life year, but could increase health care spending substantially. For example, the biomedical research community is actively seeking anti-aging compounds. Such a compound would increase health care spending by 14 percent in 2030 because, if the compound had been taken by healthy beneficiaries starting in 2002, there would be 13 million more Medicare beneficiaries in 2030.
However, researchers argue, the cost per additional year of life is well worth it�only $11,000 in 2005 dollars. And if the compound keeps people alive in very poor states of health, total health care spending in 2030 would be 70 percent higher, because there would be more elderly people in poor health, according to Goldman and colleagues. Yet even in this case, the cost per additional life year of $38,000 is still relatively modest.
In an accompanying Perspective, Harvard University�s David M. Cutler takes a more optimistic view for Medicare�s future. Taking into account information technology and other health improvement advances not included in the researchers� analysis, Cutler writes: �My forecast about medical spending is rosier than the FEM model suggests. The technological changes that the RAND authors consider will likely come to pass, and they will drive up Medicare spending (often with good value). But there is enormous potential for cost savings as well, which we have the capacity to realize. One can be an optimist even when the storm clouds are gathering.�
In the article �The Lifetime Burden of Chronic Disease among the Elderly,� economist Geoffrey F. Joyce and colleagues studied seven chronic conditions: stroke, chronic obstructive pulmonary disease (COPD), hypertension, coronary heart disease, cancer, diabetes, and acute myocardial infarction. Cumulative health care spending is only modestly higher for those with chronic diseases at age 65, ranging from about $5,000 to $18,000 (2005 dollars), because the chronically ill live fewer years. Annual Medicare expenses increase by about $750 to $2,000 for people with a serious chronic illness at age 65, while cumulative Medicare expenses increase by $2,500 to $15,000 across the seven chronic conditions studied.
Curing Obesity Could Translate Into Significant Savings For Medicare
Obesity could prove to play a large role in Medicare spending in the future, according to economist Darius N. Lakdawalla and colleagues in the article �The Health and Cost Consequences of Obesity among the Future Elderly.� Using the FEM, the authors contend that if obesity is shown to be responsible for the health differences between those who are obese and those who are not, preventing or curing obesity in any one person would return that person�s health care spending level to that of a person of normal weight. Given the growing number of obese Americans, the resulting savings to Medicare could be substantial.
How different are the costs of treating the obese elderly versus the nonobese? An obese 70-year-old incurs $38,000 in additional medical costs in old age compared with costs for a nonobese peer. And although obese 70-year-olds will live as long as those of normal weight, they will spend 40 percent more time disabled than their nonobese counterparts. Lakdawalla and his colleagues argue that the effects of disability from obesity, rather than increased spending, might be the more important component of the social burden of obesity.
Medicare will also spend about 34 percent more on an obese person than on someone of normal weight, and obesity may cost Medicare more to treat than other diseases, because higher costs are not offset by reduced longevity, according to the study. Beginning at age 70, an obese person will cost Medicare about $149,000, the highest level of any group. In addition, Medicare spending on an obese person is 20 percent higher than for the next closest group, the overweight, and 35 percent higher than spending on a person of normal weight. Medicare could experience considerable financial burden from the increase in obesity nationwide, spending about $38,000 more over the lifetime of an obese 70-year-old than it will spend on a beneficiary of similar age and normal weight.
Three additional articles, in which researchers used the FEM for all or some of their research, round out the Health Affairs Web Exclusive collection. In �Disability and Health Care Spending among Medicare Beneficiaries,� lead author Michael E. Chernew of the University of Michigan School of Public Health projects that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.
In �Technological Advances in Cancer and Future Spending by the Elderly,� lead author Jayanta Bhattacharya of Stanford University finds that no scenario holds major promise for guaranteeing the future financial health of Medicare. And in �Identifying Potential Health Care Innovations for the Future Elderly,� lead author Paul G. Shekelle evaluated innovations in cardiovascular disease, cancer, the biology of aging, and neurological disease and found that many innovations have the potential to greatly affect the costs and outcomes of health care.
This series of articles was funded in part by the National Institute on Aging and the John A. Hartford Foundation.
The articles can be read here.
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RAND STUDY FINDS ADVANCING MEDICAL TECHNOLOGY LIKELY TO GREATLY INFLATE FUTURE MEDICARE COSTS
New medical technology is likely to further inflate future Medicare costs, posing great financial risk to the program, according to a RAND Corporation study issued today.
Emerging treatments such as implantable defibrillators for heart ailments or drugs to prevent Alzheimer's disease could boost spending significantly, with single treatments potentially increasing costs by as much as 70 percent, according to a series of RAND Health reports published online by the journal Health Affairs.
�An array of new medical technology on the horizon could greatly inflate elderly health care spending,� said Dana Goldman, director of health economics at RAND Health and leader of the research. �This technology is valuable because it will improve health and extend lives. But we need to begin thinking about how to pay for it.�
Some savings may be expected if disability rates among the elderly continue to drop. But those savings probably will be overshadowed by increased spending on healthy elderly recipients who will live longer, according to one of the RAND papers.
Some cost savings may be possible if the nation can reduce the number of Americans who are obese. Medicare costs among obese seniors are significantly higher and the number of obese Medicare recipients is rising, according to the studies.
The elderly currently spend more than $300 billion on health care annually. Most of this is paid for by Medicare, which provides health insurance to Americans age 65 and older.
The warnings about a potential sharp rise in elderly spending are from a series of studies using a detailed model of Medicare spending created by Goldman and other researchers from RAND Health, Stanford University and the Greater Los Angeles VA Healthcare System.
Researchers examined the spending increases that might face the elderly through 2030 under a number of different scenarios, including potential cost spikes caused by 10 new medical technologies that a panel of experts said are likely to emerge during the period.
Some of the technologies would have small impacts, including cancer vaccines and better treatments for acute stroke, each of which is predicted to increase elderly health care spending by less than 1 percent.
But other technologies could trigger major cost increases. For example, researchers estimated what the cost might be of expanding use of implantable defibrillators, which are devices implanted in patients' chests to treat life-threatening heart beat problems. The devices show promise in treating other cardiac ailments, including heart attacks and heart failure.
If half of the patients with new cases of heart failure or heart attacks received the devices, elderly health care spending would rise by $14 billion in 2015 and by $21 billion in 2030, according to researchers. The increase would amount to almost 4 percent of total spending.
Other new technologies could cost even more. A preventive treatment for Alzheimer's disease or new cancer-fighting drugs could each increase elderly spending 8 percent, and anti-aging compounds � an area of active research in biomedicine � could drive up costs from 14 to 70 percent, according to the studies.
�Would you rather have today's health care at today's cost, or 1980s health care at 1980s cost?� Goldman said. �I think all of us want today's technology and the technology that will be developed in the future. But improved technology will cost us even more in the future.�
Another report authored by RAND economist Geoffrey F. Joyce determined that even if the incidence of chronic diseases among the elderly can be reduced, Medicare is not likely to see much savings.
Examining seven different chronic diseases such as diabetes and heart disease, researchers found that the long-term costs to Medicare for treating these ailments was relatively low, in large part because patients with chronic diseases die several years earlier than others.
If chronic diseases are eliminated in younger Medicare recipients, cumulative costs for each recipient will remain similar as people live longer. In addition, many people will develop the same diseases as they live longer, negating cost savings, according to the study.
One disease-prevention program that might help trim Medicare costs would be an effort to target obesity, according to a third paper authored by RAND economist Darius Lakdawalla.
While obese elderly people live about as long as those of normal weight, they are also much more likely to be disabled, according to the RAND study. A 70-year-old obese person can expect four years of disability-free life, while a normal-weight 70-year-old can expect seven years.
The average medical expenses of an obese 70-year-old will be about $38,000 more over his or her lifetime than a normal-weight person, according to the RAND study. These findings suggest that a less-obese population may cost Medicare significantly less.
The computer model used in the RAND studies was assembled using a representative sample of about 100,000 Medicare beneficiaries from the Medicare Current Beneficiary Survey, a national effort that asks Medicare beneficiaries about chronic conditions, use of health care services, medical care spending, and health insurance coverage. Each beneficiary in the sample is linked to Medicare claims records to track actual medical care use and costs over time.
The RAND model also incorporates information about younger people into the model, allowing researchers to gauge the impact of future Medicare recipients as well as current recipients. Those cases were selected from the National Health Interview Study.
Funding for the studies was provided by the federal Centers for Medicare and Medicaid Services and the National Institute on Aging, through its support of the RAND Roybal Center for Health Policy Simulation, the RAND Center for the Study of Aging, and the Stanford Center for Demography and Economics of Health and Aging. Funding also was provided by the UCLA Claude D. Pepper Older Americans Independence Center.
Other authors of the RAND studies are: Baoping Shang, Michael Hurd and Emmett B. Keeler of RAND; Alan M. Garber and Jayanta Bhattacharya of Stanford University; Constantijn Panis of Deloitte and Touche; and Paul Shekelle of RAND and the Greater Los Angeles VA Healthcare System.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.
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Tue Sep 20, 2005
ONCOLOGY WORLD CONGRESS SURVEY FINDS WIDE GAP BETWEEN URBAN AND RURAL ONCOLOGISTS IN RESOURCE AND INFORMATION ACCESS
Oncologists practicing in urban/metropolitan areas are significantly more satisfied than their counterparts in suburban and rural areas when evaluating their access to information, technology, new drugs, clinical trials and thought leaders, according to survey results released today by Oncology World Congress.
� 57% of urban oncologists are �very� or �completely satisfied� with their level of patient access to clinical trials vs. 30% of oncologists in suburban and rural areas.
� 57% of urban oncologists are �very� or �completely satisfied� with their level of access to new technologies vs. 33% of oncologists in suburban and rural areas.
� 67% of urban oncologists are �very� or �completely satisfied� with their level of access to new research vs. 48% of oncologists in suburban and rural areas.
