Faltering Health Care System Requires Urgent Attention from the Next Congress

The next Congress will face the critical task of addressing the impending crisis in America's health care system, including reforming the Medicare physician payment system. According to Kenneth Thorpe, MD, executive director of the Emory Institute for Advanced Policy Solutions in Atlanta, Ga., future legislation will need to rapidly accelerate the use of primary care to improve health care quality and save costs. During a September 30, 2008, media telebriefing, Thorpe emphasized the need to slow the growth in Medicare and Medicaid, and to make private sector health care coverage more affordable for working families and businesses. Former Secretary of the U.S. Department of Health and Human Services Tommy Thompson addressed the importance of disease management during the telebriefing. The amount of money spent on chronic disease care is one of the biggest contributors to the health care crisis. Diabetes, obesity, cardiovascular disease, and cancers all contribute to the $2.4 trillion spent on health care each year in the United States, according to Thompson. However, these chronic diseases can be addressed by promoting primary care and encouraging patients to change behaviors. For more information, visit https://www.aafp.org/news-now/government-medicine/20081008pfcd-tele.html or http://www.fightchronicdisease.org/media/ThompsonThorpe-ConferenceCall.cfm.

AAFP, AMA Request Exemption from FTC Identity Theft Prevention Program

The American Medical Association (AMA) and the American Academy of Family Physicians (AAFP) have joined 25 other medical organizations to protest a recent regulation by the Federal Trade Commission (FTC). The regulation would require financial institutions and creditors to develop and implement identity theft prevention programs as part of the Fair and Accurate Credit Transactions Act of 2003. The FTC may consider physicians creditors if they bill patients after appointments instead of at the time of their appointments. In a letter to the FTC, the AMA and AAFP requested that physicians be excluded from the regulations, which were expected to take effect November 1, 2008. The letter argues that physicians should not be considered creditors simply because they may allow patients to pay in installments rather than reporting the patient to a collection agency or suing the patient. For more information, visit https://www.aafp.org/news-now/government-medicine/200810117ftc-id-theft-rule.html or the FTC Web site at http://www.ftc.gov/os/fedreg/2007/november/071109redflags.pdf.

Reports Reveal Various Levels of Progress in Incentive Initiatives for EHR Systems

Cost continues to deter some physicians from purchasing an electronic health record (EHR) system. However, two recent reports show that financial assistance is available. According to a September 25, 2008, press release from the Certification Commission for Healthcare Information Technology (CCHIT), there are currently 90 programs that represent more than $700 million in potential EHR funding. The money is available from incentive programs sponsored by government agencies, insurance plans, employer coalitions, and public-private partnerships. Hospitals and hospital systems are also able to contribute funding for EHRs since the relaxation of anti-kickback laws in 2006. The Center for Studying Health System Change (HSC) also released a report on EHR financial assistance after interviewing 24 hospitals in 12 metropolitan communities. The study found that only seven hospitals had developed strategies to provide financial or other support to physicians for implementing EHRs. Some hospitals indicated that finding the right EHR and fixing any problems with the system were their first priorities. For more information, visit https://www.aafp.org/news-now/practice-management/20081009ehr-dollars.html, the CCHIT press release at http://cchit.org/about/news/releases/2008/Incentive-programs-EHR-adoption-growing.asp, or the HSC report at http://www.hschange.com/CONTENT/1015/.

Law Provides Parity for Mental Health and Addiction Services for Millions of Patients

Approximately 113 million Americans will have mental health and addiction services parity as a result of H.R. 1424, which passed in October 2008. The law, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, was part of the $700 billion economic bailout legislation. Although the law does not require businesses to cover mental health and addiction services, it does require businesses with more than 50 employees to provide the same level of coverage for these services as they do for physical ailments. Kevin Burke, Washington, DC, director of the AAFP Government Relations Division, expects that the law will allow more patients to seek treatment for mental health and substance abuse disorders now that they have better coverage. For more information, visit https://www.aafp.org/news-now/government-medicine/20081015mental-parity.html.

