Congress Reauthorizes Children’s Health Insurance Program, Expands Coverage

Beginning April 1, 2009, an additional 4 million children will be eligible for health care coverage under the State Children’s Health Insurance Program (SCHIP). President Obama signed H.R. 2 into law on February 4, 2009, extending the program for the next four and a half years. SCHIP is a joint federal and state program that currently provides coverage to more than 6 million uninsured children whose families do not qualify for Medicaid. Under the new law, states may allow children in families with incomes of up to three times the federal poverty level to qualify for the program. In addition to eliminating a five-year waiting period for legal, documented immigrant children, the measure creates a new option for states to enroll low-income pregnant women in the program. Dental benefits and parity for mental health benefits are also included in the program. The new legislation will increase SCHIP spending by $32.8 billion and expand coverage to 11 million children by 2013. Funding will be provided by a 62-cent-per-pack increase in the federal cigarette tax. For more information, visit https://www.aafp.org/news-now/government-medicine/20090206schip-enacted.html.

Access to Community Health Centers Reduces Emergency Department Visits

Community health centers (CHCs) in rural areas may help reduce emergency department use among uninsured patients, according to a study in the winter 2009 issue of The Journal of Rural Health. Researchers at the National Center for Primary Care at the Morehouse School of Medicine in Atlanta, Ga., examined data from 2 million emergency department visits in 117 counties in rural Georgia from 2003 to 2005. The study found that uninsured patients accounted for 33 percent more emergency department visits in counties without CHCs than in those with CHCs. George Rust, MD, lead study author and director of the National Center for Primary Care, said the results show that CHCs are a critical safety net for uninsured patients and can reduce inappropriate use of emergency departments. In counties without a CHC, there were 32 percent more emergency department visits for chronic conditions, such as diabetes and asthma. This indicates a lack of access to primary care services in rural areas. According to Rust, CHCs serve as patient-centered medical homes to uninsured patients by employing a team-based, physician-led model of care. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20090128chc-er-study.html or The Journal of Rural Health Web site at http://www3.interscience.wiley.com/cgi-bin/fulltext/121585401/HTMLSTART.

Salmonellosis Outbreak Reminds Physicians to Report Evidence of Foodborne Illnesses

A recent outbreak of salmonellosis linked to peanut products had produced more than 500 reports of illness in 43 states, more than 100 hospitalizations, and eight deaths as of February 2, 2009. Officials from the Centers for Disease Control and Prevention (CDC) believe the outbreak is ongoing, although the rate of case reports has slowed. In the January 29, 2009, Morbidity and Mortality Weekly Report (MMWR), the CDC requested that physicians report foodborne illnesses to their county or city health departments. Physicians should instruct patients to discard any recalled products, and avoid products with peanut butter or peanut paste if they are unsure whether the product has been recalled. A list of recalled products is available on the U.S. Food and Drug Administration Web site at http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm. Physicians should also encourage patients to contact them if they think they might have become ill from eating a contaminated product. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090204salmonellosis.html or the MMWR Web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0129a1.htm.

Hib Disease Cases Linked to Vaccine Shortages, Parents’ Refusal to Vaccinate

A nationwide shortage of vaccines and the refusal of some parents to vaccinate their children may have contributed to a recent spike in reported cases of Haemophilus influenzae type b (Hib) in Minnesota. According to the January 23, 2009, MMWR, five cases of Hib disease in children younger than five years were reported to the Minnesota Department of Health in 2008; one of the children died from the disease. Three of the children had not been vaccinated because a parent had deferred or refused the vaccine. The department found that among children seven months of age, only 47 percent had received the Hib primary series. The increase in reported Hib cases also coincides with a vaccine shortage that began in December 2007. At that time, Merck & Co. Inc., recalled products containing Hib conjugate vaccine because of potential contamination. Sanofi Pasteur has been producing a monovalent Hib vaccine in the interim, but physicians should be aware that its three-dose schedule differs from Merck’s two-dose schedule. Although the current Hib vaccine supply should be adequate for primary doses, the CDC recommends that physicians delay the booster dose until summer 2009 when the supply is expected to increase. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090128minn-hib.html or the MMWR Web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0123a1.htm.

