Manufacturers Move Forward with Development of H1N1 Virus Vaccine

The Centers for Disease Control and Prevention (CDC) continues to move forward with the development of a vaccine against the influenza A (H1N1) virus. According to Anne Schuchat, MD, interim deputy director for the CDC's Science and Public Health Program, the CDC has shipped the seed virus to several U.S. vaccine manufacturers. Schuchat indicated that upcoming clinical trials, which could begin as early as August 2009, will be vital to determine the safety and effectiveness of the vaccine. Clinical trials will also assess the number of doses needed to achieve immunity, the variations in immune response among different age groups, and whether an adjuvant is required for a satisfactory response. It will likely be late summer or early fall of this year before the CDC decides whether to recommend a national immunization program against the H1N1 virus. Schuchat said the vaccine is not expected to be available outside of clinical trials before October 2009. The CDC may move up the start of seasonal flu vaccinations to allow time for H1N1 vaccinations. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090529h1n1-vacc.html.

Obama Administration, Physician Groups Propose Medicare Payment System Reform

The Obama administration has released details of a fiscal year 2010 budget proposal that calls for reforming the current Medicare payment system by aligning payment incentives with improvements in quality and efficiency. The administration estimates it would cost $311 billion to prevent physician payment cuts that are called for under the sustainable growth rate (SGR) formula and to keep physician payments level during the next 10 years. To help compensate, the budget would increase funding for a Medicare Integrity Program to help fight fraud and abuse. U.S. Department of Health and Human Services Secretary Kathleen Sebelius estimates that targeting fraud and abuse could save $2.7 billion over the next five years. Meanwhile, the American Academy of Family Physicians (AAFP), the American Medical Association, and nearly 60 other physician-led organizations have signed a joint recommendation document asking Congress and the administration to replace the SGR formula this year with an updated payment system that reflects increases in practice costs. The groups also recommend adopting a transitional approach to replacing the SGR to ensure that the new payment system is completed by 2015. For more information, visit https://www.aafp.org/news-now/government-medicine/20090527hhs-budget-sebelius.html or https://www.aafp.org/news-now/government-medicine/20090605sgr-fix-call.html.

Study Reveals Annual Costs of Contracting with Patients' Health Insurance Plans

The annual cost of administrative tasks associated with patients' health insurance plans is estimated to be between $23 and $31 billion, according to a study published May 14, 2009, on the Health Affairs Web site. Researchers for the study, “What Does It Cost Physician Practices to Interact with Health Insurance Plans?,” based their results on responses from 1,310 physicians, including 730 primary care physicians and 580 other physician subspecialists. Physicians reported spending an average of three hours a week on tasks related to health insurance, such as pharmaceutical formularies, prior authorizations, claims and billing, credentialing, and contracting. The study authors concluded that the estimated $31 billion is equal to almost 7 percent of all U.S. expenditures for physician and clinical services. According to the study, primary care physicians spend $47,707 per year on health plan administrative costs, which is nearly one third of the average income plus benefits for a primary care physician. Physicians in primary care also spend more hours per week working with formularies and prior authorizations than other subspecialists. For more information, visit https://www.aafp.org/news-now/practice-management/20090602admin-costs-study.html or the Health Affairs Web site at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w533.

NHSC Begins Loan Repayment Program for Physicians Who Serve at Eligible Sites

As of June 2, 2009, family physicians are now able to receive assistance in paying back their educational loans through the National Health Service Corps (NHSC) Loan Repayment Program. Of the $300 million allocated to the NHSC under the American Recovery and Reinvestment Act of 2009, about $200 million is slated to go to the program. In exchange for two years of service at an eligible site in a federally designated health professional shortage area, the program offers repayment of qualifying educational loans of up to $50,000 for primary care physicians, including allopathic or osteopathic physicians, who provide full-time clinical services. Physicians who stay longer may be eligible to apply for additional years of support. The NHSC loan repayment awards will be available on a first-come, first-served basis through September 2010, or until the funds are expended. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20090602nhsc-funds.html or the NHSC Web site at http://nhsc.hrsa.gov/loanrepayment/.

