Study Examines Reasons Behind Low Level of Student Interest in Family Medicine

Family medicine will continue to face numerous challenges in the next generation, according to an article in the September 2009 issue of Family Medicine. The study examines the 2009 residency match and the low level of interest in family medicine. To prepare for the next generation of care, the article outlines several recommendations for family medicine, including improving public perception of the specialty, reorganizing family medicine practices, improving the treatment of family medicine in academia, and enhancing the remuneration of family physicians. According to the article, 75 fewer positions in family medicine residency programs were filled through the 2009 National Resident Matching Program than in 2008. Additionally, 89 fewer U.S. medical school seniors filled family medicine residency slots in 2009 than in 2008. Specific factors that may dissuade medical students from choosing family medicine are medical school debt and medical school infrastructure, which includes the absence of a family medicine department, a low proportion of family physician faculty, and the lack of clinical clerkships in family medicine. The study authors recommend evaluating family medicine residency programs and looking for more innovative initiatives to boost student interest. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20090902nrmp-report.html or http://www.stfm.org/fmhub/fm2009/September/Perry567.pdf.

Clinical Trials of H1N1 Vaccine in Adults Demonstrate No Serious Adverse Events

No serious adverse events were reported in the first two weeks of clinical trials involving the novel influenza A (H1N1) virus vaccine in adults, according to federal officials. Although some patients experienced swelling and pain at the injection site, officials said these reactions occur with most vaccines. Clinical trials in adults and older persons began August 7, 2009, and will determine whether the vaccine should contain 15 or 30 mg of antigen, and whether one or two doses are needed to provide adequate protection. Additionally, the trials will determine whether the H1N1 vaccine should be given before, after, or at the same time as the seasonal influenza vaccine. Clinical trials in children six months to 17 years of age also began in August, and trials in pregnant women began in September. The Centers for Disease Control and Prevention (CDC) estimates that more than 1 million Americans have been infected with the H1N1 virus. As of August 21, 2009, nearly 8,000 laboratory-confirmed hospitalizations and 522 deaths had been reported in the United States. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090826h1n1vacc-trials.html.

MGMA Survey Results Reveal Top Concerns of Medical Practice Managers in 2009

Medical practice managers reported their top concerns in the Medical Group Management Association's (MGMA's) 2009 survey of professional administrators and leaders of group practices. According to survey results, the most challenging concerns of running a medical practice include managing operating costs that are rising faster than revenues; maintaining physician compensation levels; selecting and implementing an electronic health record (EHR) system; collecting from patients who self-pay or who have a high-deductible health plan or health savings account; and managing finances with uncertain Medicare reimbursement rates. The standout change from the previous year's survey was patient collection concerns, which gained 10 percentage points and rose from the No. 9 ranking in 2008 to the No. 4 spot in 2009. Respondents reported that several aspects of running a medical practice were no challenge or a low challenge, such as designing and implementing a practice Web site, collecting payment from Medicare, implementing policies to improve patient safety, managing the hospital physician credentialing process, and modifying contracts to comply with Stark law regulations. For more information, visit https://www.aafp.org/news-now/practice-management/20090909mgma-surv.html or the MGMA Web site at http://www.mgma.com/medpracticetoday.