Close to 50% of oncologists practicing in urban areas categorize their place of work (private practice, hospital or cancer center) as an �innovator� on the cutting edge of finding new cancer treatments, compared to only 14% of rural/suburban oncologists. More than 10% of the latter group classify their place of work as a �late adopter� of new treatments and technologies, compared to only 2% of urban oncologists.
�Filling the information gap between local community practitioners and urban oncologists working at or near major cancer research centers is critical to achieving more effective therapeutic outcomes for patients,� said Dr. Waun Ki Hong, Oncology World Congress Chair and head of the Division of Cancer Medicine at The University of Texas M. D. Anderson Cancer Center. �With an estimated 90% of U.S. oncology care performed outside of academic cancer centers, community oncologists are in crucial need of timely information on research advances and emerging technologies, as well as greater access to clinical trials and new therapies.� Dr. Hong and 170 colleagues will be working to address these issues and bridge the current gaps in treatment information and patient care at the upcoming Oncology World Congress meeting scheduled to take place in New Yorkon November 16-19, 2005.
Eighty percent of the oncologists polled cite accessibility to clinical trials as �very� and �extremely important� for effective patient treatment. According to the President�s Cancer Panel 2004-2005 annual report, approximately 20% of oncology patients are medically eligible for clinical trials, yet only 3% of adults with cancer are currently enrolled. Access to trials is typically concentrated around academic medical centers, with many community physicians outside of these centers unable to arrange for their patients to participate.
Response across both groups (urban and rural) reflect a wide gap between attributed level of importance to and satisfaction with access to information, technology, new drugs, clinical trials and thought leaders.
� 85% feel access to new technologies is �very or extremely important,� yet only 49% are �very� or �completely satisfied� with the access they currently have.
� 89% feel access to the latest cancer treatment drugs is �very or extremely important,� yet only 54% are �very� or �completely satisfied� with the access they currently have.
� 80% feel patient access to clinical trials is �very or extremely important,� yet only 49% are �very� or �completely satisfied� with the access they currently have.
According to the survey, administrative issues such as cost of care and staffing have a significant impact on patient treatment for oncologists in both urban and rural settings. Forty-one percent of the physicians polled claim standard health coverage and Medicare pose the greatest limitations on their ability to treat patients effectively.
Oncology World Congress conducted the survey to get a current pulse on U.S.oncology practice, as well as anecdotal thoughts about obstacles that practitioners face. Results include responses from 292 oncologists across a variety of disciplines and have a margin of error of 6%.
Oncology World Congress faculty is comprised of researchers, educators and practice guideline authors committed to helping community oncologists effectively incorporate emerging medical treatments within their practices and to expediting the translation of clinical research and technological innovations to patient care. The Congress also works to focus on the day-to-day challenges of running an oncology practice, including improving reimbursement and overcoming a lack of resources. The first annual meeting, chaired by Dr. Hong, will take place at the New York Marriott Marquis on November 16-19, 2005. Institutional partners include MemorialSloan-KetteringCancerCenter, The University of Texas M. D. Anderson Cancer Center, RoswellPark Cancer Institute and FoxChaseCancerCenter.
To obtain a copy of the survey results and additional information on Oncology World Congress, visit www.oncologycongress.com/survey
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JAMA: New Incentives Exist for Young Physicians to Pursue Research Careers
Recent initiatives appear to have created renewed interest for young physicians to pursue research careers, according to a study in the September 21 issue of JAMA, a theme issue on medical research.
Results of the study were presented today at a JAMA media briefing on medical research.
Physician-scientists, defined as individuals with a medical degree who perform medical research as their primary professional activity, have contributed much to the preeminent position of the U.S. in medical science, according to background information in the article. The unique perspective that physician-scientists bring to the medical research workforce is that their scientific questions arise at the bedside and in the clinic. Despite this perspective, the pipeline of physician-scientists has had a serious problem, first described more than a generation ago: the physician-scientist population in the U.S. is smaller and older than it was 25 years ago. These and other trends have led some observers to conclude that the physician-scientist is a threatened species. A variety of factors were thought to contribute to this problem, including increasing indebtedness of medical school graduates caused by rapidly rising medical school tuition costs.
Several National Institutes of Health (NIH)-sponsored groups, private foundations, and national organizations called for new initiatives and award programs aimed at revitalizing the physician-scientist career path. These initiatives were begun between 1998 and 2002.
These initiatives included NIH career development awards for young physicians being trained to carry out clinical research, awards for established clinical investigators, awards for academic institutions with programs supporting clinical research training and infrastructure, and a series of competitive loan repayment programs (LRPs) for young physician-scientists with significant debt.
The private not-for-profit sector created new awards for young and established physician-scientists and an increasing number of research-intensive medical schools and hospitals (where most physician-scientists work) have constructed multifaceted programs aimed at encouraging medical students to become involved with research before and after receiving their M.D. degree and at protecting the research time of young physician-scientists during their junior faculty appointments.
Timothy J. Ley, M.D., of the Washington University School of Medicine, St Louis, and Leon E. Rosenberg, M.D., of Princeton University, Princeton, N.J., conducted a study to attempt to define the effects that these budgetary and institutional initiatives have had on the physician-scientist career path. The authors determined trends using data obtained from the NIH, the American Medical Association, the Association of American Medical Colleges, and other sources.
The researchers found that the number of physician-scientists in the United States has been in a steady state for the past decade, but funded physician-scientists are significantly older than they were 2 decades ago. "However, the study of early career markers over the past 7 to 10 years has demonstrated increasing interest in research careers by medical students, steady growth of the M.D.-Ph.D. pool, and a new burst of activity in the 'late bloomer' pool of M.D.s (individuals who choose research careers in medical school or in residency training), fueled by loan repayment programs that were created by the NIH in 2002. Several recent trends for more established physician-scientists have also suggested improvement."
Concerning applications for NIH research project grants (RPGs), first-time M.D. applicants, whose numbers hovered at 750 to 800 between 1995 and 1999, have slowly increased recently, reaching a total of 995 in 2003. First-time RPG applicants with M.D.-Ph.D. degrees have steadily increased, from 133 in 1970 to 600 in 2003.
"New programs recently initiated by the NIH and private foundations are beginning to have a positive impact on the decisions of young physicians to pursue research careers. To maintain this trend, strong funding commitments will be required beyond the entry level. If these commitments are sustained, we are cautiously optimistic that they will result in an increase in the population of physician-scientists in the United States in the near future," the authors conclude.
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JAMA Survey: Most Americans Want More Spent on Medical Research and Are Dissatisfied with the Current American Medical System
Most Americans rate medical research as a high national priority and strongly support greater public and private funding, according to an article in the September 21 issue of JAMA, a theme issue on medical research. However, recent opinion surveys indicate that Americans also are increasingly dissatisfied with the nation's health care system and think the national commitment to health-related research should be higher.
Also, according to the survey, most Americans do not believe that America has the best healthcare system in the workd and growing numbers are voicing dissatisfaction with its current state.
Lead author Mary Woolley, M.A., of Research!America, Alexandria, Va., presented the findings of the article today at a JAMA media briefing on medical research.
Elected and appointed officials representing the public continuously shape policy affecting the conduct of health-related research and health care in the U.S., according to background information in the article. These officials pay close attention to issues that concern the health of the public. Medical researchers and funders of health-related research should be well informed of the public's attitudes toward research.
Mary Woolley, M.A., and Stacie M. Propst, Ph.D., of Research!America, Alexandria, Va., summarized 10 years of data gathered from national and state opinion surveys on public attitudes and perceptions about health care and health-related research. Data in the article were drawn from 70 state surveys and 18 national surveys commissioned by Research!America from 1998 through 2005. Most of the surveys had a sample size of 800 or 1,000 adults (range, 800 - 5,377). Participants were selected at random and surveyed by telephone interview.
In a 2005 poll, Americans ranked health care (28 percent), education (22 percent), and jobs (20 percent) as the most important domestic issues. That same year, the majority of interviewees (78 percent) said it was very important that the U.S. maintain global leadership in health-related research. More than half (55 percent) of Americans want more spent on research, and, most importantly, they are willing to pay for it.
The majority (67 percent) of Americans said they are willing to pay $1 more per week in taxes for additional medical research, an increase from 2004, when 46 percent said were willing to pay more for health research. When asked what type of research was more valuable-research to prevent disease or research to cure disease-nearly half (48 percent) said prevention research was more valuable.
Other Survey Results:
* Health care costs are a leading concern in terms of national priorities, with accelerating medical and health research rated as very important to 66 percent, somewhat important to 28 percent.
* 58 percent indicate that as the U.S. looks for ways to manage health care costs, the national commitment to health-related research should be higher.
* 60 percent of Americans say they do not believe the U.S. has the best health care system in the world.
* More than half (55 percent) of the public say they are currently dissatisfied with the quality of health care in this country, compared with 44 percent who reported the same in 2000.
* Many Americans (66 percent) say the U.S. is spending too little on public health research, and 64 percent say at least twice as much should be spent.
* A majority of Americans (58 percent) favor embryonic stem cell research, while 34 percent strongly favor it. Of the 29 percent of people opposed to stem cell research, 57 percent said their position was based on religious objections.
* 56 percent of Americans do not believe an abstinence-only approach to teen sex education will prevent STDs and unwanted pregnancies, while 39 percent believe it will.
"The understanding, support and engagement of the public are essential if the research enterprise is to continue to succeed. To ensure that success, stakeholders in research must commit to listening to the public and being responsive to their concerns. The concerns expressed by the public are to be expected in the conduct of research that seeks to chart the unknown. The research community should embrace every opportunity to engage the public in an effort to answer their questions and put a human face on research," the authors write. "The widespread public support for research and researchers is now, as it has long been, entirely consistent with public aspirations for better health and well-being, and for longer and more productive lives."
