AAFP's GME Technical Amendments Act of 1999 Is Introduced in Congress

On March 4, Sens. Susan Collins (R-Me.) and Frank Murkowski (R-Alaska) introduced S. 541, the Graduate Medical Education Technical Amendments Act of 1999. The bill, which was drafted with the assistance of the American Academy of Family Physicians (AAFP) and the Organizations of Academic Family Medicine (OAFM), is similar to one that the two senators introduced last year. S. 541 would correct technical language in the Balanced Budget Act of 1997 (known as BBA) that is inadvertently causing serious consequences for family medicine residency programs. Current cosponsors are Sen. Pat Roberts (R-Kan.), Sen. Charles E. Grassley (R-Iowa) and Sen. Thad Cochran (R-Miss.)

Also in March, Rep. John Baldacci (D-Me.) introduced companion legislation, H.R. 1222, which bears the same name. Representative Baldacci also introduced a similar bill last year. House cosponsors include Rep. Gerald D. Kleczka (D-Wis.), Rep. Bernard Sanders (Independent-Vt.) and Rep. Martin Frost (D-Tex.).

The bills would treat all hospitals sponsoring residency programs fairly—not just those that were training residents in the hospital in 1995—by including those residents who were training in the community. The BBA capped the number of residency slots in an institution, a number that determines the amount of indirect graduate medical education funding (IME) the institution receives. It would allow hospitals that sponsor only one residency program to increase their resident count by one resident per year, up to a maximum of three residents, to help meet community needs for primary care physicians. It also would permit a few new family medicine residency programs that have long been under development to be established by extending the cut-off date for new residencies. Finally, the bill would permit the establishment of new rural training programs by allowing urban residency programs sponsoring these programs to receive an exception to the caps.

Number of Organ Donations Increases in the United States in 1998

The Department of Health and Human Services and the United Network for Organ Sharing have announced that the number of organ donors increased 5.6 percent in 1998, the first substantial increase since 1995. The number of cadaveric donors rose to 5,788 in 1998, up from 5,479 in 1997. The increase in donors occurred following the launch of a national initiative to increase donor awareness and implementation of regulations which required hospitals to report all deaths to organ procurement organizations. These organizations then discuss donation options with affected families. The greatest increase in donation occurred in the central region of the United States. “An increase in donations gives us added incentive to find out what works and replicate it across the country,” said Claude Earl Fox, M.D., M.P.H., administrator of the Health Resources and Services Administration. “Our plan is to fund creative, collaborative programs with rigorous evaluations so we'll know where to focus future efforts.”

The report notes that the waiting list for needed organs increased from 56,716 at the end of 1997 to 64,423 at the end of 1998, thus widening the gap between supply and demand for organs. “More Americans are hearing about the need for organ donation, and more are responding with the gift of life,” said Health and Human Services Secretary Donna E. Shalala. “But we need to accerlerate. Too many patients still die while waiting for a transplant.” More information about the National Organ and Tissue Donation Initiative is on the Internet at http://www.organdonor.gov. The Internet address for the Coalition on Donation is http://www.shareyourlife.org.

Preventive Services Are Greatly Underused in Elderly Persons

A new report funded by the Robert Wood Johnson Foundation and published by the Health Forum, a subsidiary of the American Hospital Association (AHA), indicates that a large percentage of elderly Americans do not receive the benefits of preventive health services even though the Medicare program will pay for these tests. “The Quality of Medical Care in the United States: A Report on the Medicare Program,” the third release of the Dartmouth Atlas of Health Care, notes that in some parts of the country, as few as 12.5 percent of elderly women receive annual mammograms. Overall, in 1995–1996, only 28.3 percent of women aged 65 to 69 years received at least one mammogram. The rates for elderly citizens receiving immunization for pneumococcal pneumonia ranged from 9 to 38 percent in various regions of the country. The 1999 Dartmouth Atlas is based on research by medical epidemiologist John E. Wennberg, M.D., M.P.H., and colleagues at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, N.H. “We should be striving for close to 100 percent use of these specific preventive services considering what we know about prevention and early detection, but we are nowhere near that goal,” stated Dr. Wennberg. “The underuse of these services and the haphazard nature of compliance with recommended guidelines indicate there is substantial opportunity to improve the quality of care.” Copies of the report may be ordered by calling the AHA at 800-AHA-2626.

Medicare Claims Are Now Required to Be Y2K Compliant

As of April, bills for services to Medicare beneficiaries submitted by health care professionals must be year 2000 compliant. Physicians, hospitals and other health care providers must submit bills that use eight-digit dates to be eligible to receive payment from insurance companies that process and pay Medicare claims. In addition to preparing billing systems for the year 2000, the Health Care Financing Administration (HCFA) emphasizes that physicians should also be readying all computer systems and various medical devices used to diagnose and treat patients. All computer systems within HCFA are now Y2K compliant. HCFA has established a toll-free telephone line (800-958-HCFA) to help provide information to physicians and answer questions about the year 2000 challenge. Materials and information have also been posted on the Internet at http://www.hcfa.gov/y2k.