Policy and Health Issues in the News
Am Fam Physician. 2007 May 15;75(10):1435-1436.
GAO Report Demonstrates Potential Cost Benefits of Physician Profiling
Federal officials could use physician profiling (using performance and efficiency measures to evaluate physicians) as one part of an overall strategy to contain Medicare costs, according to a federal report. The Government Accountability Office (GAO) studied the physician profiling programs of 10 health care purchasers. It then conducted an analysis of the Medicare treatment patterns of generalist physicians in 12 metropolitan areas, defining “efficiency” as providing and ordering services sufficient to meet patients' needs but not excessive for their health statuses. It found that physicians who were likely to practice medicine inefficiently were present in all 12 areas, and that profiling could generate savings for health care purchasers. According to the health care team director, Bruce Steinwald, the study may lead to discussion on Capitol Hill and within the Centers for Medicare and Medicaid Services (CMS) about the potential of physician profiling as a cost-containment strategy that has clear advantages over the sustainable growth rate, which currently determines physician payment rates under Medicare. It also could influence debate about the future of the sustainable growth rate. Steinwald presented preliminary findings from the report to the House Committee on Energy and Commerce's Health Subcommittee in March. The GAO submitted a draft of the report to CMS for comments to be addressed in the final document. For more information, visithttp://www.aafp.org/news-now/government-medicine/20070420gaophysicianprofiling.html, orhttp://www.gao.gov/new.items/d07567t.pdf.
Congress Requests Study of Resident Duty Hours and Patient Safety
Congress has requested that the Agency for Healthcare Research and Quality (AHRQ) fund an Institute of Medicine study into the issue of medical resident duty hours. A letter from House Energy and Commerce Committee Chair John Dingell (D-Mich.) and other committee members asked the AHRQ to determine whether the long work hours of physicians and medical residents are among the most serious threats posed to patient safety. The letter cites a December 2006 study, “Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attention Failures,” that concludes work shifts extending beyond 16 hours can increase the number of medical errors. In response to research demonstrating a causal link between resident fatigue resulting from long work shifts and the risk of medical errors, the Accreditation Council for Graduate Medical Education implemented new rules in 2003 stipulating that, averaged over a four-week period, residents cannot be scheduled for more than 80 hours per week; one day in seven must be free of patient care responsibilities; and in-house calls can be scheduled no more often than every third night. For more information, visithttp://www.aafp.org/news-now/resident-student-focus/20070418dutyhoursstudy.html.
AAFP Calls for Federal Funding Increases for Key Programs in 2008
The American Academy of Family Physicians (AAFP) has asked Congress to increase funding levels in the fiscal year 2008 budget for three health-related programs that it says are key to enhancing access to care, decreasing costs, and improving the overall quality of health care. In written testimony to the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, AAFP President Rick Kellerman, MD (Wichita, Kan.), urged Congress to increase funding for health professions training programs, rural health programs, and the AHRQ. In his 2008 budget, President Bush called for cuts to the health professions training programs authorized under Title VII of the Public Health Services Act. The AAFP asked Congress to reject that request and provide at least $300 million in funding for Title VII in 2008, including $92 million for Section 747, the Primary Care Medicine and Dentistry Cluster, to restore the program to its fiscal year 2003 level. In addition, the AAFP asked the subcommittee to approve a $350 million budget for AHRQ in 2008, an increase of $31 million above current funding levels. For more information, visithttp://www.aafp.org/news-now/government-medicine/20070409fundingincreases.html.
Universal Credentialing Form Adopted in Seven States
Kansas has become the seventh state to require health insurance companies, hospitals, and other credentialing organizations to accept a standard physician credentialing form developed by the Council for Affordable Quality Healthcare (CAQH), a nonprofit collaborative of health plans. The CAQH's mission is to improve health care access and quality and to reduce administrative requirements for physicians and other health care institutions. The organization has created the CAQH Provider Credentialing Application, a universal form that physicians can use for all health plans or hospital credentialing requests, and is urging all state insurance officials to adopt it. Rhode Island, Indiana, Vermont, Kentucky, Tennessee, Louisiana, and the District of Columbia have already designated or mandated use of the form. For more information, visithttp://www.aafp.org/news-now/practice-management/20070420credentialingform.html, orhttp://caqh.org/credapp.