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JAMA: Academic Medical Centers Face Challenges
To maintain their effectiveness for conducting medical research, academic medical centers must face critical issues such as constrained funding sources, scientific integrity, recruiting physician-scientists, and the increasing costs of research, according to an article in the September 21 issue of JAMA, a theme issue on medical research.
Lead author Jordan J. Cohen, M.D., of the Association of American Medical Colleges (AAMC), Washington, D.C., presented the article today at a JAMA media briefing on medical research.
Dr. Cohen and co-author Elisa K. Siegel, A.B., of the AAMC, examined the status of medical research at academic medical centers.
"The present era offers more promise for progress in medical research than ever before. Contemporary science has deciphered the human genome, discovered some of the potential of stem cells, and unleashed the power of information technologies. Any one of these three historic scientific achievements would have the potential to effect a fundamental transformation in medicine; their confluence has created unprecedented opportunity for spectacular breakthroughs in human health."
The authors write that despite this promise for progress, many challenges await medical research:
� The need to manage high (and often unreasonable) public expectations for lifesaving discoveries.
� The need to maintain public trust despite the suspicions aroused by financial conflicts of interest.
� The need to sustain the cultural norms of academe while partnering with industry to promote technology transfer.
� The obstacles to recruiting and retaining physician-scientists to pursue translational research.
� The widening gap between the costs of research and available funding sources.
� The unfunded mandates with which investigators and institutions must comply.
� The need to transform an academic reward structure built to encourage individual scientists to pursue their own ideas into one that fosters teams of collaborating investigators to pursue "big science".
Promoting Public Understanding
"Having raised expectations with tantalizing promises of scientific breakthroughs, the research community has an obligation to help the public understand the process of medical research and the often uneven and incremental pace of progress that characterizes most medical discoveries," the authors write. "Academic medical centers, as sources of much of the advances in medicine, have a special role to play in managing the public's expectations and can do so by ensuring that public communications about their research developments are tempered with realistic assessments of their practical impact."
Managing Financial Conflicts of Interest
Financial conflicts of interest on the part of investigators and their institutions have the potential both to undermine the integrity of the scientific process and to compromise the safe conduct of human research. "According to a 2004 AAMC survey, the academic medicine community has made substantial progress in moving beyond the minimum requirements prescribed by federal regulations to strengthen the safeguards against conflicts of interest in human research. However, this survey also revealed that the academic medicine community still has more work to do to establish a uniformly robust set of policies and procedures. . Sustaining public trust in the medical research enterprise will, at minimum, require continued efforts to identify and address ways to improve the protection of human research subjects and to buttress the management of financial conflicts of interest."
Maintaining Academic Values
According to the authors, examples of the potentially damaging effects of academic-industry relationships include real or perceived pressures to relax scientific standards, inducements to become advocates (or shills) for industry, suppression of nonoptimal research results, incomplete or misleading descriptions and interpretations of trial results, and premature termination of clinical trials. "Academic medical centers and their industry partners must be willing to adopt more uniform, more robust, and more transparent standards governing their relationships if the mutual benefits of those relationships are to be sustained."
Sustaining Research Funding
In recent years, the growth of federal funding for medical research has decreased, with the NIH's budget growing by less than the rate of inflation. Compounding this restrictive fiscal climate are the increasing costs of modern science and of complying with the ever-increasing burden of government regulations.
"The White House Office of Science and Technology Policy and Office of Management and Budget have undertaken a cross-agency initiative to identify more efficient business models and to streamline agency requirements for federally sponsored research, giving rise to some hope that the federal government will at least partially restore the balance of responsibility that formerly characterized the historic federal-academic partnership in the country's research enterprise. If some relief is not forthcoming, some institutions may find it impossible to sustain their sponsored research programs."
"Academic medical centers face many difficult challenges in pursuing their research mission, and the interconnectedness of those challenges magnifies the difficulty. The ability to nurture and sustain a vibrant clinical research workforce in the future is heavily dependent on the ability to shift the academic culture and reward system away from the traditional paradigm focused on the individual investigator in favor of one that is more collaborative, team-based, and interdisciplinary," the authors write.
"The ability to sustain financial support for medical research in the face of constrained federal and state budgets is heavily dependent on managing unrealistic public expectations and on maintaining public trust. The ability to benefit optimally from the growing relationships with industry is heavily dependent on remaining true to fundamental academic values, including the safety of human subjects research, the integrity of the scientific process, and the free exchange of research results. The degree to which medical schools and teaching hospitals are successful in meeting these challenges will determine the degree to which the historic promise of modern medical science will be realized," the authors conclude.
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JAMA: Biomedical Resarch Funding Has Soared
From 1994 to 2003, total funding for biomedical research in the U.S. doubled to $94.3 billion, with industry providing 57 percent of the funding and the National Institutes of Health providing 28 percent, according to a study in the September 21 issue of JAMA, a theme issue on medical research.
Lead author Hamilton Moses III, M.D., of the Alerion Institute, North Garden, Va., presented the findings of the study today at a JAMA media briefing on medical research.
Few comprehensive analyses of the sources of financial support of biomedical research and uses of these funds have been available, according to background information in the article. This results in inadequate information on which to base investment decisions and can create a barrier to judging the value of research to society. Previous articles have examined specific sectors, but few have done so comprehensively.
Dr. Moses and colleagues conducted a study to determine the level and trend from 1994 to 2004 of basic, translational (the application of knowledge of basic science research to clinical care), and clinical U.S. biomedical research support from the major sponsors of this research: (1) federal government, (2) state and local governments, (3) private not-for-profit entities including foundations, and (4) industry. The researchers compiled publicly available data for federal, state, and local governments; foundations; charities; universities; and industry. Proprietary (by subscription but openly available) databases were used to supplement public sources.
The researchers found that biomedical research funding increased from $37.1 billion in 1994 to $94.3 billion in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57 percent) and the National Institutes of Health (28 percent). Relative proportions from all public and private sources did not change. Industry sponsorship of clinical trials increased from $4.0 to $14.2 billion (in real terms) while federal proportions devoted to basic and applied research were unchanged.
The United States spent an estimated 5.6 percent of its total health expenditures on biomedical research, more than any other country, but less than 0.1 percent for health services research. >From an economic perspective, biotechnology and medical device companies were most productive, as measured by new diagnostic and therapeutic devices per dollar of research and development cost. Productivity declined for new pharmaceuticals.
The NIH is by far the largest federal funder of biomedical research. Adjusted for inflation, NIH obligations nearly doubled (in 2003 dollars) from $13.4 billion in 1994 to $26.4 billion in 2003. Private support for biomedical research, adjusted for inflation, increased 36 percent from $1.8 billion in 1994 to $2.5 billion in 2003 (in 2003 dollars). Private support for biomedical research comes primarily from foundations, voluntary health organizations, and the free-standing research institutes.
Industry funding from pharmaceutical, biotechnology, and medical device firms increased 102 percent from $26.8 billion in 1994 to an inflation-adjusted $54.1 billion in 2003 (in 2003 dollars). The growth rate (inflation adjusted) for the medical device sector (264 percent) exceeded that for either the pharmaceutical (89 percent) or biotechnology (98 percent) sectors. The proportion of biomedical research support coming from industry sources remained relatively constant and was 56 percent for 1994 and 58 percent for 2003.
The federal government and foundations spent $1.4 billion on health policy and health services research in 2002. Federal funding for health services research came primarily from the NIH ($787 million in fiscal year 2002) and the Agency for Healthcare Research and Quality ($299 million in fiscal year 2002). The sum of federal and foundation spending for health services research in 2002 was an estimated 1.5 percent of biomedical research funding.
"The doubling over a decade of total spending by U.S. public and private research sponsors in real, inflation-adjusted, terms should be reassuring to those who fear that financial sponsorship for research is not paralleling scientific opportunity. It is also reassuring that spending on health and biomedical science research by companies and government is not following reductions in research and development in other industries or reduced support for other areas of science. By comparison, the low proportion of spending on health services research is especially notable, since it is the main tool available to evaluate the clinical benefit of technology," the authors write.
"Barriers to the discovery of new drugs have received much attention over the past decade. Despite the doubling of biomedical research funding and the shift toward clinical research by pharmaceutical companies, the number of new molecular entities approved by the FDA has fallen. For example, from 1994 to 1997, the number of new molecular entities approved averaged 35.5 per year. From 2001 to 2004, the number of new molecular entities averaged 23.3 per year. As a consequence, pharmaceutical productivity decreased over the last 10 years, and it is lagging that of the biotechnology and device sectors," the researchers write.
"We believe a major factor in decreasing productivity stems from pharmaceutical companies' frequent determination that compounds approvable from a regulatory standpoint are not worth bringing to the market because the intensity of competition is so high that it is not worth challenging existing drugs that are safe and effective. This highlights the need to invest in clinical areas with few effective treatments and for which novel mechanisms or entirely new classes of drugs are possible. The willingness of biotechnology companies to do this may, in part, account for their greater relative productivity."
"For all sponsors, the challenge is patience. Biomedical research is an inherently high risk and lengthy process. It would be helpful to remind those making financial decisions that the promise of earlier advances in the basic understanding of physiology in the 1920s and 1930s, or of biochemistry and microbiology in the 1940s, 1950s, and 1960s, took decades to unfold."
"Enhancing research productivity and evaluation of benefit are pressing challenges, requiring (1) more effective translation of basic scientific knowledge to clinical application; (2) critical appraisal of rapidly moving scientific areas to guide investment where clinical need is greatest, not only where commercial opportunity is currently perceived; and (3) more specific information about sources and uses of research funds than is generally available to allow informed investment decisions. Responsibility falls on industry, government, and foundations to bring these changes about with a longer-term view of research value," the authors conclude.
