Payment Reform Necessary for Physicians to Provide Appropriate Chronic Illness Care

America's health care delivery and payment systems are failing patients with chronic diseases, according to a study by the Center for Studying Health System Change. The report, “Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care,” found that the system's current focus on acute or episodic conditions results in inefficient and fragmented care. Patients with chronic diseases often see multiple physicians, which increases the risk of duplication of services and avoidable hospitalizations. The report indicates that chronic diseases account for 70 percent of U.S. deaths and 75 percent of the country's $2 trillion in medical costs. Of the three main payment modalities in the health care market (i.e., fee-for-service, capitation, and pay-for-performance), none are designed to reward physicians for providing comprehensive care to patients with chronic illnesses. The report cites payment reform as critical to changing the system. Pilot programs and other payment reform experiments are being conducted around the country. As the largest single payer in the United States, Medicare's participation in a new payment system would be crucial for successful payment reform. For more information, visit https://www.aafp.org/news-now/professional-issues/20080716hsc-reform.html or http://www.hschange.org/CONTENT/995/.

CMS Offers Medicare Payment Bonus to Physicians Using E-prescribing Technology

The Centers for Medicare and Medicaid Services (CMS) hopes new incentives for electronic prescribing (e- prescribing) will encourage physicians to adopt the practice. Under the Physicians Quality Reporting Initiative, physicians who use e-prescribing technology can earn a 2 percent bonus payment from Medicare in 2009 and 2010. Preliminary calculations show that the 2009 bonus could add up to $1,300 in additional payments for an individual family physician. Smaller bonuses are scheduled for 2011 to 2013. However, beginning in 2014, CMS will penalize physicians with reduced payments if they do not use e-prescribing. According to a report by the Institute of Medicine, at least 1.5 million Americans are injured each year from adverse drug events, which could be reduced by eliminating handwritten prescriptions. American Academy of Family Physicians (AAFP) President Jim King, MD, Selmer, Tenn., believes e-prescribing will improve communication between physicians and patients because the technology will allow physicians to see when patients fill their prescriptions. King hopes any proposed penalties will be put on hold until more health insurance plans and pharmacies recognize e-prescriptions. For more information, visit https://www.aafp.org/news-now/practice-management/20080723-e-prescribe-call.html.

Influenza Vaccination Rates for Patients with Asthma Fail to Meet Expectations

Influenza vaccination rates for patients with asthma are below target levels, according to “Influenza Vaccination Coverage Among Persons with Asthma—United States, 2005–06 Influenza Season.” The study, published in the June 20, 2008, issue of Morbidity and Mortality Weekly Report (MMWR), found that only 36.2 percent of patients with asthma were immunized during the 2005–2006 flu season. Healthy People 2010, which outlines health objectives for all Americans, calls for a 60 percent influenza vaccination rate for adults 18 to 64 years of age with high-risk conditions. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommends that all patients with asthma receive an influenza vaccine because they are at higher risk of flu-related complications. Patients who had a regular place for medical care and who made more medical visits were more likely to be vaccinated. Older patients and patients whose families earned more than 4.5 times the federal poverty level were also more likely to receive a vaccine. The report recommends that physicians use reminders and standing orders to improve vaccination rates. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080709flu-asthma.html or the MMWR Web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5724a2.htm.

Physicians Receive Increase in Medicare Payment Rate for Mental Health Services

Medicare is now reimbursing for mental health services at a higher rate. The payment adjustment was included in Medicare payment legislation H.R. 6331 and is effective for 18 months beginning July 1, 2008. The 5 percent increase includes current procedural terminology codes 90801 through 90829, which cover psychotherapy services that are insight-oriented, behavior-modifying, interactive, or supportive. In addition to benefiting physicians, the legislation provides a financial break for Medicare beneficiaries with mental health disorders by reducing, and eventually eliminating, discriminatory copayment rates for outpatient psychiatric therapeutic services. Also, beginning in 2010, coinsurance rates will decrease over several years. With lower out-of-pocket expenses for mental health care, it is expected that patients will seek care they had previously delayed because of costs. For more information, visit https://www.aafp.org/news-now/practice-management/20080724mental-servs.html.

