Congress Fails to Renew Medicare Bonus Payments for Physician Scarcity Areas

Nearly 25,000 primary care physicians saw a 5 percent reduction in their Medicare payments after Congress allowed a bonus payment program to expire at the end of June 2008. The program was designed to provide a quarterly bonus to physicians practicing in designated physician scarcity areas. Without the bonus program, there is concern that fewer physicians will decide to practice in underserved areas, which often lack adequate resources and support. This could threaten the care of as many as 7.5 million Medicare beneficiaries throughout the country. Meanwhile, on July 23, 2008, the U.S. Department of Health and Human Services (HHS) withdrew a proposed rule that would have consolidated health professional shortage areas and medically underserved areas into one entity known as the Index of Primary Care Underservice. The American Academy of Family Physicians (AAFP) was one of several organizations to oppose the rule, which would have had uncertain effects on approximately 70,000 primary care physicians and more than 60 million patients in these areas. HHS plans to make changes to the rule and invite public comment before issuing a final rule. For more information, visit https://www.aafp.org/news-now/government-medicine/20080731medicare-psa.html or https://www.aafp.org/news-now/government-medicine/20080807hhs-pulls-rule.html.

New Combination Vaccines for Children May Create Additional Work for Physicians

Two new combination vaccines are now available to protect children against diphtheria, tetanus, pertussis, and polio. Kinrix (GlaxoSmithKline) has been approved for use in children four to six years of age. Pentacel (Sanofi Pasteur), which is also indicated for immunization against Haemophilus influenzae type b, has been approved for use in infants and children six weeks to four years of age. The U.S. Food and Drug Administration (FDA) has recommended that both vaccines be added to the Vaccines for Children program, which provides free vaccines for children covered by Medicaid, children with no insurance, or children who meet other eligibility guidelines. Although combination vaccines reduce the number of injections patients need, there is concern that combination products add confusion to the immunization process. Physicians must track which products are for which age ranges, as well as which product a patient received previously. Physicians must also weigh the amount of work it takes to track the new vaccines with the reimbursement they receive from payers. Other potential drawbacks include unexpected side effects and shortages of vaccine components. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080724combo-vaccines.html.

CMS Finalizes Payment Plans for Three-Year Medical Home Demonstration Project

The Centers for Medicare and Medicaid Services (CMS) will begin recruiting physician practices in January 2009 to participate in a three-year Medicare medical home demonstration project. The project will include rural and urban practices in eight states, and will focus on Medicare patients who are chronically ill. Physicians in selected practices will receive a per-member, per-month payment based on recommendations by the American Medical Association/Specialty Society Relative Value Scale Update Committee. The three-tiered payment system is similar to the medical home recognition program developed by the National Committee for Quality Assurance. Tier one medical homes will receive an estimated $30 per member per month, whereas tier two and tier three medical homes will receive $40 and $50 per member per month, respectively. CMS may be forced to adjust payments because of federal cost-neutrality requirements. Calculations are in progress to ensure that any costs incurred over the three years will be offset by savings generated by the project. For more information, visit https://www.aafp.org/news-now/government-medicine/20080806pcmh-pay-scale.html or http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/MedHome_TaxRelief_HealthCareAct.pdf.

Physicians Urge Congress to Give Financial Incentives to Practices Adopting EHRs

Physicians from several specialties recently testified before the House Committee on Small Business on the costs of electronic health records (EHRs). The July 31, 2008, hearing focused on the unforeseen challenges and expenses of incorporating EHRs into small specialty practices. Family physician Thaddeus Bort, MD, of the Family Medical Group in Cincinnati, Ohio, urged Congress to sponsor a tax incentive or reward system to make EHR adoption possible for small practices. Bort explained that the initial cost of an EHR system is only one part of the expense. Practices must also take into account the cost of transferring paper files to an electronic format, lost productivity as staff learn to use the new system, and annual maintenance expenses. Another obstacle to EHR adoption is the lack of interoperability among systems, which makes it difficult to communicate with other physicians and hospitals, and produces more paperwork. Committee members acknowledged the challenges and agreed that the federal government should provide bonuses or incentives for physicians implementing health information technology. For more information, visit https://www.aafp.org/news-now/government-medicine/20080806bort-testify.html.

