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Physicians are discovering that going green can save some green. Conversely, the desire to save some green can help them go green.

Take, for example, Richard Schoor, MD, a Smithtown, N.Y., urologist. He drives a 1999 Honda Accord on his daily commute, mostly because it uses less gas than, say, an SUV. The fact that it's also better for the environment is a bonus.

When Dr. Schoor saw his practice's energy bills triple in one year, he began taking small steps to cut energy consumption and met daily with his staff to ensure they were, too.

"I began cutting costs by turning off the lights when patients were out of the office and putting the computers on power-saving mode. You need to try and save every penny you can these days," Dr. Schoor said. "I don't keep the temperature ice cold in the summer or too hot in the winter, and when at all possible, I open the windows for fresh air. I'm on the second floor so there is no issue with people looking in."

While he has not seen a dramatic drop in his energy bills, he said they have remained steady, while energy costs for his colleagues have continued to climb.

Dr. Schoor is feeling good about how saving energy helps the environment and has taken other steps to reduce waste. His office has gone paperless, even though it would cost less to use paper than computers. And he says the practice has been vigilant about ensuring only medical waste goes into the medical waste bags, which also saves on disposal costs.

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A medical wiki is launching this year as the result of collaboration between an Internet entrepreneur and some notable medical schools and research organizations.

Wiki is the term used for an open-source Web site where users can collaborate and contribute to the content. The new site, called Medpedia, will be modeled after the online wiki encyclopedia Wikipedia.com, but will differ in that it won't accept content from just anybody.

Its contributing writers and editors will be vetted to ensure they are working health care professionals.

Robert Lash, MD, an endocrinologist at the University of Michigan Medical School, said the involvement of Internet entrepreneur James Currier added credibility to the project and contributed to the school's decision to get involved. Harvard Medical School; Stanford University School of Medicine; and the University of California, Berkeley, School of Public Health; also are involved with the launch of the project.

Currier, who runs the San Francisco-based technology incubator Ooga Labs, founded the company Tickle in 1999. Originally called Emode, Tickle allowed users to complete psychological and personality tests. Its annual revenues reached $35 million before the employment site Monster bought Tickle in 2004 for about $100 million.

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Even as the latest two settlements -- with Blue Shield of California and Anthem Blue Cross, formerly Blue Cross of California -- were reached with the state over policy rescissions, the heat on health plans' practice of canceling coverage after it already has been granted intensified on other fronts.

The accumulated fines from these and other plans' settlements total $13.6 million and could be more if the plans fail to make changes to their business demanded by the California Dept. of Managed Health Care.

In the latest settlements, reached July 17, Blue Shield agreed to pay a $3 million fine, and Anthem parent company WellPoint agreed to pay a $10 million fine.

WellPoint agreed to offer coverage to 1,770 people whose policies had been rescinded. Blue Shield said it would do the same for 450 former members.

To date none of the companies involved has admitted wrongdoing, but all have agreed to change their practices around individual policy applications, underwriting and policy cancellations. In settling, the companies avoid a case-by-case review of every policy rescission over the last four years, and a potentially larger fine. Former members benefit by getting coverage sooner than if the state and health plans had wrestled over the issue in court.

The insurers have agreed to offer guaranteed issue plans without medical underwriting, and in some cases will pay for medical care received after policies were cancelled or rescinded.

Still, California Medical Assn. President Richard Frankenstein, MD, said the actions might not be severe enough to persuade plans not to "just keep doing what they've been doing."

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Before connecting with the Indiana Health Information Exchange, physicians at Cardiac Care Associates in Crown Point, Ind., received lab and test results in a way familiar to many practices.

The doctor would send the patient for the test, then wait. And wait. The doctor would call the lab, leave several messages, get placed on hold, and maybe get an answer within a few days. Add in a lost fax or a report placed in the wrong file and it all added up to one big frustration.

When Cheryl Agent, practice administrator, was told the five-physician cardiac care practice could get lab results in real time, and in an organized, uniform fashion, it definitely got her attention. The kicker? The electronic system was free.

"It has cut down the time waiting for results tremendously and has streamlined everything we do," she said.

Now Agent can log into the system, open her in-box and pull all relevant reports for the day. She also logs in throughout the day, pulling new results as they are completed and entered in real time.

Developing a system that is free to doctors and delivers real value was the main objective of the Indiana Health Information Exchange when it developed its Docs4Docs clinical messaging system, the organization's flagship product that was jointly developed with the Regenstrief Institute, an informatics and health care research organization affiliated with the Indiana University School of Medicine.

Many regional health information organizations have failed in recent years, making President Bush's goal of having a National Health Information Exchange by 2014 seem further out of reach. But Indiana's exchange has been referred to by many as the model to emulate.

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Aetna, through its nonprofit foundation, is funding research to find out whether a daily lottery with cash prizes will help improve patients' medication adherence.

The Aetna Foundation last fall gave researchers a $400,000 grant to fund a study at the University of Pennsylvania that will use prizes of $10 and $100 as rewards for taking medication as prescribed.

"If it looks like it works, we'll try to incorporate it in things we do," said Aetna Chief Medical Officer Troyen A. Brennan, MD, MPH.

Kevin G. Volpp, MD, PhD, director of the Center on Health Incentives at the Leonard Davis Institute for Health Economics at the University of Pennsylvania's Wharton School, and Stephen E. Kimmel, MD, associate professor of medicine at the University of Pennsylvania School of Medicine, have designed a two-arm randomized trial with 100 participants to test a daily lottery as incentive for taking warfarin as prescribed.

An electronic monitor will track whether all participants are taking their medicine.

The 50 people enrolled in the lottery will have a 1-in-10 chance of winning $10 every day they take their medication and a 1-in-100 chance of winning $100. Each day a text message will tell a subject whether he or she has won the lottery, or, if the dose wasn't taken, whether he or she would have won, Dr. Volpp said.

The 50 people in the control group will use the same monitor but won't be entered in the lottery.

Aetna chose to sponsor the research because adherence is key to quality of care, Dr. Brennan said. He said statistics show that a year after beginning medication, only about 50% of patients are taking their medications as directed.

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