Policy and Health Issues in the News
Am Fam Physician. 2007 Feb 1;75(3):299-300.
Coalition Urges Congress to Enact Health System Reform
A group of 10 primary care and subspecialist medical associations led by the American Academy of Family Physicians has called on Congress to implement comprehensive health system reform that abides by 11 principles, including medical liability reform, access to health care, and management of health care costs. According to the principles, health care coverage for all is needed to ensure quality of care and to improve the health status of Americans. The principles also address the issues of unreasonable financial barriers to care, catastrophic health coverage, improvement of health care quality and safety, administrative systems, research funding, and funding for public health and other essential medical services. For more information, visithttp://www.aafp.org/news-now/government-medicine/20070111reformprinciples.html.
New Law Encourages Use of Health Savings Accounts
More patients may enroll in health plans that carry a high deductible as a result of legislation signed by President Bush in December. The legislation encourages enrollment in consumer-driven health plans by allowing Americans to invest up to $5,650 tax free in health savings accounts (HSAs). Employees can also make a one-time, tax-free transfer to their HSAs from a flexible spending account, a health reimbursement account, or an individual retirement account. Patients use funds from the HSAs to pay their health plan deductibles and other health care costs until their insurance plan coverage begins. For more information, visithttp://www.aafp.org/news-now/government-medicine/20070104hdhplaw.html.
Universal Health Proposal Emphasizes Primary Care, Medical Homes
A proposal for universal health care coverage authored by Sen. Ron Wyden (D-Ore.) rests on a more prominent role for primary care, increased use of personal medical homes, and greater patient involvement in choice of health plans. The Healthy Americans Act contains provisions that would place the responsibility for health insurance purchase on individuals and establish school-based primary care health centers. State-established Health Help Agencies would educate residents about their options for private health plans, as well as administering enrollment and assisting eligible enrollees with sliding-scale premium reductions. Primary care for Medicare patients would be promoted through a primary care management fee for physicians designated as a beneficiary's medical home. Medicare also would be required by 2008 to offer a chronic disease management program with payments for physicians who treat patients with any of the five most prevalent chronic diseases. For more information, visithttp://www.aafp.org/news-now/government-medicine/20061222wydenbill.html.
States Increase Health Care Access for Low-Income Children and Parents
A new study from the Kaiser Commission on Medicaid and the Uninsured shows that as states improve their financial situations they are moving forward with efforts to ensure that low-income, uninsured children and their parents receive health care coverage. Seventeen states increased access to health coverage between July 2005 and July 2006, and several states are working on plans to provide health coverage for all children. In addition, some states are removing paperwork and procedural barriers to attaining coverage. For the first time in four years, no states cut income eligibility in Medicaid or the State Children's Health Insurance Program. However, the study notes that new federal regulations requiring U.S. citizens to present proof of citizenship and identity when they apply for or try to renew their Medicaid coverage may slow states' progress in ensuring that children, in particular, are covered. For more information, visithttp://www.kff.org/medicaid/kcmu010907pkg.cfm.
Study Shows Increase in Quality-Based Physician Payment Programs
Physician compensation programs based on quality are increasing, but productivity incentives still dominate, a national study concluded. Released in January by the Center for Studying Health System Change, the study evaluated responses from more than 6,600 physicians surveyed in 2004 and 2005 and about 12,000 physicians surveyed since 1996. About 70 percent of physicians in 2004 to 2005 reported compensation based on individual productivity, and about 20 percent reported compensation based on quality measures—up from 18 percent in 2000 to 2001. Quality was a compensation factor in the practices of about 28 percent of primary care physicians—including more than 30 percent of family physicians and internists—compared with about 13 percent of surgical specialists. The authors note that established quality indicators are more common in primary care and for treatment of chronic conditions. Quality-based compensation was also more common in large group practices that receive a high portion of revenue from capitated payments. For more information, visithttp://www.hschange.org/CONTENT/905/ orhttp://www.aafp.org/news-now/practice-management/20070110hscstudy.html.
