Primary Care Bill Includes Steps to Address Physician Shortage, Income Disparity

The American Academy of Family Physicians (AAFP) has endorsed a bill to strengthen America's primary care infrastructure by providing scholarships, loan forgiveness, deferral of loan repayments, and grants for practices to incorporate the patient-centered medical home. The bill, known as the Preserving Patient Access to Primary Care Act, incorporates several steps to address the ongoing shortage of primary care physicians. One step includes providing scholarships of up to $35,000 per year for students who agree to serve as primary care physicians in critical shortage health facilities. The bill also would grant loan forgiveness up to $35,000 for primary care physicians who work in critical shortage areas, and it would defer student loan repayment for primary care residents until after completion of their residencies. Additionally, the bill includes measures to reduce the income disparity between primary care physicians and other specialists. For example, the bill would increase the budget-neutrality limits set by the physician fee schedule to consider the effect of primary care in saving money across the Medicare program. For more information, visit https://www.aafp.org/news-now/government-medicine/20090520schwartz-pc-bill.html.

Organizations Respond to Senate Finance Committee's Health Reform Options Paper

The AAFP, the American College of Physicians, and the American Osteopathic Association have responded to an options paper issued by the Senate Finance Committee on Medicare payments for primary care services. Specifically, the organizations are advocating that beginning in 2010, payments for primary care physician services should increase by at least 10 percent more than payments made to non-primary care physicians, with an additional 5 percent increase each year for the subsequent four years. Currently, the options paper recommends a Medicare bonus of at least 5 percent for primary care services over the next five years. The organizations have suggested that these payment increases be cumulative, permanent, and adjusted each year by the U.S. Department of Health and Human Services based on the initial market analysis and the effectiveness of payment increases on increasing the number of primary care physicians in the workforce. The AAFP also submitted a separate point-by-point response to the options paper, expressing concern over several issues, such as the absence of a plan to eliminate the sustainable growth rate formula and the switch from a fee-for-service payment model to a model based on accountable care organizations. For more information, visit https://www.aafp.org/news-now/government-medicine/20090520options-response.html.

TransforMED Evaluators Present Initial Lessons from Demonstration Project

An independent evaluation team under contract with the AAFP to analyze data from TransforMED's national demonstration project on the patient-centered medical home released a preliminary report in the May/June 2009 issue of Annals of Family Medicine. Coauthor Paul Nutting, MD, MSPH, director of research at the University of Colorado Health Sciences Center in Denver, said the goal of the preliminary report was to share some lessons regarding how practices make the transformation to a medical home. For example, the authors discovered that the transformation process may be more difficult and take longer than anticipated. Practices attempting to undergo massive changes within short time frames of six months to one year may be setting themselves up for failure. Other lessons outlined in the report address the significant process that practices must undertake to become a medical home. These include the challenges of implementing health information technology (HIT), requiring physicians to make personal adjustments to their leadership styles, and handling change fatigue. In the report, the authors also encouraged the National Committee for Quality Assurance to modify its medical home recognition requirements to make it easier for practices to complete the process. For more information, visit https://www.aafp.org/news-now/practice-management/20090513t-medeval.html or the Annals of Family Medicine Web site at http://www.annfammed.org/cgi/content/full/7/3/254.

Stakeholders Pledge to Help Reduce Health Care Spending, Improve Quality of Care

A group of health care stakeholders recently sent a letter to President Obama pledging to help achieve the administration's goal of decreasing the annual health care spending growth rate by 1.5 percentage points during the next 10 years. This would represent a 20 percent reduction in the projected rate of growth, and result in a savings of at least $2 trillion. The group, which represents physicians, health care workers, payers, suppliers, manufacturers, and organized labor, plans to implement several measures to save costs and improve the quality of care. The four consensus proposals include focusing on administrative simplification, standardization, and transparency; aligning quality and efficiency incentives; coordinating care in the public and private sectors, and encouraging adherence to evidence-based practices; and reducing costs through improvements in health care delivery, HIT, and workforce deployment. During a White House press conference on May 11, 2009, President Obama indicated that the stakeholders' efforts represent an important step toward health care reform. For more information, visit https://www.aafp.org/news-now/government-medicine/20090514stkhldrs-savngs.html.

