Medicare Announces Final Rule for 2007 Physician Payment Rates

The Centers for Medicare and Medicaid Services (CMS) has announced its final rule setting physician payment rates and policies for 2007. Under the new rule, the work component for relative value units (RVUs) for face-to-face visits will increase, which CMS hopes will encourage physicians to spend more time with their patients. The work component for RVUs for the most commonly billed service—intermediate office visits—will increase by 37 percent, and the component for RVUs for an office visit that requires moderately complex decision making will increase by 29 percent. Preventive services benefits will be expanded to include ultrasonography for abdominal aortic aneurysm in beneficiaries at risk, and diabetes outpatient self-management training and medical nutrition therapy services also will be covered. CMS projects total payments of $61.5 billion in 2007, representing a 5 percent reduction mandated to account for increases in volume and intensity of physician services. Changes to the methodology for determining practice expenses will be phased in over four years. To access the rule, go tohttp://www.cms.hhs.gov/center/physician.asp. For more information, visithttps://www.aafp.org/news-now/government-medicine/20061108cmsfinalrule.printerview.html andhttps://www.aafp.org/news-now/government-medicine/20061108medicareservices.printerview.html.

Cochrane Coordinator Questions Evidence for Influenza Vaccination

In an October article published in the British Journal of Medicine, Coordinator of the Cochrane Vaccines Field Tom Jefferson questioned the viability of evidence behind influenza vaccination policies. After reviewing evidence on influenza vaccination, Jefferson noted three problems: heavy reliance on nonrandomized studies; lack of any evidence or of convincing evidence on beneficial effects of vaccination; and limited data on the safety of inactivated vaccines. According to Jefferson, when the data are rigorously compiled and assessed there is a large gap between policy and evidence. Possible reasons for this, he suggests, include the confounding of influenza and influenza-like illness, which results in an overestimation of influenza’s impact and vaccine performance, and the desire of policy makers to be seen to deal with problems, which leads them to favor available interventions. Jefferson calls for accurate surveillance based on a calculated sampling system for influenza-like illness cases that meet specified criteria, as well as quick determination of the circulating viruses. He also argues there is an urgent need for placebo-controlled randomized trials assessing vaccine effects. To view the full article, go tohttp://bmj.bmjjournals.com/cgi/content/short/333/7574/912?ehom=.

Proposed New Orleans Health System Builds on Medical Home Concept

A health system reform plan for New Orleans submitted to CMS in October takes the concept of the medical home as its foundation. Designed by the Louisiana Health Care Redesign Collaborative, the plan relies on a formal network of providers in primary, secondary, and tertiary care, each of whom would have access to patient information through an electronic health record system. Primary care physicians would facilitate and coordinate care and act as a point of entry to the health care system. A Health Insurance Connector would provide information about insurance options and enrollment methods for those earning up to 300 percent of the federal poverty level. A financial credit would be provided for low-income uninsured workers and those eligible for Medicaid. According to family physician Richard Streiffer, M.D., who worked on the project, the new system would push patients toward a primary care relationship and stop reliance on hospital care. Initially the plan would apply only to the New Orleans area, but it would later be applied to the whole of Louisiana. For more information and to access the plan’s concept paper, visithttps://www.aafp.org/news-now/government-medicine/20021101nolareform.html.

CCHIT Recognized as Official Certification Body for EHR Evaluation

The U.S. Department of Health and Human Services (HHS) has announced the official desig nation of the Certification Commission for Healthcare Information Technology (CCHIT) as recognized certification body. CCHIT’s certification will allow electronic health record (EHR) software and other health information technology (IT) products to be donated to physicians under recent Anti-Kickback rules. The HHS also hopes that the CCHIT seal of approval will speed the adoption of health IT by reducing the risks involved for health care providers. In 2005, CCHIT was awarded a $2.7 million contract by HHS to develop a certification mechanism for health IT products. In its first phase of certification—outpatient or ambulatory EHRs—it has certified more than 30 products. The next phases will involve inpatient or hospital EHRs and systems enabling the exchange of information among health care providers and institutions. For more information, visithttps://www.aafp.org/news-now/practice-management/20061101cchit.html. To view a list of certified products, go tohttp://www.cchit.org.

NHSC Clinicians May Draw Physicians to Rural, Underserved Areas

The presence of National Health Service Corps (NHSC) clinicians in rural, underserved areas may increase the chances of recruiting other physicians to the locale, according to the results of study funded by the American Academy of Family Physicians’ Robert Graham Center. Contrary to concern that NHSC clinicians might be seen as competition for other physicians, researchers found that between 1981 and 2001, the number of non-NHSC primary care physicians increased an average of 1.4 per 10,000 population in counties staffed by NHSC clinicians, compared with an average of 0.6 per 10,000 population in counties without them. The number of non-NHSC primary care physicians in counties with NHSC staff increased by about two physicians per county more than would have been expected without the involvement of the NHSC. For more information, go tohttps://www.aafp.org/news-now/clinical-care-research/20061103nhsc.html.

Researchers Call for Targeted AIDS Prevention in Hispanic Communities

A white paper addressing human immunodeficiency virus (HIV) and acquired immuno deficiency syndrome (AIDS) in Hispanic communities calls for a new strategy to tackle the problem. According to researchers from the National Council of La Raza and California State University at Long Beach Center for Latino Community Health, Hispanics are disproportion ately affected by HIV/AIDS, and Hispanic women in monogamous relationships are especially more likely to die from the disease. Traditional gender roles, stigma, and lack of access to cul turally relevant information are primarily to blame, the researchers suggest. Most women par ticipants infected with HIV were married or in stable relationships; those who suspected their partners of risky behavior felt unable to ask them to use protection or were refused. Prevention and outreach strategies in current use do not effectively reach the Hispanic community, the researchers state. They call for a new strategy integrating family-focused themes with proven approaches to increase awareness of the disease among Hispanics and encourage behavioral change. To access the full report, visithttp://www.nclr.org/content/publications/detail/42686.

AHRQ Releases Recommendations e-Tool for Primary Care Physicians

The Agency for Health Care Research and Quality (AHRQ) has released an interactive tool to help primary care physicians recommend preventive services for their patients. The Electronic Preventive Services Selector, or ePSS, contains 110 recommendations for specific patient populations with a search function for age, sex, and behavioral risk factors. A database associ ated with the tool contains information on screening tests, counseling topics, and preventive medications. When physicians enter a patient’s characteristics into the search function, the software generates a tailored recommendations report. The tool is designed for use on a per sonal digital assistant or desktop computer and can be downloaded from the AHRQ Web site athttp://www.ePSS.ahrq.gov.