Med Watch: FDA Issues Warning on Risks of Thyroid Drug Propylthiouracil

The U.S. Food and Drug Administration (FDA) has issued a warning about the risks of liver injury, including liver failure and death, associated with the use of propylthiouracil. The medication is used to treat hyperthyroidism from Graves disease in certain patients. Physicians should instruct patients to alert them if they experience any of the following symptoms: fatigue, weakness, vague abdominal pain, loss of appetite, itching, easy bruising, or yellowing of the eyes or skin. If liver injury is suspected, propylthiouracil therapy should be discontinued and the patient should be evaluated for evidence of liver injury. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090605fda-ptu-warn.html or the FDA Web site at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm164207.htm.

AAFP Creates Online Collection of Patient-Centered Medical Home Resources

The AAFP has developed a new collection of Web pages focused on the patient-centered medical home. The Web pages include a variety of tools to help physicians make the transition to a medical home. Physicians can choose to explore resources in four areas: practice organization, health information technology, quality measures, and patient experience. Physicians may also download a checklist to monitor their progress. For more information, visit https://www.aafp.org/news-now/practice-management/20090601new-pcmh.html or the AAFP's Web site at https://www.aafp.org/online/en/home/membership/initiatives/pcmh.html.

Report Shows High Costs, Uncertain Effects of Proposed Limits to Resident Work Hours

New recommendations from the Institute of Medicine to further limit the work hours of medical residents would cost U.S. teaching facilities about $1.6 billion a year to hire additional personnel, according to a report from the RAND Corp. and the University of California, Los Angeles. The report, “Cost Implications of Reduced Work Hours and Workloads for Resident Physicians,” appears in the May 21, 2009, issue of the New England Journal of Medicine. Although the intent of the proposed work hour limits is to reduce fatigue-related medical errors by resident physicians, the report found that the effects of such limits were uncertain. One study of shorter work shifts suggested a 25 percent decrease in serious errors might be plausible in hospital intensive care units; however, few errors cause patient injuries, and the effects of making such work hour changes could differ in other clinical settings. According to the report, additional patient hand-offs could increase the number of preventable adverse outcomes. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20090527rand-hours-study.html or the New England Journal of Medicine Web site at http://content.nejm.org/cgi/content/short/360/21/2202.

Percentage of Prenatal Care Visits to Family Physicians Falls in Rural Areas

A study in the March/April 2009 issue of the Annals of Family Medicine reports that the percentage of prenatal care provided by family physicians is falling dramatically in rural areas. The study, “Declining Trends in the Provision of Prenatal Care Visits by Family Physicians,” was based on 1995–2004 data gathered as part of the ongoing National Ambulatory Medical Care Survey. Of 244.5 million prenatal visits made between 1995 and 2004, the percentage of prenatal visits provided by family physicians decreased from 11.6 to 6.1 percent. The percentage of such visits to family physicians in rural areas fell from 38.6 to 12.9 percent during that period. The study authors believe closure of some rural hospital maternity wards and insurance issues are two possible factors in this decline. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090529annals-prenatal.html or the Annals of Family Medicine Web site at http://www.annfammed.org/cgi/content/full/7/2/128.

AAFP to Discontinue Award of Double Credit for Evidenced-Based CME in 2011

The AAFP will stop awarding double credit for its evidence-based continuing medical education (EB CME) on January 1, 2011. Although eligible activities will no longer receive two-for-one credit after this date, members can still report two-for-one credit for EB CME activities that were accredited before that date. The policy change to phase out the double credit for EB CME was recommended by the AAFP Commission on Continuing Professional Development, and approved by the AAFP Board of Directors on April 20, 2009. For more information, visit https://www.aafp.org/news-now/cme-lifelong-learning/20090515eb-cme-sunset.html.

— AFPandAAFP NEWS NOWstaff