New Legislation Addresses Disparities in Urban versus Rural Physician Payments

Sen. Charles Grassley, R-Iowa, has introduced a bill aimed at decreasing Medicare payment disparities between rural and urban areas. Sen. Grassley, ranking member of the Senate Finance Committee, says that the disparities are linked to the use of Geographic Practice Cost Indices (GPCI), which penalizes rural physicians instead of equalizing payments. The Medicare Rural Health Access Improvement Act of 2008 would revise GPCI calculations to reduce payment differences and provide more accurate payments for rural physicians. The bill would also extend through 2009 the 5 percent bonus payment for those practicing in areas of physician scarcity. Additional legislation is expected from Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, that would temporarily increase Medicare payments for all physicians, allowing Congress time to develop an alternative to the flawed sustainable growth rate system. The bill would block a 10.6 percent payment reduction that is scheduled to take effect in July and a 5.4 percent reduction scheduled for 2009. The committee hopes to bring Sen. Baucus' bill to the Senate floor by mid-May. For more information, visit https://www.aafp.org/news-now/government-medicine/20080423financecmtebills.html or http://www.senate.gov/~finance/press/Gpress/2008/prg031408.pdf.

MedPAC Endorses Altering Medicare Systems to Promote Primary Care Services

The Medicare Payment Advisory Commission (MedPAC) has voted to recommend two key proposals to Congress that would shift Medicare payment and delivery toward primary care–based systems. The first proposal calls for an increase in payments for primary care services, and the second proposal recommends a three-year, $400 million medical home pilot project. The fee schedule adjustment does not specify how much of a payment increase primary care providers should receive. However, MedPAC principle policy analyst Kevin Hayes, PhD, says there are two precedents Congress could consider: a 10 percent Medicare bonus for physicians working in areas with a health professional shortage and a 5 percent bonus for those working in areas of physician scarcity. The medical home pilot project would fund demonstration projects in eight states beginning in 2009 and would include a physician pay-for-performance component. Although the project would cost $400 million, proponents contend that it would improve health care quality, enhance care coordination, and reduce costs. MedPAC plans to include the recommendations in its June report to Congress. For more information, visit https://www.aafp.org/news-now/government-medicine/20080417medpacrpt.html or the MedPAC Web site at http://www.medpac.gov.

Physicians Meet to Reflect on the Results of the National Demonstration Project

More than 70 physicians and other health care professionals met in April to mark the end of the National Demonstration Project. TransforMED launched the project in June 2006 to assess what changes were needed to achieve high-quality, efficient, cost-effective health care under a patient-centered medical home. During the meeting, representatives from 30 participating practices shared the successes and challenges that they encountered during the project. The demonstration project included two groups. One group focused on a process of change and was guided by trained facilitators who offered expertise, resources, and assistance. The other group also aimed for practice change but was self-directed and received no assistance from TransforMED. Physicians said that the project improved practice efficiencies, leading to better job satisfaction among physicians; however, the process of change also led to fatigue, time pressures, and temporary lapses in productivity. TransforMED is expected to release its final report on the project in 2009. For more information, visit https://www.aafp.org/news-now/practice-management/20080418tmedndp.html or the TransforMED Web site at http://www.transformed.com/ndp.cfm.

E-mail Health Care Notification Service to Replace Inefficient Paper-Based System

A free e-mail service will soon begin delivering product safety notices mandated by the U.S. Food and Drug Administration (FDA). The real-time, electronic safety alerts will replace paper letters currently sent to physicians via U.S. mail. The Health Care Notification Network (HCNN) is governed by the not-for-profit organization iHealth Alliance. Nancy Dickey, MD, chair of iHealth Alliance, says that the paper system is ineffective, often with weeks of delay before a notice reaches physicians. The e-mail system will be based on specialty; therefore, physicians will receive alerts only related to their area of practice. The new system will also include options for physicians to add staff members to the e-mail list and to send appropriate information to patients. The FDA supports the transition. Janet Woodcock, MD, acting director of the FDA's Center for Drug Evaluation and Research, praises the system because it will provide physicians with information as soon as it is available. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080423hcnn.html or the HCNN Web site at http://www.hcnn.net/default.aspx.

Study Shows That Sustained Practice Improvement Relies on Multiple Efforts

Implementing several activities for a prolonged period leads to meaningful, sustainable practice improvements, according to a study recently published in CE Measure. The “Impact of Educational Interventions on Physician Performance and Patient Outcomes” study found that performance can be enhanced by ongoing in-service education, support from a medical director or peer mentor, or follow-up coaching to reinforce improvement. Interactive activities, as opposed to traditional passive learning, and point-of-care reminder systems also contribute to improvements. The authors of the study used their research to assess four performance-improvement continuing medical education programs developed by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics, the American Board of Family Medicine, and the American Board of Internal Medicine. They conclude that programs that include baseline assessment, education, application of learning, and subsequent assessment may positively affect practice performance. For more information, visit https://www.aafp.org/news-now/cme-lifelong-learning/20080415cemeasure.html or the CE Measure Web site at http://www.cemeasure.com/media/journal/2-1/002-006.07-105.McKenna.pdf.

Experts Say Medical Homes Should Include Mental Health, Substance Abuse Services

During a primary care forum held March 29 in Washington, D.C., experts contended that integrating mental health and substance abuse services into the patient-centered medical home would improve patient care and reduce costs. Robert Phillips, MD, MSPH, director of AAFP's Robert Graham Center, argued that patient-centered care should focus on who the patient is and provide an array of services, including those related to mental health and substance abuse. Forum experts also called on public and private insurers to reconfigure their payment systems to integrate mental health and substance abuse services into the medical home. The U.S. House and Senate recently passed bills requiring health plans to provide the same coverage for mental health services as they do for other conditions; these bills (H.R. 1424 and S.B. 558) apply only to plans that already provide mental health coverage. For more information, visit https://www.aafp.org/news-now/professional-issues/20080416mentalhlthforum.html.

AHRQ Provides Online Resource to Promote Correct Medication Use and Patient Safety

To address the problem of incorrect medication use, the Agency for Healthcare Research and Quality (AHRQ) has launched a new online tool that provides patients with step-by-step instructions on how to create “pill cards.” The pill cards, which are designed by the patient, use pictures and simple phrases to describe how and when to take a medication. Users are given sample clip art and suggestions for design and use. Each card also includes important information for patients (e.g., physician and pharmacy phone numbers). For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080418pillcard.html or the AHRQ Web site at http://www.ahrq.gov/qual/pillcard/pillcard.htm.

CMS Issues Final Standards for Physician E-Prescribing Under Medicare Part D

The Centers for Medicare and Medicaid Services (CMS) has released a rule that sets the standards for electronic prescribing (e-prescribing) in the Medicare Part D program. The rule, which is effective in April 2009, includes standards for transmittal of certain information. This includes medication history, health plan formularies and benefits information, and prescription fill-status notifications, which allow pharmacists to notify physicians when a prescription is dispensed. The rule does not require Medicare Part D participants to use e-prescribing. For more information, visit https://www.aafp.org/news-now/practice-management/20080410eprescriberule.html.

FDA Approves New Two-Dose Vaccine to Protect Young Children Against Rotavirus

The FDA has approved a second oral rotavirus vaccine for young children. Rotarix, which is manufactured by GlaxoSmithKline, is given in two doses to children six to 24 weeks of age. RotaTeq, the current rotavirus vaccine, is manufactured by Merck and is given in three doses at two, four, and six months of age. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices is expected to discuss recommendations for Rotarix use during its June meeting. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080416rotarix.html.

— AFP and AAFP NEWS NOW STAFF