CMS Proposes Rule to Adjust Fee Schedule, Increase Payments for Primary Care

Family physicians could see a Medicare payment increase of 8 percent in 2010, pending approval of a proposed rule from the Centers for Medicare and Medicaid Services (CMS). Under the rule, CMS would adjust the relative values of several Current Procedural Terminology (CPT) codes, which determine the level of payment physicians receive for providing medical, surgical, and diagnostic services. CMS has suggested ceasing payments for most consultation codes and using the savings to increase payments for evaluation and management codes. Additionally, the agency would use more recent data to calculate practice expense relative values, which would lead to higher payments for primary care services. The proposed rule also would eliminate physician-administered drugs from the sustainable growth rate formula. This would make it less expensive to permanently fix the current formula, and create a long-term solution to Medicare physician payment problems. The CMS proposal was published in the July 13, 2009, Federal Register. The final rule is expected to be published on November 1, 2009, and would take effect on January 1, 2010. For more information, visit https://www.aafp.org/news-now/government-medicine/20090708cms-cpt-rule.html.

ACIP Members Express Preference for Combination vs. Component Vaccines

The Center for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) produced several provisional recommendations during a recent meeting. If adopted, final recommendations will appear in future issues of Morbidity and Mortality Weekly Report. Committee members approved a recommendation stating that combination vaccines are generally preferred over separate injections of equivalent component vaccines. However, physicians should also consider patient preference, the potential for adverse events, vaccine storage costs and availability, and the likelihood of patient compliance. The committee made one exception regarding the combined measles, mumps, rubella, and varicella (MMRV) vaccine. Compared with a separate varicella vaccine, the MMRV vaccine has been associated with one more febrile seizure per 2,000 children immunized. Because of this, committee members said children one to three years of age may receive the MMRV vaccine or the MMR vaccine plus a separate varicella vaccine. The committee also voted on vaccine recommendations for postexposure rabies, meningitis, polio, and Japanese encephalitis; and received a briefing on a 13-valent pneumococcal vaccine for children. The new vaccine, which is expected to be licensed by the U.S. Food and Drug Administration, will cover six more serotypes than the current recommended vaccine. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090708acip-rndup.html.

House Testimony Underscores Importance of Primary Care in Health Reform

Any potential health reform legislation must emphasize the critical role primary care plays in the U.S. health care system, according to American Academy of Family Physicians (AAFP) President Ted Epperly, MD, of Boise, Idaho. During separate testimonies before the House Ways and Means Committee and a House Energy and Commerce health care subcommittee, Epperly described the importance of primary care in providing long-term, high-quality, cost-effective care for the whole person. Epperly also praised the House's recent draft of a health care reform bill that includes a 5 percent bonus for primary care services and as much as a 10 percent bonus for primary care services provided in a health professional shortage area. To qualify for the bonus, at least 50 percent of a physician's services must be primary care. Epperly estimates that 68 percent of family physicians would qualify. He also recommended that Congress grant “deemed status” to subspecialties that are, by definition, primary care. This would ensure that only physicians who provide coordinated and comprehensive care receive the bonus. For more information, visit https://www.aafp.org/news-now/government-medicine/20090702epperly-house-test.html.

IOM Publishes Report of Comparative Effectiveness Research Priorities

The Institute of Medicine (IOM) has published a report identifying 100 health-related topics that should receive attention from the recent federal investment in comparative effectiveness research. The report is intended to provide independent guidance to Congress and the secretary of the U.S. Department of Health and Human Services (HHS) on how to spend $400 million that is allotted for research under the American Recovery and Reinvestment Act. The 100 topics are divided into quartiles, which are presented in descending order of importance. The first quartile includes suggestions for care coordination programs, such as the patient-centered medical home and chronic disease management. According to the IOM, comparative effectiveness research weighs the benefits and harms of various ways to prevent, diagnose, treat, or monitor clinical conditions to determine which work best for patients in different settings and circumstances. For more information, visit https://www.aafp.org/news-now/government-medicine/20090707iom-cer-report.html or the IOM report at http://www.nephronline.com/uploaded/reports/cer%20priorities%20list.pdf.

Medical Societies Urge HHS to Include All Preventive Vaccines Under Medicare Part B

The AAFP has joined several medical subspecialty organizations in urging HHS to include all recommended preventive vaccines under Medicare Part B. Currently, some vaccines are only available through Medicare Part D, which is designed as a retail pharmacy benefit. This forces patients to purchase Part D vaccines in their physician's office, which is considered an out-of-network provider, and then file a claim for reimbursement from their Part D plan. Because of this inconvenience, some patients choose to purchase vaccines from an in-network pharmacy and bring the product to their physician's office for administration. This practice is considered dangerous because many vaccines must be frozen or refrigerated until just before use, and physicians cannot verify whether the vaccine has been stored properly. For more information, visit https://www.aafp.org/news-now/government-medicine/20090707vaccine-partb-consolidate.html.

AARP Tool Calculates Patients' Drug Costs, Provides List of Cheaper Medications

A new online tool from the AARP is available to help Medicare Part D beneficiaries avoid a gap in their prescription drug coverage. Known as the “doughnut hole,” the gap occurs after patients have exceeded their basic Medicare Part D coverage but before they reach the catastrophic coverage threshold. To use the calculator, patients provide their zip code, Medicare Part D plan, and current medications. First, the tool calculates patients' monthly out-of-pocket medication expenses to determine whether their prescription costs will push them into the coverage gap. The tool then searches online drug information databases and peer-reviewed journal articles to develop a list of what AARP calls lower-priced but therapeutically similar medications. Patients may print out personalized letters with the list of medications to discuss with their physicians. The AAFP's Practice Support Division has reviewed the tool and cautions physicians that the list of medications is based solely on economic reasons without consideration of the patient's medical history. For more information, visit https://www.aafp.org/news-now/practice-management/20090708donut-hole-tool.html or the AARP tool at http://doughnuthole.aarp.org/.

Payment Expert Links Medical Home to Lower Costs, Fewer Hospital Readmissions

Patient-centered medical homes should take responsibility for reducing hospital readmissions, according to Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality and Payment Reform. Speaking at a forum on payment reform sponsored by the Robert Wood Johnson Foundation, Miller said that improving the delivery of primary care services and reducing hospital readmissions will create a clear case for funding the medical home model. Miller explained that the majority of preventable readmissions involve patients with chronic conditions, making chronic disease a major driver of health care costs. He pointed to studies showing that simple interventions in the medical home model, such as patient education, self-management support, and immunizations, can lead to reductions in admissions and readmissions. Miller also addressed the need for a physician payment model that provides incentives for controlling health care costs. For more information, visit https://www.aafp.org/news-now/practice-management/20090624miller-forum.html.

AMA Delegates Reject Call for More Research on Vaccines and Autism

The American Medical Association (AMA) House of Delegates recently rejected a proposal to review the most recent research on vaccines and autism. The proposal was included in a resolution submitted by the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association, and the American Academy of Psychiatry and the Law. In its concluding report, the AMA reference committee asserted that the relationship between vaccines and autism has already been studied extensively, and there is sufficient research demonstrating that the two are not linked. The resolution also recommended that the AMA reaffirm its support for universal vaccination and continue to support research into the etiology and treatment of autism. Delegates overwhelmingly agreed to accept these resolves. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20090626ama-vaccines.html.

— AFP and AAFP NEWS NOW staff