Companies Merge to Form Single Health Information Technology Network

Two of the largest e-prescribing companies in the United States, SureScripts and RxHub, have merged to provide health information technology services to physicians from a single source. The new SureScripts-RxHub expects to process around 100 million e-prescription transactions and 70 million drug formulary and patient medication history requests this year. Steven Waldren, MD, director of AAFP's Center for Health Information Technology, anticipates the merger will improve the e-prescribing process for physicians. The company plans to offer better access to mail-order pharmacies and enhanced patient formulary information. The merger will also simplify the set-up process for electronic health record systems. For more information, visit https://www.aafp.org/news-now/practice-management/20080716surescripts-rxhub.html or http://www.surescriptsrxhub.com/.

Rotavirus Vaccine Recommendations Aim to Prevent Infection in Infants and Children

ACIP has issued provisional recommendations for the use of rotavirus vaccine in infants and young children, and the AAFP has approved the recommendations. According to an article in the June 25, 2008, issue of MMWR, rotavirus infection is responsible for as many as 70,000 hospitalizations and 410,000 physician office visits in the United States each year. An accompanying editorial attributes a recent decline in rotavirus activity to the increased use of the vaccine. The two vaccine products currently available, Rotarix (marketed by GlaxoSmith-Kline) and Rotateq (marketed by Merck), are administered orally, with the first dose given at two months of age. Both vaccines require a second dose at four months of age, and Rotateq requires a third dose at six months of age. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080715rotavirusrecs.html or the MMWR Web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e625a1.htm.

ACS Increases Awards for Primary Care Physicians Researching Cancer Control

The American Cancer Society (ACS) has increased the awards given to primary care physicians pursuing academic careers in cancer control. The Cancer Control Career Development Awards for Primary Care Physicians now total as much as $100,000 per year for three years. The awards are designed to help primary care physicians conduct cancer control research with an academic mentor. The ACS hopes the awards will also promote expertise in teaching and clinical care. The application deadline for the 2008 awards is October 15. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080722acs-awards.html or the ACS Web site at http://www.cancer.org.

New Online Classroom Program Offers Course Series on Pain Management

The AAFP has designed a new online classroom that focuses on specific diseases and medical conditions. Launched in July 2008, the LearningLink program consists of five one-hour activities in the form of Webcasts and audio and video podcasts. AAFP members who register can earn free continuing medical education credits. Participants take tests on the topic before and after the program to identify knowledge gaps and help organizers improve future courses. LearningLink will also provide access to online point-of-care resources that physicians can download and incorporate in their practices. The first program topic is pain management, which begins with the Webcast, “Assessment and Management of Chronic Pain.” The Webcast addresses the diagnosis of chronic pain and treatment with pharmacologic and nonpharmacologic methods. Future programs in the pain management series will be released through February 2009. For more information, visit https://www.aafp.org/news-now/cme-lifelong-learning/20080723learninglink.html or the LearningLink Web site at https://www.aafp.org/online/en/home/cme/selfstudy/learninglink/pain1.html.

AHRQ and AARP Publish Checklists to Help Adults Track Preventive Screenings

The Agency for Healthcare Research and Quality (AHRQ) and the AARP have released three publications to help adults 50 years and older maintain good health and prevent disease. Two of the publications are checklists, one for men and one for women, that patients may use to record their screening test history and to plan follow-up appointments. The third publication is a timeline out-lining screening recommendations by the U.S. Preventive Services Task Force, and is designed for physicians and other health care agencies to post in public places. For more information, visit http://www.ahrq.gov/news/press/pr2008/ppip50pr.htm.

— AFP and AAFP NEWS NOW staff