Survey Reveals Most Important Factors for Students Applying to Residency Programs

In a recent survey from the National Resident Matching Program (NRMP), 282 family medicine residency directors shared the factors they felt were most important when choosing which students to interview and rank. Medical Student Performance Evaluation results, clerkship grades, letters of recommendation, and standardized test scores were listed as major factors. Personal statements and previous volunteer or extracurricular experiences were also considered when selecting students to interview. After applicants have completed the interview process, program directors use their interview performance to rank them for matching. From the interview, directors can evaluate applicants’ interpersonal skills, interactions with faculty, demonstration of professional attributes, interactions with house staff, and perceived commitment to the specialty. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20090128nrmp-survey.html or the NRMP Web site at http://www.nrmp.org/data/programresultsbyspecialty.pdf.

MGMA’s Project SwipeIT Initiative Receives Endorsement from Insurance Company

Insurance company Humana Inc., has become the first in the industry to support Project SwipeIT, an initiative of the Medical Group Management Association (MGMA). Project SwipeIT, which launched in January 2009, was created to advance the adoption of standardized patient health insurance identification cards containing machine-readable information. MGMA has asked health insurers, vendors, and health care providers to support the standardized cards by January 1, 2010. The cards are designed to provide real-time patient information at the point of care. Although a card reader will cost practices about $200, MGMA estimates that machine-readable patient identification cards could save physician offices and hospitals up to $1 billion per year by reducing unnecessary administrative efforts and denied claims. When Humana launched a card-based pilot program two years ago, health care providers experienced a 50 percent reduction in denied transactions. Project SwipeIT has been endorsed by several health care organizations and associations, including the American Academy of Family Physicians (AAFP). For more information, visit https://www.aafp.org/news-now/practice-management/20090204swipeit.html.

Clear Posthospital Instructions Lead to Fewer Emergency Visits and Lower Costs

Educating patients with posthospital care instructions has several benefits, according to a study funded by the Agency for Healthcare Research and Quality, and published in the February 3, 2009, Annals of Internal Medicine. The study’s researchers created the Re-Engineered Hospital Discharge (RED) program, which uses specially trained nurses to help patients arrange follow-up appointments, confirm medication regimens, and understand their diagnoses with a personalized instruction booklet. The randomized controlled trial found that patients who received posthospital care instructions were 30 percent less likely to be readmitted to the hospital or to visit the emergency department. This also translated into lower costs. The total costs for patients who participated in the RED program were an average of $412 less than those who did not. Additionally, of the patients in the RED program, 94 percent left the hospital with a follow-up appointment, and 91 percent had their discharge information sent to their primary care physician within 24 hours of leaving the hospital. For more information, visit http://www.ahrq.gov/news/press/pr2009/redpr.htm.

AAFP Urges Cooperation from AMA in Seeking Payment Increase for Primary Care

The AAFP has expressed disappointment in recent comments made by American Medical Association (AMA) Board of Trustees Chair Joseph Heyman, MD. In the February 2, 2009, issue of American Medical News, Heyman stated that the AMA would not support payment increases for primary care physicians if it meant corresponding reductions in payments for subspecialists. AAFP President Ted Epperly, MD, Boise, Idaho, said he believes the AAFP and AMA should act together to support payment increases for primary care physicians. Epperly stressed that although shifting payment from other specialities is not the ideal solution, it may be the only way to finance the payment increases needed to support primary care. For more information, visit https://www.aafp.org/news-now/professional-issues/20090204ama-letter.html or the American Medical News Web site at http://www.ama-assn.org/amednews/2009/01/26/edca0126.htm.

— AFPandAAFP NEWS NOWstaff