Budget Fight Could Affect Funding for Some Title VII Health Programs

House and Senate conferees have agreed on a 2008 fiscal year appropriations bill (H.R. 2642) for government agencies related to labor, health and human services, and education. The bill provides for a $6.2 billion increase in discretionary spending compared with the 2007 fiscal year. This increase is $9.8 billion more than President Bush had requested, and he is expected to veto the bill if it passes Congress. The bill would increase overall funding for Title VII health professions programs to $212 million, a 14.7 percent increase. However, the current funding level of $48.9 million for Title VII primary care health professions training programs would not change. Funding levels for key health-related programs include the following: $145.4 million for rural health programs, representing a 13 percent increase from the 2007 fiscal year; $334.6 million for the Agency for Healthcare Research and Quality, representing a 4.8 percent increase; and $29.7 billion for the National Institutes of Health, representing a 3.1 percent increase. The Senate has enough votes to override a veto, but the House does not. For more information, visit https://www.aafp.org/news-now/government-medicine/20071106budgetshowdown.html.

Chronic Diseases Coalition Impacting 2008 Presidential Campaigns

The Partnership to Fight Chronic Disease (PFCD) has persuaded several 2008 presidential candidates to adopt chronic disease prevention and management as major platform themes. The PFCD is a coalition of 80 organizations, including the American Academy of Family Physicians (AAFP), that aims to make health care more affordable through changes in delivery and payment systems. The coalition recently released a policy platform that urges candidates to focus on five major health care themes: chronic disease prevention and early intervention; promotion of healthy lifestyles; rewarding advances in clinical practice that improve the quality of care for patients with chronic diseases; improving the availability of health information technology; and reducing health disparities by focusing on barriers to good health. The platform is intended to refocus the health care reform debate and support the patient-centered model of care. All Democratic candidates' health care plans contain at least some of these themes, and some Republican candidates are advocating for the coalition's proposals. For more information, visit https://www.aafp.org/news-now/government-medicine/20071030pfcddrivesreform.html or the PFCD Web site at http://www.fightchronicdisease.org/advocate/platform/index.cfm.

Senate Debates One-Year vs. Two-Year Medicare Physician Payment Update

The Senate Finance Committee plans to introduce a bill that would update physician Medicare payment rates to offset recent reductions in those rates called for under the sustainable growth rate formula; some of the increase would be paid for with funds from the government's Medicare Advantage program. The committee is divided, however, on whether to implement a one- or two-year plan. One proposal calls for a two-year payment update that would slightly increase payments over two years, whereas another proposal calls for a one-year physician payment freeze that would address the 9.9 percent reduction in physician payment rates in 2008. Although the two-year plan would require more money from the Medicare Advantage program, supporters contend that a one-year update is not sufficient and would not address the 5 percent rate reduction scheduled to take effect in 2009. Several physician groups, including the AAFP, have urged Congress members to reject a one-year freeze, emphasizing the importance of a two-year update. The House of Representatives is waiting for the Senate's legislation before introducing its own Medicare physician payment bill. For more information, visit https://www.aafp.org/news-now/government-medicine/20071105senatefinancebill.html.

PCPCC Announces Certification Plan for Patient-Centered Medical Homes

A plan unveiled at a national health care summit in November would certify physician practices as patient-centered medical homes in an effort to promote comprehensive and coordinated care. The plan, which the Patient-Centered Primary Care Collaborative (PCPCC) expects to introduce in January, would use a new voluntary designation program from the National Committee for Quality Assurance (NCQA). The NCQA developed the criteria for certification in conjunction with the AAFP, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. To be certified, physician practices must meet requirements based on several factors, including patient registries, care management programs, electronic prescribing, and follow-up on tests. The NCQA executive vice president, Greg Pawlson, MD, MPH, said the success of this plan is contingent on payers recognizing the value of the patient-centered medical home and paying physicians and practices appropriately. For more information, visit https://www.aafp.org/news-now/professional-issues/20071107pcpccsummit.html or the PCPCC Web site at http://www.pcpcc.net/.

