Physician Groups Urge Congress to Adopt New Payment Model

Representatives from several physician organizations called on the House Small Business Subcommittee on Regulation, Health Care, and Trade to support a new, accurate Medicare payment system to replace the current sustainable growth rate (SGR) formula. American Academy of Family Physicians (AAFP) Board member Bradley Fedderly, MD, Milwaukee, Wis., told the subcommittee that it is time to replace the SGR formula with a system that reflects changes in the amount it costs small practices to provide care and that incorporates the patient-centered model of care. Fedderly suggests a model that includes a fee for services plus payment for coordination of care. Although payment updates have been considered to counteract rate reductions called for by the SGR formula, the physician representatives testified that the formula must be eliminated to fix the underlying problem. Although it is unclear whether physicians are declining services because of decreased Medicare payment rates, Rep. Charles Gonzalez (D-Tex.), chair of the subcommittee, agrees that the rate cuts need to be addressed. For more information, visit https://www.aafp.org/news-now/government-medicine/20071114fedderlytestimony.html.

Major New York Insurers Agree to Restructure Physician Ranking Systems

Cigna, Aetna, and Empire BlueCross BlueShield, major health insurance companies in New York state, have agreed to restructure their physician ranking programs in response to pressure from New York Attorney General Andrew Cuomo. Cuomo hopes that other payers will follow the new system, which requires companies to fully disclose the ranking process and ensure that the rankings are accurate and not solely based on cost. AAFP Board Chair Rick Kellerman, MD, Wichita, Kan., praised Cigna for being the first to sign the agreement, and said that insurance companies should have to follow transparency rules similar to those physician practices are required to follow. The agreement ensures that the ranking systems are not based on cost alone; use established quality standards, including those endorsed by the National Quality Forum; incorporate measures that facilitate more accurate physician comparisons; disclose how physicians are ranked; and provide a process for physicians to appeal their ranking and for patients to register complaints about the system. Payers are also required to nominate and pay for a Ratings Examiner to oversee their compliance to the agreement parameters. For more information, visit https://www.aafp.org/news-now/professional-issues/20071116docrankingmodel.html.

Pay-for-Performance Programs May Not Affect Patient Outcomes

Initiatives provided under pay-for-performance programs do not improve patient outcomes, according to a new study. “The Impact of Pay-for-Performance on Diabetes Care in a Large Network of Community Health Centers” study, published in the November 2007 issue of the Journal of Health Care for the Poor and Underserved, included primary care physicians and low-income patients with diabetes. The physicians received an 11 to 21 percent salary cut but were eligible to receive incentives for providing outpatient visits and for meeting certain quality-of-care measures. The study showed that although pay-for-performance programs focusing on a chronic condition improve processes, they do not improve patient outcomes. For example, although the programs led to an increase in testing recommended by the American Diabetes Association, they did not improve blood-sugar control in patients. The authors conclude that incentives alone do not lead to necessary quality-of-care improvements, and that programs should reward physicians who show improvement, not just those who meet high quality standards. For more information, visit https://www.aafp.org/news-now/professional-issues/20071121p4poutcomes.html or http://muse.jhu.edu/login?uri=/journals/journal_of_health_care_for_the_poor_and_underserved/v018/18.4coleman.html (password required).

AHRQ Guide Aims to Make Health Information Technology Accessible

Although more physicians, health insurance companies, and government entities are using health information technology products to provide information and tools to patients, these products are not always useful for those with limited literacy. The Agency for Healthcare Research and Quality (AHRQ) has released a guide for developers and buyers of health information technology products to help ensure that the products are functional for patients. The guide, prepared by the National Opinion Research Center at the University of Chicago (Ill.), offers tips on how to engage adults with limited literacy. These tips include using plain, clear language that is at or below a sixth-grade reading level; content that is diverse, relevant to patients, and requires only basic knowledge about the human body or health care system; and formatting that is easy to follow and read. The guide also includes information about how to create health information Web sites that are organized and easy for patients to navigate. Buyers of health information technology can use checklists provided in the guide to evaluate products, such as computer kiosks, personal digital assistants (PDAs), and home medical devices. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20071114healthitguide.html or the AHRQ Web site at http://healthit.ahrq.gov.