Organizations Reinforce Safety of HPV Vaccine, Approve New Hib Vaccine Booster

After reviewing more than 12,000 adverse events reported following the administration of the quadrivalent human papillomavirus (HPV) vaccine (Gardasil), the U.S. Food and Drug Administration (FDA) and the CDC have concluded that the vaccine is safe and effective. The findings were reported in the August 19, 2009, issue of the Journal of the American Medical Association. Researchers reviewed all 12,424 reports of adverse effects made to the CDC/FDA Vaccine Adverse Event Reporting System from June 2006 to December 2008, and found that the adverse event rates were similar to other vaccines. However, there was a disproportional reporting of syncope (8.2 per 100,000 doses) and blood clots (0.2 per 100,000 doses) compared with other vaccines. In other vaccine news, the U.S. supply of Haemophilus influenzae type b (Hib) vaccine should see an upsurge after the FDA's recent approval of Hiberix as a booster dose for children 15 months to four years of age. A nationwide Hib vaccine shortage began in 2007 after Merck recalled a dozen lots of Hib-containing vaccines and subsequently suspended production of the vaccines. On June 25, 2009, the CDC recommended that physicians reinstate the Hib booster dose for children 12 to 15 months of age who have completed the three-dose primary series. A booster dose also should be given to children up to 59 months of age in whom the booster was deferred because of the shortage. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20090902gardasil-jama.html or https://www.aafp.org/news-now/clinical-care-research/20090826hiberix.html.

Health Information Exchanges Allow Physicians to Share Patient Data

Health information exchanges are gaining ground across the United States as a way to move health information electronically among physicians. The exchanges generally operate within a region or community. Physicians do not need a full-fledged EHR system to exchange patient information with other health care stakeholders. According to the eHealth Initiative, a nonprofit organization that works to improve health care through technology, more than 200 health information exchanges are currently in operation around the country in various stages of development. A recent survey of operational health exchanges conducted by eHealth Initiative showed that exchanges improved practices' access to test results; reduced hassles in locating information; and reduced staff time spent handling laboratory results, radiology reports, and clerical tasks. For more information, visit https://www.aafp.org/news-now/practice-management/20090826info-xchanges.html.

New Online Registry Tool Helps Physicians Report Patient Data Under PQRI Program

Members of the American Academy of Family Physicians (AAFP) can now download an online resource to help track patient data for Medicare's 2009 Physician Quality Reporting Initiative (PQRI). The PQRIwizard registry, which is approved by the Centers for Medicare and Medicaid Services, is available to AAFP members for $199. The registry involves a four-step process that requires physicians to launch the program, create a personal registry, complete one short form per patient to input data, and submit the report. According to Bruce Bagley, MD, AAFP medical director of quality improvement, family physicians who participate in the PQRI program can receive bonus payments of $600 to $2,000, depending on their Medicare population. To estimate their potential PQRI bonus, physicians can multiply their 2008 Medicare revenue by 2 percent. The deadline for 2009 PQRI submissions is February 26, 2010. For more information, visit https://www.aafp.org/news-now/practice-management/20090902pqri-tool.html or https://aafp.pqriwizard.com/default.aspx.

Health Insurer Changes Policy for Same-Day Preventive and Problem-Oriented Services

Beginning October 27, 2009, Humana will pay for a problem-oriented evaluation and management service and a preventive service performed on the same day only if modifier 25 is documented on the claims form. Physicians who contract with Humana should have received a letter from the company outlining these coding changes. According to Laura Schmidt, a private sector advocacy specialist for the AAFP, Humana will continue to pay physicians at 100 percent for both codes if modifier 25 is appended to the evaluation and management code. Additional information on the policies of other major health insurance companies is available on payer Web sites. For more information, visit https://www.aafp.org/news-now/practice-management/20090908mod-25.html.

HITECH Priority Grant Programs Provide $1.2 Billion to Spur EHR Adoption

Nearly $1.2 billion soon will be available to help U.S. hospitals, physicians, and other health care professionals purchase and use EHR systems, according to a recent announcement from Vice President Joe Biden. Money from the Health Information Technology for Economic and Clinical Health (HITECH) Act priority grant programs, which are funded by the American Recovery and Reinvestment Act of 2009, will become available in 2010. The money will be divided between the Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program. The former will allow about 70 health information technology regional extension centers to offer technical assistance and guidance to support health care professionals using EHR systems. The latter will help states and other entities establish health information exchange capacity among hospitals and health care professionals. For more information, visit https://www.aafp.org/news-now/practice-management/20090826hitech-grants.html.

— AFP and AAFP NEWS NOW staff