Study Finds Juries Favor Physicians over Patients in Liability Litigation
Juries seem to have more sympathy for physicians than they do for patients who allege medical malpractice and likely will rule in the physician's favor in any given case, particularly when the evidence is weak, according to a study in theMichigan Law Review. “Doctors and Juries” presents an analysis of medical liability lawsuits from 1989 to 2006. It reports that juries can identify weak allegations against physicians and that 80 to 90 percent of the time jurors make the same decisions that independent legal experts would have made. Expert witnesses are important, but juries find more merit in testimony by the physician's expert when the evidence conflicts with that presented by the plaintiff's expert, the study showed. The author notes that the findings seem to contradict assumptions made by lawmakers who introduce bills that would remove juries from medical liability litigation. For more information, visithttp://www.aafp.org/news-now/professional-issues/20070417malpracticestudy.html, orhttp://munews.missouri.edu/NewsBureauSingleNews.cfm?newsid=14425.
HealthLandscape Provides Residency Programs with Tool to Evaluate Value
The AAFP's Robert Graham Center, in combination with the University of Cincinnati and the Health Foundation of Greater Cincinnati, has developed HealthLandscape. org, a tool family medicine residency training programs can use to demonstrate their value to sponsoring hospitals, their communities, and their states. The Web site allows users to combine several types of demographic, economic, and other data to document and illustrate family medicine's contributions to improving community health, easing health care disparities, enhancing access to care, and reducing primary care shortages. The site is available to the general public, with additional features specifically for and limited to residency training program directors and constituent chapter executives. The tool allows residency programs to illustrate how they support the local medical community via referrals, limiting the impact on community private practice physicians from uninsured and underinsured patients, and raising the standard of care in sponsoring institutions. For more information, visithttp://www.aafp.org/news-now/resident-student-focus/20070411healthlandscape.html.
AAFP Enters into Partnership with Revolution Health Group
The AAFP is partnering with Revolution Health Group, an organization based in Washington, D.C., that has built a comprehensive online health and medical information Web site. Steve Case, a cofounder of America Online, launched Revolution Health in 2005 and serves as its chairman and chief executive officer. According to AAFP President Rick Kellerman, the partnership is an opportunity to use technology to help deliver the AAFP's message about the personal medical home to millions of consumers, especially as more patients turn to the Internet for health information. Currently, the AAFP is the only professional medical organization with which Revolution Health has entered into a partnership. For more information, visithttp://www.aafp.org/news-now/professional-issues/20070419revolutionhealth.html.
CDC Offers Free Brochure and Counseling Materials on HPV Vaccine
The Centers for Disease Control and Prevention (CDC) has updated its brochure “Human Papillomavirus: HPV Information for Clinicians” and released four sets of counseling messages to help family physicians discuss HPV with patients. The brochure and messages are intended to help physicians answer patients' and parents' questions about the HPV vaccine, which was approved last June for use in females age nine to 26 to prevent cervical cancer, precancerous genital lesions, and genital warts caused by four HPV types. The counseling messages address what patients should know if they are diagnosed with genital warts, what women should know before they get an HPV test, what women with a positive HPV test result should know, and what parents of preteens and adolescents should know about the HPV vaccine. The materials are available for download athttp://www.cdc.gov/hpv/vaccine.html. For more information, visithttp://www.aafp.org/news-now/clinical-care-research/20070417hpvbrochure.html.
—AFP and AAFP NEWS NOW staff
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Copyright © 2007 by the American Academy of Family Physicians.
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