FDA Explores the Benefits of “Behind-the-Counter” Drug Access

The U.S. Food and Drug Administration (FDA) is examining whether there is a public health benefit to allowing certain prescription drugs to be dispensed from behind pharmacy counters. Advocates of “behind-the-counter” access contend that pharmacists are knowledgeable enough to ensure correct use of the drugs and to provide patient education, and that behind-the-counter access may help uninsured patients get certain drugs that are currently only available with a prescription. Several countries have regulations for behind-the-counter drug access. Steven Crawford, MD, Oklahoma City, Okla., chair of the AAFP Commission on Governmental Advocacy, expressed safety concerns because many patients have comorbidities, and physicians should be involved in the institution and modification of long-term therapies. The commission is also concerned that behind-the-counter drug access would inhibit the patient-centered medical home model of care. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20071108fdabtcdrugs.html.

Government Launches Five-Year EHR Demonstration Project for Physicians

The Department of Health and Human Services (HHS) announced that the Centers for Medicare and Medicaid Services (CMS) will launch a five-year project to encourage small- and medium-sized physician practices to use certified electronic health records (EHRs). Under the project, practices using EHRs will receive small bonuses based on how well the system supports delivery of care; an additional bonus will be given to practices with an EHR system that is well integrated into the management of patient care. Mike Leavitt, HHS secretary, says that the project will potentially improve the quality of care for 3.6 million Americans. In a letter to the HHS secretary, Executive Vice President of AAFP Douglas Henley, MD, Leawood, Kan., said that the demonstration project appears to address barriers to EHR adoption, such as cost and misalignment of payment structures. However, Henley proposed questions about what resources practices must provide to participate in the project, how data must be structured and transmitted for quality reporting, and how much money physicians would receive for participating. For more information, visit https://www.aafp.org/news-now/government-medicine/20071107cmsehrdemo.html.

Panelists Denounce Consolidation of the Health Insurance Industry

A panel addressing the House Committee on Small Business spoke out against the growing consolidation of the health insurance industry, which panelists say threatens family physicians and patient care. The panel included AAFP President Jim King, MD, Selmer, Tenn., and speakers from the American Medical Association (AMA), National Association for the Self-Employed, Consumers for Health Care Choices, and Victory Wholesale Grocers. A 2007 AMA report showed that in 280 U.S. markets, at least one third of covered patients are members of the largest insurer in that market. Panelists testified that decreased competition gives insurance companies power over coverage and physician payment, straining patient-physician relationships, undermining the patient-centered model of care, and blocking access to health care. Panelists called on Congress to change outdated policies and to block future mergers of large insurance companies. For more information, visit https://www.aafp.org/news-now/government-medicine/20071029kingtestimony.html or http://www.ama-assn.org/ama/pub/category/9573.html.

Study Shows Decrease in Cancer Incidence and Mortality Rates

A new report shows a decrease in overall cancer mortality rates and in the incidence rates of most cancers. The “Annual Report to the Nation on the Status of Cancer, 1975–2004” was published in the November 15, 2007, issue of Cancer. The study found that the overall average rate of decline in cancer mortality was 2.1 percent from 2002 to 2004 compared with 1.1 percent per year from 1993 through 2002. Mortality rates have decreased for the three leading causes of cancer deaths in men (lung, prostate, and colorectal cancers) and for two of the three leading causes of cancer deaths in women (colorectal and breast cancers). Cancers with increasing incidence rates include myeloma and liver, kidney, and esophagus cancers in men; and non-Hodgkin's lymphoma, melanoma, and leukemia and bladder, kidney, and thyroid cancers in women. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20071108cancerreports.htmlorhttp://www3.interscience.wiley.com/cgi-bin/fulltext/116330621/HTMLSTART.

— AFP and AAFP NEWS NOW STAFF