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Mon Sep 19, 2005
Research Finds Low Electronic Health Record Adoption Rates for Physician Groups
A comprehensive study by the Medical Group Management Association (MGMA) Center for Research and the University of Minnesota School of Public Health has captured the current state of adoption of electronic health records (EHR) by U.S. medical group practices. More than 3,300 medical group practices participated in the Assessing Adoption of Health Information Technology project, which was funded by the federal Agency for Healthcare Research and Quality (AHRQ). The study reports current rates of EHR adoption, which EHR features are more frequently used, barriers to adopting an EHR and how users rated the benefits of having adopted an EHR.
Smaller Practices Report Lower Adoption Rates
The research shows that just 14.1 percent of all medical group practices use an EHR, and just 11.5 percent indicated that an EHR was fully implemented for all physicians and at all practice locations. More significantly, the research shows that only 12.5 percent of medical group practices with five or fewer full-time-equivalent physicians (FTE) have adopted an EHR. The adoption rate increased with the size of practice; groups with six to 10 FTE physicians reported a 15.2 percent adoption rate, groups with 11-20 FTE physicians reported an 18.9 percent adoption rate, and groups of 20 or more FTE physicians had a 19.5 percent adoption rate.
Other data reveals that 12.7 percent of groups were in the process of implementing an EHR; 14.2 percent said implementation is planned in the next year; and 19.8 percent said implementation was planned in 13-24 months. The remaining 41.8 percent have no immediate plans for EHR adoption. Among those with no immediate plans for implementation, the difference between large and small groups is striking�47.8 percent of practices with five or fewer FTE physicians compared with only 20.7 percent of practices with 21 or more physicians.
"Obviously, rates are low across the spectrum of all group sizes, but smaller groups face more challenges in adopting these technologies and progress more slowly than their larger counterparts," said Terry Hammons, MD, senior vice president, research and information, MGMA Center for Research, and co-author of the study. "For widespread adoption of EHRs to be successful, more work needs to be done, and small to medium size medical group practices will need more help than they are getting now."
Contributing researchers from the University of Minnesota School of Public Health Bryan E. Dowd, Ph.D., professor and director of Graduate Studies, Division of Health Services Research, Policy, and John E. Kralewski, Ph.D., professor, Division of Health Services Research and Policy, note that while some practices report important efficiency gains from their EHRs, there is widespread dissatisfaction with the design and performance of these technologies.
Nationally Representative Sample Surveyed
With funding from AHRQ, MGMA Practice Management Resources Director David N. Gans, FACMPE, Kralewski, Hammons and Dowd surveyed a nationally representative sample of medical group practices to assess their current use of information technology. They conducted the survey in January and February 2005. MGMA members made up 25 percent of the sample.
"This survey provides a guidepost for where we should focus our efforts to move the adoption of state-of-the-art electronic health record systems," said AHRQ Director Carolyn M. Clancy, M.D. "Adoption of these EHR systems is an important means to an end in our efforts to improve the quality of health care in America."
Findings of the research are also highlighted in the September/October edition of Health Affairs in "Medical Groups' Adoption of Electronic Health Records and Information Systems" written by Gans, Kralewski, Hammons and Dowd.
EHR Capabilities Vary
The report provides insight into which EHR capabilities are actually used, as not every EHR has all functions and not every medical group fully uses the capabilities of its EHR system. More than 97 percent of the respondents with an EHR reported that their system had functions for patient medications, prescriptions, patient demographic and visit/encounter notes. Less than 65 percent reported the EHR provided drug formulary information or clinical guidelines and protocols. Equally important was that only 83.1 percent of respondents said their EHR was integrated with their practice billing system.
"System integration is a highly important function of the EHR," Gans said. "Integration with the practice billing system facilitates cost savings by eliminating the manual entry of billing information, improving charge capture and improving documentation in the medical record of billed services."
Cost a Barrier to Adoption
Despite State and federal efforts to encourage adoption of these technologies, group practices cited "lack of capital resources to invest in EHR" as the top barrier to adoption. Also, University of Minnesota researchers noted, an important barrier to adoption is that practices are not convinced EHRs will improve their performance. The return on investment in terms of cost and quality are not yet evident, according to Kralewski.
The research indicates that the average purchase and implementation cost of an EHR was $32,606 per FTE physician. Maintenance costs were an additional $1,500 per physician per month. Not surprising was the finding that smaller practices had the highest per-physician implementation cost at $37,204. The study also found that the average cost for EHR implementation was about 25 percent more than initial vendor estimates.
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Fri Sep 16, 2005
British Liberal Democratic Party Launches "NHS Watch website" to Monitor Brits National Health Service
The British Liberal Democratic Party is launching a website, NHS Watch, to monitor whether the British National Health Service is "not working as it should be."
Examples of items this website is seeking include:
- Are the British Government's NHS reforms working? If not, why not?
- Are Government targets creating perverse incentives / distorting clinical priorities? Which ones?
- Is the new IT system a triumph or a disaster?
- Are cash-strapped Trusts having to make cuts that compromise patient care?
- What is happening in the NHS that the British Government needs to know about?
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Thu Sep 15, 2005
Study: Providing Doctors With Financial Incentives to Rein In Their Prescription Practices Has Not Led to Cost-Cutting Innovations
With rising concern over the cost of the new Medicare prescription drug benefit program � going into effect January, 2006 and estimated to cost $593 billion over the next decade � a new UCSF study reveals that a key cost-cutting strategy employed by HMOs for 15 years is simply not working.
Health insurance companies have increasingly sought to limit the amount of expensive drugs doctors prescribe to patients in order to keep drug costs form spiraling, according to the study authors. A major strategy has been to restrain drug costs by assuring that a medical group will make money if member doctors prescribe within the drug budget set by the insurance company, and will lose money if member doctors over-prescribe.
The underlying assumption is that placing doctors at financial risk for their drug prescribing practices will lead them to adopt new practices to control drug costs, the authors explain. These practices include hiring pharmacists for expert advice, using "physician profiling" to compare doctors' prescribing patterns, and adhering to professional protocols that specify what each drug should be prescribed for, at what dose and for how long.
The new study shows that providing financial incentives for doctors to rein in their prescription practices has not led to cost-cutting innovations.
The study is being published in the August issue of the Journal of Health Policy, Politics and the Law, available mid-September. It is based on a survey of executives in more than three dozen physician groups and HMOs in four large U.S. cities.
The survey found widespread dissatisfaction with the HMO strategy of making doctors financially liable for prescription drug costs above a certain limit. It also found doctors were often confused or unaware of the incentives, either because of unclear contracts with HMOs or failure of HMOs to share drug cost information with doctors appropriately. In addition, frequent changes in the contract made it hard for physicians to know if an investment in innovation made under today�s deal would still pay off under tomorrow's, the survey shows.
"The problem lies in the contract terms and information-sharing between the HMO and doctors. Fix that, and you'll go a long way to controlling drug costs," says study co-author R. Adams Dudley, MD, UCSF associate professor of medicine and health policy.
HMOs negotiated their own prices for drugs with the manufacturers via pharmacy benefit managers but typically failed to disclose that information to physicians, the survey revealed.
"Profitably managing something as complex as prescription drug risk requires accurate, timely information, but most of the surveyed physician groups couldn't even calculate their total drug costs," says Jonathan D. Agnew, PhD, a study co-author and senior policy consultant at the British Columbia Medical Association.
Even when HMOs were willing to share price information, the study found that the data usually got to the doctors too late for them to determine if they were over or under budget.
"On the one hand, doctors get too much information from working with so many HMOs, each with its own array of prescription drug benefits and policies. On the other hand, the information they do get from the HMO is often incomplete or not timely enough to help them make good management decisions," says Helene Levens Lipton, PhD, professor of health policy and pharmacy at UCSF and lead author of the study.
The survey also found that HMO contracts with physician groups focused far more on efforts to contain costs than to maintain or improve the quality of care, Dudley said.
The researchers propose three major changes:
* Contracts between physician groups and HMOs should be clearer and more accurate, and information about changing drug-cost incentives should be provided to physicians in a more timely way.
* Doctors should not be held liable for the costs of doing the "right thing": If giving a prescription is the right thing to do, the costs should not be included in a budget target. Rather, the expenditure targets should be limited to situations in which medication use is more discretionary, such as whether or not a patient needs to continue on anti-ulcer drugs after an ulcer has healed.
* When HMOs evaluate a group's performance, the assessment should be fair. For example, in the late 1990s, doctors should not have been penalized for rising prescription costs related to the introduction of new drug therapies they could not have budgeted for, such as the first drug therapies for attention deficit disorder.
As another example of a drug-risk contract considered unfair by physician groups, the authors report that one physician group was penalized for not controlling its costs as well as another group in the HMO's network, even though the other group was in a different health care market.
Under the new Medicare drug benefit, reimbursement for HMOs depends, in part, on their establishing sound drug use management programs to contain drug costs, the authors point out.
"As HMOs establish and modify these programs, we hope the data presented here can help them avoid some of the major pitfalls we found in several large cities across the country," says study co-author Marilyn Stebbins, PharmD, UCSF professor of clinical pharmacy. "And doctors can learn to request fairer contracts and better information sharing."
Angela Kuo, MS, a former research associate with Lipton, was also a co-author on the paper.
The study was supported by the Robert Wood Johnson Foundation�s Changes in Health Care Financing and Organization initiative.
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Survey: The Percentage of Businesses Offering Health Insurance to Their Workers Has Declined Steadily Over the Last Five Years
The percentage of businesses offering health insurance to their workers has declined steadily over the last five years as the cost of providing coverage continues to outpace inflation and wage growth, according to the 2005 Annual Employer Health Benefits Survey released by the Kaiser Family Foundation and Health Research and Educational Trust.
The survey found that three in five firms (60%) offered coverage to workers in 2005, down significantly from 69% in 2000 and 66% in 2003. The drop stems almost entirely from fewer small businesses offering health benefits, as nearly all businesses (98%) with 200 or more workers offer such benefits.
