Policy and Health Issues in the News
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Am Fam Physician. 2007 Sep 1;76(5):617-618.
Senate Finance Committee Passes SCHIP Reauthorization Bill
The Senate Finance Committee has approved a $35 billion expansion of the State Children's Health Insurance Program (SCHIP) as part of a five-year reauthorization bill that would bring an estimated 3.3 million more recipients into the SCHIP. The bipartisan Senate bill would increase SCHIP federal funding from $25 billion to $60 billion by 2012, raising program eligibility standards from 200 to 300 percent of the federal poverty level and providing coverage to approximately 10 million children. The bill would finance SCHIP expansion through a 61-cent-per-pack increase in tobacco taxes, raising the cigarette tax to $1 per pack. The program currently provides health care coverage for about 6 million low-income children and 600,000 adults who do not qualify for Medicaid but are unable to afford private insurance. It is set to expire on September 30 without congressional reauthorization. For more information, visit http://www.aafp.org/news-now/government-medicine/20070725senateschip.html.
CMS Alerts Physicians That Some Clearinghouses Are Removing NPIs
The Centers for Medicare and Medicaid Services (CMS) cautioned physicians who are Medicare providers and use clearinghouses to process their claims that some clearinghouses are stripping physicians' National Provider Identifier (NPI) numbers from claims before submitting them to Medicare. According to CMS, some clearinghouses have also taken the NPI out for Medicare processing then added it back in on the physician's remittance advice, giving the impression that claims have been submitted with the NPI number. CMS urged physicians to ask clearinghouses whether Medicare claims are being sent through with NPI numbers intact. Use of NPI numbers is voluntary but is tied to bonus payments under the voluntary Physician Quality Reporting Program. For more information, visit http://www.aafp.org/news-now/practice-management/20070807npiclearinghouse.html.
Health IT Legislation Passed by Senate Committee Prompts Objections
Legislation passed by the Senate Health, Education, Labor, and Pensions Committee would award grants to help health care providers purchase health information technology (IT) systems that would link to local or regional health information plans. If adopted, the Wired for Health Care Quality Act would require practices to submit an application and strategic plan, adopt federal government standards, implement quality measures as outlined in the legislation, demonstrate financial need, and provide matching funds. The American Academy of Family Physicians (AAFP) objected that the legislation emphasizes federal support for large entities and hospitals rather than the small and medium-sized practices where most health care interactions occur. In a letter to the sponsors of the bill, the AAFP said it is important to ensure physicians and patients in local community practices and clinics can access and share necessary information because more than 80 percent of health care is delivered in physicians' offices. For more information, visit http://www.aafp.org/news-now/government-medicine/20070724healthitbill.html.
Data Show Primary Care Residencies Provide Financial Benefit to Hospitals
Primary care residency programs attract tens of millions of dollars to teaching hospitals, bringing in more money per resident than subspecialty training programs, according to payment tables released by the Robert Graham Center in Washington, D.C. The tables list the amount of federal direct and indirect medical education funds that went to every teaching hospital for 2001 through 2005. They demonstrate that primary care residency programs often bring in huge amounts—in one case $152 million—to their sponsoring institutions. Robert Phillips, MD, MSPH, director of the Graham Center, noted that many residency programs do not know their institutions are receiving that amount of money for their residents. However, this information may help family medicine residency programs reinforce the message that primary care training provides financial benefits to sponsoring hospitals. For more information, visit http://www.aafp.org/news-now/resident-student-focus/20070726gmetables.html.
AAFP, Health Insurance Companies Discuss Policies Affecting FPs
Some of the nation's largest health insurance companies visited the AAFP this spring and summer to hear the Academy's viewpoint on insurer policies toward family physicians (FPs). Between April 30 and July 6, the Academy met with representatives from WellPoint Inc., United-Healthcare, Humana Inc., CIGNA HealthCare, and Aetna. Issues that were discussed during the meetings included payment for same-day preventive and acute care services; fair payment for the purchase and administration of vaccines; physician performance programs that use evidence-based quality performance measures identified by a consensus of national organizations; and the Academy's request that health plans institute patient co-payments for visits to retail health clinics. For more information, visit http://www.aafp.org/news-now/practice-management/20070723healthplanmeetings.html.
