Recently Introduced Legislation Provides for 18-Month Physician Payment Update

A bill recently proposed in the Senate would block steep reductions in Medicare physician payment rates through 2009. A 10.6 percent decrease in payments is scheduled to take effect on July 1, 2008, and a 5 percent reduction is scheduled in 2009. The Save Medicare Act (S.B. 2785) does not provide a solution to the flawed sustainable growth rate (SGR) payment formula; however, it gives Congress time to develop an alternative system by providing a 0.5 percent increase in payment rates for the last six months of 2008 and a 1.8 percent increase for 2009. Sen. Debbie Stabenow (D-Mich.), a member of the Senate Finance Committee and sponsor of the bill, says that the extension is needed for payment stability and, ultimately, the implementation of a suitable replacement for the SGR system. Stabenow's bill does not have a Republican cosponsor and does not address the budgetary offsets needed to pay for the Medicare update; however, she hopes parts of her bill, including the 18-month update, will be part of a bill she expects to be introduced by Sen. Max Baucus (D-Mont.) and Sen. Charles Grassley (R-Iowa). Baucus is the Senate Finance Committee chair, and Grassley is the committee's senior Republican member. For more information, visit https://www.aafp.org/news-now/government-medicine/20080325stabenowbill.html or the American Academy of Family Physicians' (AAFP) legislative action center Web site at http://capitol.aafp.org/aafp/issues/alert/?alertid=10007791&process=take+action.

Candidate Health Care Proposals Focus on Insurance Coverage, Not Systematic Change

The leading 2008 presidential candidates' health care proposals reflect the candidates' general philosophies but avoid in-depth plans for health care reform. Robert Blendon, PhD, professor of health policy and political analysis at the Harvard School of Public Health, says that the health care debate in the 2008 election has been about offering better insurance choices and improving coverage and not about restructuring the health care system. Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have focused on a series of mandates aimed at providing universal or near-universal health insurance coverage to U.S. residents, whereas Sen. John McCain (R-Ariz.) has focused on market and tax reform to create more health insurance choices at cheaper rates. A side-by-side analysis of the presidential candidates' health care proposals conducted by the Kaiser Foundation is available at http://www.health08.org/sidebyside.cfm. For more information, visit https://www.aafp.org/news-now/government-medicine/20080317usprescands.html.

AHRQ Provides State-by-State Snapshots of Health Care Quality Performance

The Agency for Healthcare Research and Quality (AHRQ) recently released its 2007 State Snapshots Web tool, an annual analysis of each state's quality of health care aimed at helping state leaders identify strengths and weaknesses of their state's health care system. The analysis is based on data from the “2007 National Healthcare Quality and Disparities Report” (http://www.ahrq.gov/qual/qrdr07.htm). The 2007 State Snapshots includes new information, such as obesity rates, health insurance coverage, and number of subspecialists in each state. The updated tool tracks each state's progress toward the federal government's Healthy People 2010 goals. Nearly 150 quality measures are analyzed based on three dimensions: type of care, setting of care, and clinical area (e.g., diabetes or cancer care); the states are ranked on selected measures. This year's new features also include state contextual factors, such as demographics, and focused analyses of diabetes care and preventive services. For more information, visit the AHRQ Web site at http://statesnapshots.ahrq.gov/snaps07/index.jsp.

MedPAC Considers Recommendations, Including Medical Home Pilot Project

The Medicare Payment Advisory Committee (MedPAC) is considering a number of recommendations to Congress that include positive measures for primary care. The recommendations under consideration include an increase in Medicare payments for primary care services and a medical home pilot project. The payment proposal would establish a budget-neutral payment adjustment based on the Medicare physician fee schedule. Eligibility would be determined by the U.S. Department of Health and Human Services. According to MedPAC Senior Analyst Christina Boccuti, MPH, a goal of the medical home pilot project would be to enhance the viability and role of primary care while improving beneficiaries' access to primary care. Practices participating in the pilot project would be required to provide primary care services, use health information technology, provide case management, offer 24-hour patient communication and access, maintain up-to-date records of patients' advance directives, and obtain external accreditation or certification. If approved, MedPAC is expected to include the recommendations in its report to Congress in June 2008. For more information, visit https://www.aafp.org/news-now/government-medicine/20080319medpacrecs.html or the MedPAC Web site at http://www.medpac.gov.