�It is low-wage workers who are being hurt the most by the steady drip, drip, drip of coverage draining out of the employer based health insurance system,� Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D., said.
Premiums increased an average of 9.2% in 2005, down from the 11.2% average found in 2004. The 2005 increase ended four consecutive years of double-digit increases, but the rate of growth is still more than three times the growth in workers� earnings (2.7%) and two-and-a-half times the rate of inflation (3.5%). Since 2000, premiums have gone up 73%.
The annual premiums for family coverage reached $10,880 in 2005, eclipsing the gross earnings for a full-time minimum-wage worker ($10,712). The average worker paid $2,713 toward premiums for family coverage in 2005 or 26% of the total health premium. While workers� share of their premium has been relatively stable over the past few years, they are now paying on average $1,094 more in premiums for family coverage than they did in 2000.
�While premium increases slowed this year, they continue to rise much faster than inflation and other economic indicators. As a result, workers and businesses alike are finding it harder to afford health coverage,� said Health Research and Educational Trust President Mary A. Pittman, Dr. P.H.
High-deductible health plans
The survey found that 20% of employers who offer health insurance now provide a high-deductible health plan option. Jumbo firms � those with 5,000 or more workers � are significantly more likely than smaller firms to offer a high-deductible plan option, with 33% offering one in 2005. The survey defines high-deductible health plans as those with at least a $1,000 deductible for single coverage or at least a $2,000 deductible for family coverage.
Among employers who offer a high-deductible plan, relatively few (19.5%, or 3.9% of all offering employers) also make a contribution to a health reimbursement arrangement (HRA), offer a plan that would permit an enrollee to establish a health savings account (HSA), or do both. HRAs and HSAs are tax-favored accounts that employees can use to pay for medical expenses. Such arrangements are often described as consumer-driven because patients pay for a greater share of their health care directly, rather than through insurers, and therefore may have a financial incentive to reduce their health-care spending.
Despite the growing availability of high-deductible plans, relatively few workers are enrolled in consumer-driven arrangements. The survey estimates that this year about 2.3% of non-federal covered workers, or 1.6 million people, are enrolled in high-deductible health plans with an HRA, and about 1.2%, or 810,000 people, are enrolled in plans that are eligible for use with an HSA.
�Consumer-driven plans are proving attractive to some, but with just a couple million people now enrolled, it's too early to know whether they'll have a meaningful effect on the health system,� said Gary Claxton, a Kaiser Family Foundation vice president and co-author of the study. �The jury is still out on whether employees feel that these arrangements work for them, particularly when they get sick, and on whether employers feel that they have a real impact on costs.�
The survey also provides a detailed look at the features of high-deductible health plans, including premiums, deductibles, use of spending accounts, and employer and worker contributions. Such plans can cost less than other forms of employer-sponsored health coverage, but also leave workers exposed to greater potential out-of-pocket costs.
�Premium increases have slowed somewhat, but there's little confidence out there that we have an answer to health care cost growth,� said Jon Gabel, co-author of the study. �In the mid-1990s, premium hikes dropped to less than 1%, and we're still far away from that right now.�
Other highlights from the 2005 survey include:
* Reasons for not offering coverage. Firms that do not offer health benefits to their workers � the overwhelming majority of whom are small firms � were most likely to cite cost as a key factor, with nearly three in four (73%) saying high premiums were �very important� to their decision. In comparison, just over half (52%) said their firm�s small size and one in three (33%) said the fact that their workers had access to other coverage were very important to their decision.
* Type of insurance. In 2005, PPO plans were more common than ever, with 61% of all employees with health coverage enrolling in a PPO (up from 55% in 2004). Enrollment in HMOs, which generally cost less than PPOs, fell to 21% in 2005 from 25% in 2004. Conventional, or indemnity, benefit plans have all but disappeared, covering just 3% of covered workers.
* Future plans. Looking toward the future, more than 40% of large firms (200 or more workers) offering health benefits say they are �very likely� to ask employees to pay more in premiums next year, while just 15% of smaller firms say they plan to do so. Across all firms offering coverage, relatively few say that they are �very likely� in the next year to raise deductibles (8%), raise office visit cost-sharing (7%) or raise prescription drug copayments (7%). About 1% of firms say they are �very likely� to drop health coverage entirely in the near future.
* Utilization and disease management. About eight in 10 covered workers (81%) are in a health plan that uses case management for high-cost claims. Most covered workers also must get prior certification for inpatient services (75%) and outpatient surgery (55%). More than half (56%) of covered workers are enrolled in a plan with at least one disease management program. Among workers in these plans, virtually all (99%) are in a plan that provides management for diabetes. Large majorities are also in plans that provide management for asthma (86%), hypertension (82%), and high cholesterol (66%).
* Confidence in cost-containment strategies. Few employers have a lot of confidence in strategies to contain rising health-care costs. For example, 16% of employers say consumer-driven health plans are �very� effective at controlling costs, while another 45% say they are �somewhat� effective. Nearly as many view higher employer cost-sharing as very (12%) or somewhat (46%) effective, and view disease management as very (14%) or somewhat (38%) effective. Fewer see tighter managed-care networks as very (7%) or somewhat (37%) effective.
The 2005 Employer Health Benefits Survey was conducted between January and May of 2005 and included 2,995 randomly selected, non-federal public and private firms with three or more employees (2,013 of which responded to the full survey and 982 of which responded to an additional question about offering coverage).
The full survey is available online.
The survey is a joint project of the Kaiser Family Foundation and the Health Research and Educational Trust. A research team at Kaiser and HRET conducted and analyzed the survey, led by Gary Claxton, Vice President and Director of the Health Care Marketplace Project at Kaiser, and Jon Gabel, formerly of HRET and now Vice President of the Center for Studying Health System Change.
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Wed Sep 14, 2005
Sen. Durbin Blocks Federal Aid to High Risk Health Pools
Citing alleged unfavorable treatment to Illinois and other states with large populations, Senator Dick Durbin, (D., Ill.) has blocked legislation that would provide states with $300 million federal aid in order to provide high risk benefit pools to people who otherwise cannot obtain medical insurance, according to the Chicago Tribute.
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Survey: Health Care Costs Rise More Slowly For Employers As They Shift Costs to Employees
The health care benefit cost trend continues to move in the right direction for employers, but only because they continue to cut benefits and take other steps to manage cost. According to a survey of 1,883 employers released today by Mercer Human Resource Consulting and Marsh Benefits, if employers simply renewed their current medical plans, making no changes, their average cost increase would be nearly 10% � about three times the rate of general inflation. For many employers, an increase of that size just isn�t manageable.
When asked what their actual cost increase for 2006 will be � after making plan design changes � employers predicted an average increase of 6.4%. The tactic many will use to hold down their cost increase is cost-shifting.
�We used to think of cost-shifting as something you could do only every so often. But we�re seeing a new willingness on the part of employers � born of desperation � to shift cost in successive years to achieve acceptable cost increases,� says Blaine Bos, Mercer�s Minneapolis office leader for health and group benefits. �At the same time, we�re helping many employers with longer-term initiatives such as health management and consumerism, with encouraging results.�
Last year, according to Mercer�s National Survey of Employer-Sponsored Health Plans 2004 , cost rose 7.5% for all employers. However, large employers (500 or more employees) experienced a much sharper increase (9.0%) than smaller employers (5.5%). Small employers are much more likely to use insured, rather than self-funded, health plans, and an effect called the underwriting cycle brought lower prices in the insured health plan market. In 2006 small employers will again fare better than large, although the difference will not be as marked as in 2004. Large employers predict an average final increase of 6.8% for 2006, compared to 5.8% among small employers.
When asked about the types of changes they would make to reduce their cost increase for 2006, nearly two-thirds of the large employers surveyed (62%) said they would shift cost to employees. Cost-shifting tactics include increasing the percentage of premium paid by the employee (39% of large employers), or raising deductibles, copayments, coinsurance, or out-of-pocket maximums (32%). An additional 17% said they will increase cost-sharing some other way.
With cost rising more slowly for small employers, a smaller percentage of them (35%) said they would shift cost to employees in 2006. �Small employers also have less flexibility to tinker with plan design,� says Mr. Bos. �They�re most likely to shop around for a cheaper plan.�
These are preliminary findings from Mercer�s National Survey of Employer-Sponsored Health Plans 2005 . The survey is still in the field and the complete results, including the actual cost increase for 2005, will be released by the end of the year. The preliminary results discussed above are based on employers who responded by Sept. 7; these results are not weighted and represent only the respondents. Ultimately, close to 3,000 employers will participate in the survey and the final results will be weighted to be nationally projectable. For more information on Mercer�s survey, visit www.mercerhr.com/ushealthplansurvey
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Indian Government to Promote Medical Tourism by Recommending Common Price Bands for Medical Services
The Indian government is planning to recommend common price bands for graded hospitals to provide medical services like cardiovascular operations, minimally invasive surgery, oncology and orthopedics to foreign patients, according to the Financial Expressof India.
These price bands will be applicable on end-to-end costs, including initial diagnostics, tests and costs borne after operations. The Indian ministry of tourism will be marketing these facilities as medical packages in foreign markets to promote medical tourism in India, it added.
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Tue Sep 13, 2005
VISTA is On Track
Denying earlier reports that the federal government's effort to supply doctors with a free version of the VISA computer records system had been put indefinitely on hold, Officials from the Centers for Medicare & Medicaid services said this project remains on track, according to Healthcare IT News.
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Mon Sep 12, 2005
Federal Project to Distribute Free Software to Doctors is on Hold
A federal Department of Health and Human Services project to distribute a free version of VISTA, the electronic records management software used by the Department of Veterans Affairs, is indefinitely on hold, according to Government Health IT.