Increase in Health Care Spending Growth Slows for Third Consecutive Year
Government programs financed 40 percent of all health care services and supplies in 2005, according to a Centers for Medicare and Medicaid (CMS) report in the January/February issue of Health Affairs. The data were part of a comprehensive review of health care spending, which showed the rate of health spending growth slowed for the third consecutive year in 2005. Public sector health spending increased 7.7 percent in 2005, down slightly from the 7.8 percent growth in 2004. Of that increase, Medicare spending grew 9.3 percent. Medicare spending for physician and clinical services also showed strong, though somewhat slower, growth in 2005, according to CMS. Reflecting recovery from the 2001 recession, the rate of spending increases for Medicaid declined for the fourth consecutive year, growing by 7.2 percent in 2005. In the private sector, spending slowed to a 6.3 percent increase. Private health insurance premium growth slowed in 2005 to 6.6 percent, compared with 7.9 percent in 2004. However, out-of-pocket expenses for patients grew as employer-sponsored plans restrained insurance costs by implementing coinsurance, deductibles, and constraints on covered medications or treatments, the study said. For more information, visithttp://content.healthaffairs.org/cgi/content/abstract/26/1/142.
Poll Shows Americans Underestimate Obesity Problem
Many Americans are unaware that they are overweight or obese, according to a recently released Gallup survey, and those who acknowledge their weight problems are often unwilling to change. Responders to the survey reported their approximate weight and height, which was used to calculate their body mass index (BMI). According to the responses, 20 percent of Americans are obese (BMI 30 kg per m2 or higher), 38 percent are overweight (BMI 25 to 29), 31 percent are normal weight (BMI 18.5 to 24), and 6 percent are under-weight (BMI less than 18.5). However, these figures differ from objective findings released by the Centers for Disease Control and Prevention (CDC). According to the latest CDC figures, about 35 percent of Americans are overweight and 30 percent are obese. The discrepancy between the figures shows that Americans may be underestimating their own weight and therefore down-playing the problem of obesity, the authors suggest. For more information, visithttp://www.aafp.org/news-now/health-of-the-public/20061221obeseandunaware.html.
CMS Urges Health Care Providers to Get NPI Numbers Now
On May 23, 2007, health care providers must begin using the National Provider Identifier (NPI), instituted as part of the Health Insurance Portability and Accountability Act of 1996. The CMS, which is administering the NPI program, is urging health care providers to get their numbers in advance of the deadline. The NPI is a unique, 10-digit numeric identifier that does not expire or change. According to CMS, use of the NPI will benefit physicians by helping ensure that medical claims are processed on time and payments are made correctly. After the NPI is fully implemented, physicians will no longer need different identifying numbers when filing claims with various health plans. For more information, visithttp://www.cms.hhs.gov/NationalProvIdentStand/.
Study Suggests Racial Disparities in HIV/STD Risk Not Linked to Behavior
Young black adults are at increased risk of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) even when their level of risky behavior is relatively low, according to a study published in the American Journal of Public Health. The authors state that factors other than individual behavior appear to account for racial disparities in the risk of STDs and HIV infection. Participants in the study were divided into 15 behavior pattern groups ranging from low risk (e.g., few sexual partners; limited alcohol, tobacco or drug use) to high risk (e.g., intravenous drug use, exchanging sex for money, men having sex with men, using marijuana and other illicit drugs). Prevalence of STDs and HIV infection was higher among blacks in all 15 groups, whereas in a test group of white adults, high prevalence of HIV infection and STDs occurred only among participants with the four highest risk behavior patterns. The authors recommend continuing prevention strategies aimed at all young black adults, including universal screening and provision of treatment and testing in nontraditional venues. For more information, visithttp://www.nida.nih.gov/newsroom/06/NR12-5.html orhttp://www.aafp.org/news-now/clinical-care-research/20070104hivstdrisk.html.
—AFP and AAFP News Now staff
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Copyright © 2007 by the American Academy of Family Physicians.
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