2008 Resident Matching Program Shows Increased Interest in Primary Care Specialty

Medical student interest in primary care is growing, according to the results of the 2008 National Resident Matching Program (NRMP). The results show that 1,172 U.S. medical school graduates chose family medicine in 2008, 65 more graduates than in 2007; family medicine residency positions had a nearly 91 percent fill rate. The results come after studies showed that there is a national shortage of primary care physicians, and that the need for these physicians is expected to greatly increase by 2020. The increase in residents reflects primary care organizations' efforts over recent years to reach out to medical students, according to Perry Pugno, MD, director of AAFP's Division of Medical Education. He says that students can see the growing recognition of primary care and the demand for family physicians. Although the 2008 NRMP results are encouraging for primary care, AAFP President Jim King, MD, Selmer, Tenn., contends that a major increase in the number and distribution of primary care physicians is needed to end the shortage. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20080320matchresults08.html or https://www.aafp.org/online/en/home/residents/match.html.

National Organization Launches Campaign to Expand Community Health Centers

The National Association of Community Health Centers (NACHC) recently unveiled a plan aimed at increasing federal funding for community health centers by billions of dollars over seven years. The Access for All America plan, announced on Capital Hill in March, would increase federal funding from $2 billion in 2008 to $5 billion in 2015 and would give facilities easier access to the capital needed for infrastructure expansion. The announcement of the plan coincides with the release of the NACHC's report “Access Capital: New Opportunities for Meeting America's Primary Care Infrastructure Needs” (http://www.nachc.com/client/documents/Access_Capital_Report_FINAL.pdf). To facilitate access to capital, the plan proposes a federal credit enhancement program that can be coupled with tax-exempt bonds, dedicated tax credits, and a national entity in charge of streamlining access to the tax credit and tax-exempt bond market. The goal of the plan is to reach 30 million patients by creating new community health centers and expanding those already in existence. However, many community health centers must be renovated or rebuilt in order to expand. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080320chcaccess-plan.html or the NACHC Web site at http://www.nachc.com/pressrelease-detail.cfm?PressReleaseID=237.

Effective Diabetes Prevention, Management May Differ Between Men and Women

A study published in the February issue of Canadian Family Physician showed that diabetes counseling, management, and education should be presented differently to men and women. The Characteristics of Men and Women with Diabetes study examined the psychosocial, behavioral, and clinical differences between men and women during their initial visit to a diabetes education center. The authors concluded that these differences may help gauge a patient's risk of acquiring diabetes, attitude about self-care, and health outcomes. Specific recommendations included emphasizing self-care in men and encouraging them to attend self-care education sessions; promoting regular screening in women, especially those with a family history of diabetes or a high body mass index; and focusing on screening women with diabetes for depression. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080320diabetes-gender.html or the Canadian Family Physician Web site at http://www.cfp.ca/cgi/content/full/54/2/219.

Online Resource Offers Patients, Physicians Information About Laboratory Testing

The AAFP office laboratory proficiency testing program has joined several other organizations as a collaborating partner of Lab Tests Online. The Web site offers peer-reviewed information, such as explanations of specific tests and the patient's role in preparing for laboratory tests. Although the Web site was initially created as a patient resource, 20 percent of visitors to the site are physicians who want to stay up to date on laboratory testing. The American Association for Clinical Chemistry, an organization of professional laboratory scientists, oversees Lab Tests Online. A free office display that includes information about the Web site is available. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080325labtestsonline.html or http://www.labtestsonline.org.

— AFP and AAFP NEWS NOW staff