Physicians Permitted to Waive Retroactive Beneficiary Liability for Medicare Patients

Physicians are not required to bill Medicare patients for additional coinsurance for services provided during the first two weeks of July 2008, according to a statement by the HHS' Office of Inspector General. The decision is a result of bill H.R. 6331, which passed on July 15, 2008, and rescinded a 10.6 percent physician pay cut that had been in effect since July 1, 2008. Because the pay cut was in effect for two weeks before the legislation was passed, patients who paid a bill or who had been billed during this time are responsible for paying a larger portion of their Medicare coinsurance under a process known as retroactive beneficiary liability. Ordinarily, physicians who waive the retroactive beneficiary liability would be violating fraud and abuse regulations. However, because CMS has permitted the waiver in this situation, family physicians are not obligated to generate a new claim to send to the patient or to the secondary insurance after Medicare's adjusted payment. For more information, visit https://www.aafp.org/news-now/practice-management/20080731oig-waiver.html or http://oig.hhs.gov/fraud/docs/alertsandbulletins/2008/MIPPA_Policy_Statement.PDF.

Contracting Guide Provides Strategies for Physicians Negotiating with Health Plans

A new guide developed by the AAFP is available to help AAFP members navigate contract negotiations with health plans. The “Managed Care Contract Negotiation” guide advises physicians on several strategies to use when making negotiations, including deciphering contract definitions, responding to common negotiation denials, and understanding the obligations of their practice and the health plan. The guide recommends physicians begin the negotiating process by conducting a unit cost analysis to show how much it costs the practice to provide each service. For more information, visit https://www.aafp.org/news-now/practice-management/20080806contract-guide.html or https://www.aafp.org/online/en/home/policy/privatesector.html.

AHRQ Effective Health Care Program Offers Guides on Prostate Cancer Treatments

The Agency for Healthcare Research and Quality (AHRQ) has released two guides on prostate cancer treatment, one for patients and one for physicians, as part of its Effective Health Care program. “Treating Prostate Cancer: a Guide for Men with Localized Cancer” and “Treatments for Clinically Localized Prostate Cancer” compare the effectiveness and risk of eight treatment approaches, including surgical prostate removal, radioactive implants, and no treatment. The patient guide provides facts on how prostate cancer is found, and potential side effects of various treatments. The physician guide includes a confidence scale that rates available evidence. Other comparative effectiveness guides in the AHRQ series include type 2 diabetes, osteoarthritis, and depression. For more information, visit http://www.Effectivehealthcare.ahrq.gov.

New Health Care Purchasing Guide Focuses on the Patient-Centered Medical Home

Health care purchasers now have a guide to help them make the patient-centered medical home a part of their health care plans. The new Patient-Centered Primary Care Collaborative booklet provides purchasers with strategies for adopting the medical home concept and with sample insurance contract language to help them begin the process. The booklet represents the first time health care professionals, consumers, and health care plans have collaborated on a purchasing document. For more information, visit https://www.aafp.org/news-now/professional-issues/20080731pcpcc-guide.printerview.html.

FDA Approves Six Influenza Vaccines to Target Three Virus Strains for 2008–2009

The FDA has approved six influenza vaccines for the upcoming 2008–2009 flu season. The vaccines will target three influenza virus strains that have been identified as most likely to circulate this season. The World Health Organization, the U.S. Centers for Disease Control and Prevention, and other institutions collaborate with the FDA each year to study virus samples from around the world and predict which will cause the most illness. Even if the vaccines are not matched perfectly to the circulating strains, they may provide protection against flu-related complications and may reduce the severity of the illness. For more information, visit http://www.fda.gov/bbs/topics/NEWS/2008/NEW01872.html or http://www.fda.gov/cber/flu/flu2008.htm.

— AFP and AAFP NEWS NOW staff