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Fri Sep 09, 2005
Medical Tourism: Malaysian Travel Packages Introduced
Malaysian tourism is expected to take a boost with the introduction of Malaysia Airlines� first ever medical travel package launched today. Named Golden Holidays - HSC Medical package, these packages are introduced in support of the Government�s effort in promoting Malaysia as a preferred health and medical facilities country destination under the Tourism Ministry.
Through a strategic partnership with HSC Medical Center, a total of five diagnostic packages are offered, each includes a medical check-up, accommodation with daily breakfast, return airfare and airport transfers.
To seal this arrangement, a Memorandum of Understanding (MOU) was signed between Dr Y.C. Lim, Executive Director of HSC Medical Center and YM Raja Nordiana Zainal Shah, Assistant General Manager Marketing Support Malaysia Airlines, at the national airline�s headquarters in Kuala Lumpur.
Speaking at the signing ceremony, Dr Y.C. Lim, said, �HSC Medical Center is the first fully computerized one-stop medical, heart and diagnostic center in this region. It is also the first and only medical center in the world where full medical report including MSCT coronary angiogram report] balloon angioplasty & stent implantation are completed on the same day, which is a breakthrough in medical history.�
Dr YC Lim is also confident that with the introduction of the Golden Holidays � HSC Medical Package, HSC Medical Center, one of the biggest contributors in medical tourism in Malaysia is set to generate even higher medical tourist arrivals to the country.
On behalf of Malaysia Airlines, YM Raja Nordiana said �Travel trends have evolved considerably where travel is not merely for leisure and sight-seeing. It has grown to include medical tourism, in line with the changing lifestyle of today where health and wellness has become important to people.�
She added,� This strategic partnership enhances our positioning as a destination experience provider not only for the leisure and business market but also gives Golden Holidays a place in the health and medical destination network.�
MAS Golden Holidays � HSC Medical Package can be purchased worldwide by contacting Malaysia Airlines� offices and agents.
About HSC Medical Center
HSC Medical Center is the first fully computerized one-stop medical, heart & diagnostic center in the region. It is also the first to upgrade to the state-of-the-art Siemens 64-slice MSCT for non-invasive diagnosis on heart disease, stroke and cancer in the region. The Center is manned by internationally trained doctors and is equipped with new generation medical technology of diagnostic accuracy for advanced treatment of certain illnesses.
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Thu Sep 08, 2005
Competition: Is it a Boon or Bane for Health Care
Proponents assert that competition boosts health care quality while lowering its cost. Opponents assert the reverse results, according to the Williamsburg Virginia Gazette.
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Cost Issues Compel Pharmaceutical Companies to Make Drug Development More Financially Viable
The global pharmaceutical industry is currently in a state of flux. Imminent patent expiries, growing generic competition and drug failures are combining to create significant cost issues for pharmaceutical companies, compelling them to cut expenditure on product development without compromising on quality. In such a scenario, excipients, inert substances used as diluents or vehicles for drugs, offer a welcome opportunity to add better functionality to products at lower costs, according to a press release.
Pharmaceutical companies are increasingly realising the importance of excipients in drug efficacy, safety, stability and storage. Although traditionally, little attention has been paid to excipients, companies are expressing greater interest in them for their cost-saving potential in drug development. Excipients enable enhanced functionality, besides helping to innovate drug formulations and extend patents.
Global growth consulting company Frost & Sullivan (http://healthcare.frost.com) estimates the total pharmaceutical excipients market revenue to be worth USD 1.13 billion in 2004. The market is expected to grow at a compound annual growth rate (CAGR) of 5.3 per cent between 2004 and 2008, representing revenues of USD 1.39 billion in 2008.
One of the major challenges facing pharma companies is that their profit margins do not reflect the constantly increasing investment in drug development. On the one hand, this factor has acted as a key driver for pharmaceutical companies� growing interest in cost-effective excipients.
�The low returns on investment coupled with various regulatory issues account for the dwindling focus on innovation in the pharmaceutical industry,� remarks Frost & Sullivan Industry Analyst Himanshu Parmar. �However, new technological advancements and novel drug applications in the pharmaceutical industry are likely to drive the excipients market, as well as heightened innovation in this sector.�
While Europe and North America currently contribute to approximately 75 per cent of the global excipients market � with Europe accounting for about half of this share � the entry of manufacturers with substantial cost advantages is posing a challenge to European pharmaceutical excipients manufacturers.
For instance, India and China are poised to enter the excipients market in the next four to five years. These countries are likely to have the advantage of low-cost manufacturing capabilities without compromising on product quality. Moreover, both India and China have a strong presence in active pharmaceutical ingredients (APIs) and intermediates manufacturing and have built up a good brand image here. This is likely to help both countries in improved market penetration.
Added to this challenge, excipients, particularly bulk excipients such as microcrystalline cellulose and lactose, face the problem of continuous commoditisation. This has created a situation of increased price pressure and shrinking profitability, with even speciality products likely to be at risk. Commodisation is primarily caused by manufacturers that are always looking for opportunities to reduce their expenses. Manufacturers from low-cost countries entering the market are another contributory factor.
The need of the hour, therefore, is for companies to focus on understanding the customer�s requirements comprehensively and managing myriad aspects such as technical and budgetary issues, regulatory issues and quality assurance. Manufacturers that understand and follow such approaches are more likely to gain customers� trust and consequently, earn continuous business from them. This is likely to help them avoid downward price pressure while achieving comfortable margins as customers could well agree to pay higher prices for value-added services.
Despite these challenges, the market outlook for pharmaceutical excipients in Europe continues to be positive. Frost & Sullivan believes that the changing definition of excipients from inactive ingredients to functionally active materials has contributed and will continue to contribute tremendously to their success. Biotechnological developments and various emerging protein-based therapies are broadening the definition for excipients products.
�The definition for excipients is changing and includes a wider range of products such as anti-bodies and chimera products,� says Mr. Parmar. �Many new natural products, synthetic polymers, small molecules and the modifications of these molecules are likely to assume importance as this happens, and this enhanced product portfolio is likely to improve the market conditions.�
If you are interested in an analysis overview, which provides manufacturers, end users, and other industry participants with a synopsis, summary, advantages and disadvantages of Strategic Analysis of Pharmaceutical Excipients Market in Europe (B533-52) � then send an e-mail to Katja Feick � Corporate Communications at [email protected] with the following information: your full name, company name, title, telephone number, e-mail address, city, state and country. We will send you the information via e-mail upon receipt of the above information.
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Wed Sep 07, 2005
JAMA: The United States Has 100,000 Physicians-In-Training: The Highest Recorded Amount
There are more than 100,000 physicians-in-training in the U.S., the highest recorded amount, according to an article in this issue of JAMA.
Over the last decade, the primary care specialties have experienced an ebb and flow in popularity, according to background information in the article. A description of the future primary care workforce could help plan for the health care needs of the population.
Sarah E. Brotherton, Ph.D., of the American Medical Association, Chicago, and colleagues examined graduate medical education data from the past 9 years to determine the major trends among residents in family medicine, internal medicine, pediatrics, combined internal medicine/pediatrics programs, and obstetrics/gynecology. They also examined trends in fellows training in Accreditation Council for Graduate Medical Education (ACGME)-accredited subspecialties of internal medicine and pediatrics.
The study of the National GME Census, conducted by the American Medical Association and Association of American Medical Colleges, included survey data from 8,246 allopathic graduate medical education (GME) programs during the academic year 2004-2005 about active, transferred, and graduated residents, as well as about program characteristics. Program directors confirmed the status of 97.3 percent of active residents. The accompanying program survey was completed by 7,163 (87 percent) of the program directors.
The census counted 101,291 physicians-in-training during the 2004-2005 academic year, the largest number ever recorded by this survey. The number of osteopathic medical school graduates (DOs) in allopathic GME decreased from 5,838 in 2003-2004 to 5,675, following many years of annual increases. The number of residents in primary care specialties reached a peak in the mid 1990s. The number of family medicine residents who are graduates of U.S. allopathic medical schools (USMDs) has fallen from 8,232 (77.6 percent) in 1998-1999 to 4,848 (51.7 percent) in 2004-2005. The number of primary care residents who are graduates of foreign medical schools and U.S. citizens (USIMGs) nearly doubled between 1995-1996 (n=1,768) and 2004-2005 (n=3,304).
The number of USIMGs training in internal medicine or pediatrics subspecialties increased by 45.7 percent between 1995-1996 (n=622) and 2004-2005 (n=906). The number of pediatric subspecialty fellows grew 55.7 percent, mostly because of the near doubling of USMDs, from 813 to 1,617. More than half of primary care residents are women (52.5 percent). All primary care specialties and subspecialties experienced gains in the proportion of female residents, with the greatest in obstetrics/gynecology, which increased by 28.7 percent (57.9 percent in 1995-1996 vs. 74.5 percent in 2004-2005).
"There are now more than 100,000 physicians training in ACGME-accredited programs. An increasing proportion of these physicians are pursuing subspecialty training, while the number in primary care specialties has leveled off after a period of popularity in the mid 1990s. The trends we describe suggest that the primary care medical workforce of the future will include more women, more IMGs, and more DOs, information which may inform the current discussions about physician workforce needs," the authors conclude.
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JAMA: Supply of Medical Students Has Remained Constant Over Last 10 Years
The enrollment at U.S. medical schools has changed very little over the last 10 years,according to an article in the September 7 issue of JAMA, a theme issue on medical education.
Barbara Barzansky, Ph.D., and Sylvia I. Etzel, of the American Medical Association, Chicago, examined the status of a number of variables related to medical education that represent areas that recently have been in flux or have potential impact on health care delivery. The study compared selected results of the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire between 2004-2005 and 1994-1995. The questionnaire was sent to the deans of all 125 LCME-accredited medical schools. The response rate was 100 percent in both years.