Researchers Find Medicare Costs Higher Among Previously Uninsured
Research published in the July 12 New England Journal of Medicine demonstrates a link between lack of health insurance at 51 to 61 years of age and higher medical expenditures when qualifying for Medicare at 65 years of age. Researchers found that when adults who were uninsured at age 51 to 61 years qualified for Medicare, their self-reported health care expenditures were 51 percent higher than those of persons who had been insured. When compared with their insured counterparts with similar health conditions, previously uninsured patients reported 13 percent more physician visits, 20 percent more hospitalizations, and 51 percent more medical expenses after they qualified for Medicare. Use of Medicare-funded health services for previously uninsured patients with cardiovascular disease or diabetes remained elevated through age 72, indicating an association between lack of insurance and persistent increases in health care needs. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20070726uninsuredmedicare.html, or http://content.nejm.org/cgi/content/short/357/2/143.
Study Shows U.S. Patients Have Lower Exposure to Primary Care
According to the findings of a study published in the June 16 British Medical Journal, Americans have less “face time” with their primary care physicians than do patients in Australia or New Zealand, which may have consequences for preventive care and management of chronic conditions. The study compared survey data from 2001 to 2002 for the three countries. It found that Americans spend an average of 29.7 minutes per year with a primary care physician, compared with 55.5 minutes for New Zealanders and 83.4 minutes for Australians. Although physicians in all three countries saw similar numbers of patients per day and managed similar numbers of health problems per patient visit, American primary care physicians spent an average of 10 percent longer in each patient visit. However, Americans pay fewer visits to their primary care physicians, which accounts for the lower overall exposure time. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20070801primcarefacetime.html, or http://www.bmj.com/cgi/content/full/334/7606/1261.
Studies Find EHR Use Alone Does Not Improve Health Care Quality
Two studies assessing the relationship between the use of electronic health records (EHRs) and the quality of health care delivered to patients concluded that the use of EHRs in an ambulatory care setting does not improve the quality of health care delivered to patients. The authors of “Electronic Health Record Use and the Quality of Ambulatory Care in the United States,” published in the July 9 Archives of Internal Medicine, found that on 14 of 17 patient-visit quality indicators there was no significant difference in performance between practices that used an EHR and those that did not. The authors of “Electronic Medical Records and Diabetes Quality of Care,” published in the May/June Annals of Family Medicine, concluded that the use of an EHR in primary care practices was insufficient to ensure the provision of high-quality care. Efforts to increase the use of EHRs should focus on improving technology and developing methods for implementing and integrating technology into practice, the authors said. For more information, visit http://www.aafp.org/news-now/practice-management/20070724ehrstudies.html, http://www.annfammed.org/cgi/content/full/5/3/209, or http://archinte.ama-assn.org/cgi/content/short/167/13/1400.
AAFP Updates Annual Influenza Immunization Recommendations
The AAFP updated its annual influenza immunization recommendations and included them in a policy statement approved in July. The revised recommendations contain relatively few outright changes from last season but reemphasize some key considerations. They state that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the entire influenza season. They also recommend that health care facilities consider making influenza immunization coverage among their staff a measure of their patient-safety quality programs, and implement policies to increase immunization among health care personnel. To access the policy statement, go to http://www.aafp.org/online/en/home/clinical/immu-nizationres/flu05.html. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20070727influenzarecs.html.
— AFP and AAFP NEWS NOW staff
For more news, visit AAFP News Now at http://www.aafp.org/news-now.
Copyright © 2007 by the American Academy of Family Physicians.
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