FDA Issues Rule Requiring Warning Labels on OTC Pain Relievers and Fever Reducers

The U.S. Food and Drug Administration (FDA) has issued a final rule in the April 29, 2009, Federal Register that requires manufacturers of over-the-counter (OTC) pain relievers and fever reducers to include organ-specific warnings about potential safety risks on medication labels. The new labeling requirements will take effect within one year, and are designed to inform consumers about the risk of severe liver damage when using acetaminophen and the risk of stomach bleeding when using nonsteroidal anti-inflammatory drugs. Manufacturers also must ensure that the active ingredients of the medications are displayed prominently on labels that appear on the packaging and individual medication bottles. According to the FDA, accidental overdose of acetaminophen is associated with thousands of emergency department visits and hospital admissions, and an estimated 100 deaths each year. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20090512fda-label-chngs.html.

Incentive Payments for Implementing HIT Hinge on Definition of ‘Meaningful Use’

The AAFP has joined more than 70 organizations in signing a consensus statement addressing how to meet the HIT objectives outlined in the American Recovery and Reinvestment Act (ARRA) of 2009. Drafted by the Markle Foundation's Connecting for Health collaborative, the statement outlines seven key principles related to investments made in HIT and attempts to clarify what ARRA labels “meaningful use” of HIT. Physicians and health care institutions will use the finalized definition to qualify for HIT funding. Steven Waldren, MD, director of the AAFP's Center for HIT, said the definition of meaningful use will likely expand over time to encompass more ambitious health improvements. However, he hopes that any potential changes will not alter the criteria in a way that makes previously eligible physicians ineligible for incentive payments. For more information, visit https://www.aafp.org/news-now/government-medicine/20090513meaningfulehr.html or the consensus statement at http://www.markle.org/downloadable_assets/20090430_meaningful_use.pdf.

Report Shows Government Incentives for EHR Systems May Not Cover Costs

A recent report from the PricewaterhouseCoopers Health Research Institute indicates that government incentives for physician practices and hospitals to implement electronic health record (EHR) systems will fall significantly short of covering the costs. Although the ARRA legislation makes up to $44,000 available to physician practices that implement a government-certified EHR system, the report estimates that a three-physician practice could spend from $173,750 to $296,000 on an EHR package that includes software, implementation, training, and software maintenance. However, choosing not to implement an EHR system could also prove costly. Beginning in 2017, the government will reduce Medicare payments to noncompliant physicians by 1 percent per year for up to five years. Hospitals could see even larger reductions for failing to implement an EHR system. For more information, visit https://www.aafp.org/news-now/practice-management/20090513pricewater-rpt.html.

Osteopathic Schools Play Important Role in Bolstering Primary Care Workforce

Enrollment at the 25 member colleges of the American Association of Colleges of Osteopathic Medicine has been growing steadily over the past several years. The first-time enrollment among osteopathic medical students in 2008 reached 4,768, which was an increase of about 8 percent from 2007. Osteopathic medical colleges continue to attract students who choose a career in primary care. According to the 2008 National Resident Matching Program, more than 55 percent of osteopathic medical students chose a residency in family medicine, internal medicine, or pediatrics, compared with 45 percent of all program participants. Perry Pugno, MD, MPH, director of the AAFP Division of Medical Education, believes osteopathic schools play an important part in the primary care workforce. Faculty at osteopathic medical colleges who serve on admissions committees often seek students with characteristics that make them more likely to choose a primary care specialty. For more information, visit https://www.aafp.org/news-now/professional-issues/20090519dos-primcare.html.

— AFP and AAFP NEWS NOW staff