The authors found that the number of medical students in 1994-1995 and in 2004-2005 remained constant, at about 67,000. The number of full-time faculty members increased from 90,016 in 1994-1995 to 119,025 in 2004-2005 (a 32 percent increase). In 2004-2005, 68 percent of all first-year medical students were residents of the state in which the medical school is located and an average of 43 percent of 2005 graduates remained in the same state as the medical school for graduate medical education; results were similar in 1995. In 2004-2005, night call was less common in the family medicine, internal medicine, pediatrics, and psychiatry clerkships compared with 1994-1995.
"A number of factors may have contributed to this increase [in faculty size]. Some disciplines, such as genetics and emergency medicine, increased well beyond the average, perhaps indicating a newly-defined need for this expertise for patient care or research. In addition, during 2002-2003 medical schools derived 35.9 percent of their total revenue from faculty practice and 32.6 percent from grants and contracts (including direct and facilities/administrative costs). Maintaining these revenue streams requires considerable faculty effort and has provided some of the impetus to increase the size of the faculty," the authors write.
"Many of the variables that we have examined, including faculty size and the geographic pipeline into medical school and residency training, may be affected by factors external to the medical school. Understanding these interrelationships will be critical in addressing important issues in medical education and health care today and in the future," the authors conclude.
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JAMA: Medical Students Report Drug Companies' Attempts to Influence Them
Third-year medical students receive on average one gift or attend one activity sponsored by a pharmaceutical company per week, and most believe that sponsored educational events are likely to be biased, according to an article in the September 7 issue of JAMA, a theme issue on medical education.
Medical students are entering an environment with progressively fewer boundaries between medicine and the pharmaceutical industry, which spends $12 billion to $18 billion annually marketing to physicians (including residents), according to background information in the article. This includes 60 million visits annually by pharmaceutical representatives and most of the $1.54 billion spent annually on continuing medical education. Drug company-physician interaction presents information favoring the sponsor's product and increases the likelihood of prescribing that product. Prescribing may be inconsistent with evidence-based guidelines and may reflect the presence of drug samples or patient demand due to direct-to-consumer advertising, even if a drug was not the physician's first choice. While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students.
Frederick S. Sierles, M.D., of the Rosalind Franklin University of Medicine and Science, North Chicago, Ill., and colleagues measured the frequency of medical students' exposure to drug company gifts, students' attitudes about gifts, and correlates of these frequencies and attitudes. In 2003 the researchers distributed a 64-item anonymous survey to 1,143 third-year students at 8 U.S. medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, the researchers conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions.
The overall response rate of the surveys was 72.3 percent (826/1,143). The researchers found that average exposure for each student was 1 gift or sponsored activity per week. Of respondents, 93.2 percent were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 68.8 percent believed gifts would not influence their practices and 57.7 percent believed gifts would not affect colleagues' practices. Of the students, 80.3 percent (553/604) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 86.3 percent had accepted one.
Nearly 60 percent (59.6 percent) of the students simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased. Students at one school who had attended a seminar about drug company-physician relationships were no more likely than the non-attending classmates to show skepticism. Of the respondents, 85.6 percent did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10.1 percent reported having school-wide policies about these interactions.
"Our study adds to previous literature by demonstrating experiences and attitudes among large numbers of students at a variety of medical schools and indicating acceptance of the value of drug company-sponsored gifts and activities. Research should focus on evaluating methods to limit these experiences and affect the development of these attitudes, with a goal of ensuring that physicians' decisions are based solely on helping the individual patient achieve the greatest possible benefit," the authors conclude.
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JAMA: Overworked Medical Residents Might As Well Be Drunk
During heavy call rotation and long hours, effects on residents' neurobehavioral performance are comparable to the impairment associated with a 0.04 to 0.05 grams percent blood alcohol concentration, according to an article in the September 7 issue of JAMA, a theme issue on medical education.
"Work-related sleep loss and fatigue in medical training has become a source of increasing concern," according to background information in the article. One study found that interns got 5.8 hours less sleep, had 50 percent more attentional mistakes, and made 22 percent more serious errors on critical care units while working a traditional schedule compared with a schedule with less hours. Also, self-reported lifetime rates of motor vehicle crashes and near-miss crashes among residents are 3 and 2.5 times those of nonresident drivers, respectively.
J. Todd Arnedt, Ph.D., from the University of Michigan, Ann Arbor, and colleagues compared post-call neurobehavioral performance of 34 medical residents (18 women, 16 men) after their rotations to examine the effect of extended work hours. The residents were tested after light call rotation (four-week rotations averaging 44 hours per week), light call with alcohol, heavy call (an average of 90 hours per week, every fourth or fifth night, 80 hours after July 2003), and heavy call with placebo. In the light call with alcohol condition, participants' blood alcohol concentrations were raised to 0.05 grams percent. Average age of residents was 28.7 years.
The researchers found that performance impairment during a heavy call rotation was comparable to impairment associated with a .04 to .05 grams percent blood alcohol concentration during a light call rotation. Compared with light call, heavy call reaction times were 7 percent slower and lane variability and speed variability during the simulated driving test were 27 percent and 71 percent greater, respectively. Speed variability was 29 percent greater in heavy call with placebo than light call with alcohol, and there were similar errors and reaction times.
"These findings have important clinical implications. Residents must be aware of post-call performance impairment and the potential risk to personal and patient safety. There should be sleep loss, fatigue and countermeasure education in residency programs. Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters. Additional studies should examine the impact of these operational and educational interventions on resident driving safety and on patient care and safety," the authors conclude.
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Sun Sep 04, 2005
While Millions Go Uninsured, Hospitals Offer Luxury Suites
According to the Washington Post, hospitals are now offering luxury suites to those willing to pay extra.
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Sat Sep 03, 2005
NEW INFORMATION ON HOSPITAL CARE QUALITY NOW AVAILABLE
Consumers across the U.S. will be able to see more about how well their local hospitals are performing with new information now available at the Hospital Compare website (also at www.medicare.gov) The consumer-oriented website will now report on steps that hospitals take to prevent surgical infections and will reflect up to four quarters of data from 2004. The website has been updated and improved by the Centers for Medicare & Medicaid Services and the Hospital Quality Alliance (HQA).
�We are continuing to work together to make progress in helping consumers and health care professionals get better information at Hospital Compare, and to use this information to improve care,� said CMS Administrator Mark B. McClellan, M.D., Ph.D. �As we enhance the information on hospital quality, patients can get more help in making important decisions about their care, and health professionals can take further steps to improve care.�
The two new surgical infection prevention measures and a new pneumonia measure bring the total number of measures on www.hospitalcompare.hhs.gov to 20, including the 10 clinical measures that short-term acute care hospitals must agree to report publicly in order to receive the incentive payments as created by the Medicare Modernization Act. The two new surgical infection prevention measures are the first of a larger set of patient safety measures that will be collected as part of the Surgical Care Improvement Project (SCIP). The SCIP is designed to improve patient safety and reduce the incidence of postoperative complications by 25 percent by 2010 in U.S. hospitals. The HQA is actively considering how to incorporate these and other patient safety measures into the measures available at www.hospitalcompare.hhs.gov
There has been significant growth in the number of hospitals reporting more than the ten �starter measures.� In addition, CMS and the HQA are seeing an increase in the information that hospitals are now providing:
* More than 90 percent of the 4048 participating U.S. hospitals are reporting at least the 10 �starter� measures,
* Over 70 percent (2903) are reporting all 17 of the quality measures first introduced in April 2005, an almost three-fold increase in active participation (967 hospitals).
* Just over 80 percent (3291) of all reporting hospitals publicly reported the new pneumonia measure,
* More than 20 percent (777) of facilities took the lead in reporting on patient safety using the two surgical infection prevention measures, and.
* More than 450 critical access hospitals, a category of small rural hospital established in Medicare law that are not eligible for the incentive payment, are submitting data, and 11 percent increase in reporting.
Hospitals are required to accurately abstract and report their data. For 2006, approximately 96 percent of the hospitals that submitted the data will meet the criteria and are eligible to receive the incentive payments. Those not receiving the full update did not meet the validation requirement, did not submit the 10 starter measures (where applicable) continuously each quarter, or chose not to participate.
�While it is too early to determine any major trends in hospital performance on the measures, the latest information makes it even clearer that there are important opportunities for quality improvement,� said Dr. McClellan. �Certain processes appear to be well ingrained in U.S. hospitals � rates for aspirin at arrival and discharge and beta blocker at discharge for heart attack patients and assessment of blood oxygen levels for pneumonia patients remain high � but the rates for other measures indicate a continuing need for improvement efforts at the national level.�
There is also improvement in counseling smokers to stop smoking, particularly among heart failure and pneumonia patients. Among the �starter set� measures, only pneumoccocal vaccination showed notable, although albeit small, improvements in a rate that remains below 50 percent.
�We�re pleased that hospitals are submitting information about the quality of care they provide, and that the information is increasingly being used to help patients get better care,� said Dr. McClellan. �But the information clearly shows some important areas where care can be improved, to improve lives and avoid costly complications. We intend to continue to build on these steps together, to get higher quality care to patients.�
The Hospital Quality Alliance is a public-private collaboration of government agencies, hospitals, quality experts, purchasers, consumer groups and other health care organizations that are working together to implement a national strategy for hospital quality measurement and advancing quality of care.
In addition to the new hospital quality measures, beginning today, Spanish users of www.medicare.gov will find information about the quality of care provided by the nation�s home health agencies in Spanish. The Spanish Home Health Compare joins Spanish language translations of Nursing Home Compare, Medicare Health Plan Compare and the Prescription Drug and Other Assistance Programs sites.