Ask and Act Program Offers Tools for Group Smoking Cessation Visits

The Future of Family Medicine project identified group visits as one of 10 features that directly affects physician practices and as potential revenue sources for physicians. As part of its Ask and Act smoking cessation program, the AAFP is offering tools to help physicians implement smoking cessation group visits as part of their practices. The tools assist in preparing for and conducting the visits and help with billing issues. Resources include a timeline that physicians can follow to help prepare for the visits, sample forms (e.g., patient confidentiality), scripts for communicating with patients, and tips on setting up and conducting a successful group visit. For more information, visit https://www.aafp.org/news-now/inside-aafp/20071121fybtobaccogroup.html or the Ask and Act Practice Toolkit at https://www.aafp.org/online/en/home/clinical/publichealth/tobacco/toolkit.html.

CDC Unveils Contingency Plan After Merck Unable to Ship Hib Vaccine

Merck has announced that it is temporarily unable to ship its Haemophilus influenzae type b (Hib) conjugate vaccine for children two to 71 months of age. The company says the vaccine will be available in the first quarter of 2008, but it cannot give a more definite date until manufacturing issues are resolved. Additionally, Merck said that it has enough of its combination Hib/hepatitis B vaccine for children six weeks to 15 months of age to meet historical demand, but not to meet additional demand. The Centers for Disease Control and Prevention (CDC) has not changed its recommendations for Hib immunization, but is working with Merck and Sanofi Pasteur, another manufacturer of the Hib vaccine, to create a contingency plan. Under the plan, the CDC will release limited doses of the Hib vaccine from its stockpile to meet the historical demand, and Sanofi Pasteur will work to meet additional demand. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20071116hibvaccine.html or the CDC's Current Vaccine Shortages & Delays Web page at http://www.cdc.gov/vaccines/vacgen/shortages.

Physician Turnover Affects Patient Satisfaction, Preventive Care

A recent study, published in the August 2007 issue of the American Journal of Managed Care, shows that high physician turnover rates in managed care organizations are related to lower patient satisfaction and quality of preventive care. The “Primary Care Provider Turnover and Quality in Managed Care Organizations” study used data from the National Committee for Quality Assurance to evaluate the effects of turnover among health care professionals (i.e., physicians, nurse practitioners, and physician assistants). The organizations with the highest turnover rates had lower patient satisfaction with the physician, obtaining appointments, wait time during a visit, and overall health care and health plan. These organizations also had lower rates of childhood immunizations by two years of age, well-child visits within the first 15 months of life, and cholesterol and cervical cancer screening. The authors of the study conclude that physicians who stay with an organization are better able to maintain patient relationships, which leads to increased patient satisfaction. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20071113turnoverrates.html or http://www.ajmc.com/article.cfm?ID=3346.

AAFP Adds Features to its 2008 Presidential Campaign Web Page

The AAFP has enhanced its “2008 Presidential Campaign” Web page, which provides information about each of the Democratic and Republican candidate's positions on issues that pertain directly to family medicine. The new features include a grid detailing each candidate's health care plans, fact sheets about primary care issues, and a list of questions family physicians can ask candidates at campaign events. Director of the AAFP Government Relations Division Kevin Burke says the Web page offers physicians an easy way to make a side-by-side comparison of candidates' positions on health care issues, specifically those directly related to family medicine. For more information, visit https://www.aafp.org/news-now/government-medicine/20071119presidentialgrid. html or AAFP's “2008 Presidential Campaign” Web page at https://www.aafp.org/online/en/home/policy/federal/presidentialrace.html.

— AFP and AAFP NEWS NOW STAFF