CMS Publishes First Batch of Billing Edits from Medically Unlikely Edit Program

The Centers for Medicare and Medicaid Services (CMS) recently released billing edits in its Medically Unlikely Edit (MUE) program. The first batch of edits was released on October 1, 2008, and future edits will be published quarterly. The edits are applied during the electronic processing of claims to make sure that Medicare providers do not report excessive services. When CMS initiated the MUE program in 2006 to improve the accuracy of Part B claims payments, it did not intend to publish the edits; however, the AAFP and several other medical organizations pressured CMS to make them public. Because most of the billing errors are typographical, publicizing the edits could allow software vendors to build practice management systems that would catch common errors before a claim was submitted to Medicare. For more information, visit https://www.aafp.org/news-now/practice-management/20081015mue-prog.html or the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp.

Congress Reauthorizes CHCs and the NHSC with Set Funding for the Next Five Years

Congress has unanimously reauthorized the federal community health centers (CHCs) program and the National Health Service Corps (NHSC) for the next five years. President Bush signed the bill into law on October 8, 2008. H.R. 1343 calls for Congress to increase the funding levels for CHCs to $3.3 billion and the NHSC to $186 million by 2012. CHCs serve as medical homes for more than 18 million patients who are predominantly uninsured or underinsured. The NHSC provides financial assistance to medical students who agree to practice in medically underserved areas after graduation. This is the first time since 1981 that both programs have been reauthorized with specific funding levels for each of the next five years. For more information, visit https://www.aafp.org/news-now/government-medicine/20081008chcs-nhsc.html.

New Resource Encourages Physicians to Embrace Electronic Prescribing

A new electronic prescribing (e-prescribing) guide is now available to physicians as a free online download. The AAFP is one of several organizations that collaborated to produce “A Clinician's Guide to Electronic Prescribing.” Steven Waldren, MD, Leawood, Kan., director of the AAFP's Center for Health Information Technology, said the guide explains why physicians should embrace e-prescribing and how to overcome potential barriers. The guide also describes how physicians can move forward with the technology. For more information, visit https://www.aafp.org/news-now/practice-management/20081010e-prescribe-guide.html or download the guide at http://www.thecimm.org/PDF/Clinician's_Guide_to_e-Prescribing_Final_100708.pdf.

AAFP Bulletin Shares Information on Preventing and Treating Childhood Obesity

The AAFP's latest CME Bulletin aims to help family physicians manage obesity in their younger patients. “Assessment, Prevention and Treatment of Childhood Obesity” focuses on children and teenagers two to 19 years of age. The bulletin describes the causes and consequences of childhood obesity; offers information to help physicians assess patients' weight status; discusses obesity prevention strategies; and outlines four stages of treatment, including counseling and multidisciplinary intervention. The bulletin also provides links to several Web-based obesity assessment tools. Each CME Bulletin offers one Prescribed CME credit for AAFP members. For more information, visit https://www.aafp.org/news-now/cme-lifelong-learning/20081015cme-obesity.html or https://www.aafp.org/online/en/home/cme/selfstudy/cmebulletin/childobesity.html.

FDA Mandates Stronger Package Label Warnings for TNF Blockers

The U.S. Food and Drug Administration (FDA) has issued a new requirement for manufacturers of tumor necrosis factor (TNF) blockers. Product labels for TNF blockers must now display stronger warnings that highlight the risks of opportunistic fungal infections that can lead to death. TNF blockers suppress the immune system and are approved to treat conditions such as rheumatoid arthritis, plaque psoriasis, ankylosing spondylitis, and Crohn's disease. TNF blockers currently available in the United States include certolizumab pegol, etanercept, adalimumab, and infliximab. Physicians should consider discontinuing TNF blockers in patients who present with signs and symptoms indicating a possible fungal infection. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20081015tnf-blockers.html or the FDA Web site at http://www.fda.gov/cder/drug/InfoSheets/HCP/TNF_blockersHCP.htm.

— AFPandAAFP NEWS NOWstaff