CMS� Quality Initiative uses a multi-prong approach to drive systems, support and provide incentives to facilities � and the clinicians and professionals working in those settings � in their efforts to achieve superior care through:
* Ongoing regulation and enforcement conducted by state survey agencies and CMS;
* New professional and consumer hospital quality information on our websites, www.cms.hhs.gov and www.medicare.gov and at 1-800-MEDICARE;
* The testing of rewards for superior performance on certain measures of quality;
* Continual, community-based quality improvement programs through our Quality Improvement Organizations (QIOs); and,
* Collaboration and partnership to leverage knowledge and resources.
A quality measure is a formula that converts medical information from patient records into a rate or percentage that shows how well a hospital cares for its patients.
The twenty measures now available at www.hospitalcompare.hhs.gov are:
Heart Attack (Acute Myocardial Infarction or AMI)
o Aspirin at arrival
o Aspirin at discharge
o ACE Inhibitor for Left Ventricular Systolic Dysfunction
o Beta Blocker at arrival
o Beta Blocker at discharge
o Thrombolytic agent received within 30 minutes of hospital arrival
o Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival
o Adult smoking cessation advice/counseling
o Assessment of Left Ventricular Function
o ACE Inhibitor for Left Ventricular Systolic Dysfunction
o Discharge Instructions
o Adult smoking cessation advice/counseling
o Oxygenation Assessment
o Initial Antibiotic Timing
o Pneumococcal Vaccination Status
o Blood culture performed prior to first antibiotic received in hospital
o Adult smoking cessation advice/counseling
o Appropriate Initial Antibiotic Selection*
Surgical Infection Prevention
o Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision*
o Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time*
Note: * denotes measure displayed for the first time in September 2005
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Thu Sep 01, 2005
USA Today/Kaiser/Harvard Release Comprehensive Survey
USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health today released the results from a new comprehensive survey looking at how Americans are being affected by rising health care costs. A three-day series based on the results of the survey and reporting by USA Today is appearing in the paper this week.
The Health Care Costs Survey includes information on:
* The problems Americans have paying for medical care and prescription drugs;
* The impact paying health care bills has on family budgets;
* The barriers health care costs pose to obtaining medical care; and
* The special burden of medical bills for people with chronic health conditions, moderate and lower incomes, and those without insurance.
The Health Care Costs Survey is based on a nationally representative sample of 1,531 adults ages 18 years and older, conducted between April 25 and June 9, 2005. The USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey Project is a three-way partnership. USA Today, Kaiser, and Harvard jointly design and analyze surveys examining health care issues. USA Today retains editorial control over the content published by the paper.
The full survey results and a link to the USA Today articles are available online.
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Lost Labor Time Costs U.S. $260 Billion Each Year
Sickness and health problems among working-age Americans and their families carry an estimated price tag of $260 billion in lost productivity each year. This reflects economic losses from adults with chronic disease, disability, or other health problems who are not working; workers who take sick days to care for themselves or sick family members; and workers who show up for work sick or worried about sick relatives, according to a study released today by The Commonwealth Fund.
Approximately 18 million adults, 12 percent of all U.S. adults ages 19 to 64, have a disability, handicap, chronic disease, or other health problem, and are not employed as a result. This lack of labor force participation takes a toll both on families and the overall economy in terms of lost income. Valued at the minimum wage, the loss amounts to $185 billion annually.
In addition, an estimated 69 million workers reported missing days of work due to illness in the past year, for a total of 407 million lost work days in 2003, and $48 billion in lost economic output.
"The health status of workers has significant implications for the economy," said Karen Davis, president of The Commonwealth Fund and lead author of this study. "The main focus of policymakers has been on the cost of providing health insurance to all Americans, but we have neglected to consider the costs sustained by those who are too sick to work or function effectively."
When workers show up for work even though they are not feeling well or are distracted with thoughts of a sick family member or their own health, their reduced productivity can exact a cost in the workplace. Approximately 55 million workers reported a time when they were unable to concentrate at work because of illness or a family member's illness. This amounted to 478 million days per year of reduced productivity, at an estimated cost of $27 billion. There is also increased risk of injury and spreading contagious diseases to co-workers.
"Providing workers with the means to maintain their health�through affordable and comprehensive health insurance coverage, sick leave, and disease management programs�has the potential to enhance the health and productivity of our workforce," said Sara R. Collins, senior program officer at The Commonwealth Fund and a co-author of this report. "Investments in worker health could yield economic payoffs for working families, employers and the economy as a whole."
Adults with children, either single or married, were more likely to report taking any sick days than single or married adults without children. They were also more likely to report inability to fully concentrate at work, according to the report, Health and Productivity Among U.S. Workershttp://www.cmwf.org/publications/publications_show.htm?doc_id=294176, by Fund staff Karen Davis, Sara R. Collins, Michelle M. Doty, Alice Ho, and Alyssa L. Holmgren.
Employer benefits such as paid sick leave or paid time off to see a physician or dentist can make a difference in worker productivity. Workers who are unable to take paid time off to see a doctor during work hours were more likely to miss work or experience one or more days at work in which they were unable to concentrate because of their own illness or that of a family member.
The authors note several strategies that policymakers and business leaders could adopt to help stem economic losses due to illness:
* Research has shown that well-run corporate disease management and health promotion programs can improve workers' health and productivity.
* Providing health insurance coverage for all workers would increase the use of preventive care and help ensure early treatment of acute illnesses and ongoing management of chronic conditions.
* Sick leave and paid time off to see a physician are important benefits to ensure that workers have time to get needed care, recover, or tend to sick family members.
Data come from The Commonwealth Fund Biennial Health Insurance Survey (2003), a national telephone survey conducted September 3, 2003 through January 4, 2004 among a random, nationally representative sample of 4,052 adults (defined as individuals age 19 and older) living in the continental United States, weighted by age, sex, race/ethnicity, education, household size, and geographic region. The analytic sample consists of 1,808 part-time and full-time workers. The survey has an overall margin of sampling error of +/� 2 percentage points at the 95 percent confidence level. The 50 percent survey response rate was calculated consistent with standards of the American Association for Public Opinion Research.
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Report: Pharmaceutical Companies Outsource R&D; to India, China
The rise of India and China as global economies presents immense opportunities for the international pharmaceutical industry. Besieged by ever-increasing cost pressures, shorter product life cycles and numerous regulatory challenges in the West, the industry is increasingly shifting its research and development (R&D;) base to the two developing nations.
This is done to minimise the expenses, time and risk involved in R&D.; During the 90s, the cost of bringing one new molecule to the market was as high as $800.0 million in developed nations. The European Federation of Pharmaceutical Industries and Associations (EFPIA) estimates that on an average out of 10,000 molecules developed in laboratories, only one or two will successfully pass all stages of drug development and be commercialised.
If you are interested in an analysis, which provides manufacturers, end users, and other industry participants with an overview, summary, advantages and disadvantages of pharmaceutical R&D; outsourcing to India and China � please send an e-mail to Surbhi Dedhia and Samantha Unnikrishnan- Corporate Communications at [email protected]/ [email protected] with the following information: Full name, Company Name, Title, Contact Tel Number, Contact Fax Number, E-mail. Upon receipt of the above information, an overview will be e-mailed to you.
Pharmaceutical companies looking for lucrative solutions, thus, prefer low-cost, developing countries to expensive R&D; in the West. Alliances with local companies, contractual outsourcing arrangements and establishing local subsidiaries are good options for enterprises thinking of utilising the strong intellectual potential in India and China.
�Contract research organisations (CROs) are a popular option and carry out, on behalf of multiple clients, medical and scientific studies on a contractual basis,� says Frost & Sullivan Research Analyst Himanshu Parmar (http://pharmaceuticals.frost.com). �They provide part of or all of the processes of clinical research including clinical trial management, data management, statistical analysis, protocol design and final report development.�
These outsourcing activities in India and China amount to 20.0 to 30.0 per cent of total global clinical trials. The competitive advantage here lies in the access to specialised skills in excellent research institutes in both countries on a 24/7 basis. In addition, better management from the start reduces development risks.
Despite these benefits, there has been a relatively low level of utilisation of the opportunities in both countries due to various concerns with respect to quality and infrastructure. Companies are worried about probable loss of control in processes and proprietary knowledge. Proper management is needed to utilise complicated and long-distance collaborative third-party relationships. Delays can even happen due to regulatory hold-ups.
This has motivated domestic companies and government in individual countries, keen to increase foreign participation and to figure prominently on the global map, to implement necessary changes to improve clinical research facilities.
�Government commitment in India and China to improve access to high-quality healthcare is a bonus for R&D; outsourcing,� opines Parmar. �The regulatory environment in both countries is gradually changing in favour of clinical research.�
Recent amendments to Schedule Y of Drugs and Cosmetics Rules of India, 1945, signify progressive attitude on the part of the Indian Government, clarifying the environment for clinical research in the country. In China, regular monitoring of clinical trials ensures good clinical practice (GCP)-compliant research centres established by the government. These steps will assist the two countries attain international standards in pharmaceutical research.
For those companies wishing to utilise the regulatory changes and high-quality research, considering alliance strategy and identifying the region of opportunities should be priorities. Embracing the changes through innovative strategies and flexibility alone will allow international pharmaceutical enterprises to capitalise on these new attractive propositions. Looking ahead to the increasing trend towards partnerships and alliances in the pharmaceutical industry, Frost & Sullivan is organizing a premium event, �Global PharmAlliance 2005 � Becoming the partner of choice� being held at Mumbai (India) on September 30th and 1st October, 2005.For more information visit: www.frost.com/pharmalliance
Frost & Sullivan, a global growth consulting company, has been partnering with clients to support the development of innovative strategies for more than 40 years. The company's industry expertise integrates growth consulting, growth partnership services, and corporate management training to identify and develop opportunities. Frost & Sullivan serves an extensive clientele that includes Global 1000 companies, emerging companies, and the investment community by providing comprehensive industry coverage that reflects a unique global perspective and combines ongoing analysis of markets, technologies, econometrics and demographics. For more information, visit http://www.frost.com
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