Policy and Health Issues in the News
Am Fam Physician. 2007 Oct 1;76(7):927-928.
Legislation Proposes Changes in Tamper-proof Prescription Pad Law
Proposed legislation would lessen the impact of a newly passed law requiring physicians to start using electronic prescribing or tamper-resistant prescription pads for their Medicaid patients as of October 1. One bill (H.R. 3090) would change the law so that it applies only to Schedule II narcotic drugs. Another (S.B. 2013) would delay full implementation of the law; under this legislation, the law would apply to Schedule II drugs on October 1, but it would not pertain to all Medicaid prescriptions until April 2009. The law that requires use of electronic prescribing or tamper-resistant prescription pads was passed in late July. It will deny federal reimbursement to states for Medicaid patients' prescriptions that are not written on tamper-resistant prescription pads as of October 1. According to the U.S. Department of Health and Human Services, the requirement will save $510 million in Medicaid prescription fraud over 10 years. For more information, go to http://www.aafp.org/news-now/practice-management/20070906prescriptionpadlaw.html.
False Claims Rule Has Relatively Small Impact on Family Physicians
Section 6032 of the Deficit Reduction Act of 2005, which went into effect in 2007, requires health-related entities that receive at least $5 million per year in Medicaid funds to develop fraud and abuse prevention policies and then communicate those policies to their staff members and contractors. Because of this, family physicians may receive notification from hospitals and managed care companies about compliance with the regulation and the federal law. Most physician offices are considered contractors under the regulation, meaning that most family physicians will need to sign hospital, managed care, and health system letters acknowledging receipt of the entities' policies and agreeing that they will comply with the policies in interactions with these organizations. Guidelines written to help states interpret the provisions of the act can help physicians educate their staff members about what constitutes a false claim, the remedies and methods for reporting a false claim, and the protections afforded those who report false claims. The American Academy of Family Physicians (AAFP) suggests that physicians post the False Claims Act guidelines, as well as policies from large health care organizations, on a bulletin board in their offices, and that they include this information in employee manuals. To view the federal guidelines, go to http://www.taf.org/OIG-guidance-on-State-FCA.pdf. For more information, visit http://www.aafp.org/news-now/government-medicine/20070827falseclaimsrule.html.
Study Shows Primary Care Plays Central Role in Reducing Hospitalizations
Effective primary care and other outpatient treatments could prevent millions of unnecessary hospitalizations each year while saving billions of dollars in annual health care costs, according to a new report conducted by the Agency for Healthcare Research and Quality. The report, “Trends in Potentially Preventable Hospitalizations Among Adults and Children, 1997–2004,” suggests that three key factors could potentially prevent more than 4 million hospitalizations each year. These are improvements in ambulatory care, greater access to effective treatments, and patient adoption of healthy behaviors. In 2004, hospitals spent about $29 billion on care for preventable conditions such as congestive heart failure, asthma, urinary tract infections, and high blood pressure, according to the report. Data were taken from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type or lack of insurance. For more information, go to http://www.aafp.org/news-now/government-medicine/20070824ahrqstudy.html or http://www.hcup-us.ahrq.gov/reports/statbriefs/sb36.pdf.
AAFP Congress of Delegates Acts on Proposed Bylaw Amendments
The 2007 AAFP Congress of Delegates will act on proposed amendments to the AAFP Bylaws, as well as on resolutions submitted by various constituencies, at the October 1–3 meeting in Chicago, Ill. Proposed Amendment 1 would allow uniformed services chapter membership for former members of the uniformed services who practice within a military facility. Proposed Amendment 2 would change the continuing medical education requirements for active and supporting family physician membership. Topics of the resolutions submitted so far this year include cultural proficiency, changes in current procedural terminology codes, chronic disease registries, condemnation of the criminalization of medical practice, retail health clinics, disaster planning, procedural training in family medicine residencies, and patient/physician confidentiality. For more information, go to http://www.aafp.org/news-now/inside-aafp/20070821bylawsresols.html.
Online Kaiser Database Shows Medicaid Benefits by State and Service
An interactive online database released August 16 by the Kaiser Commission on Medicaid and the Uninsured presents information on Medicaid benefits for 2003, 2004, and 2006 organized by state and by service. Using the database, physicians can identify the services covered by their state's Medicaid program and review co-payments, coverage limitations, type of reimbursement, and populations covered. The online database also provides an interactive map and the ability to compare data across the three years. To access the database, go to http://www.kff.org/medicaid/benefits/index.jsp. For more information, visit http://www.aafp.org/news-now/practice-management/20070820medicaiddatabase.html.
AMA Launches Campaign for Covererage of America's Uninsured
The American Medical Association (AMA) has announced the launch of a multimillion-dollar campaign aimed at motivating the public and pressuring politicians and Congress to tackle the issue of Americans without health insurance. The three-year campaign, “Voice for the Uninsured,” includes print and broadcast advertising and a Web site dedicated to the cause. During the first year, the focus of the campaign will be to educate American voters and presidential candidates about the plight of the uninsured. The second year will focus on persuading voters to support presidential candidates who advocate for coverage for the uninsured. During the third year, the AMA will pressure Congress to pass legislation that will ensure all Americans have health insurance. To access the AMA campaign Web site, go to http://www.ama-assn.org/ama/pub/category/17712.html. For more information, visit http://www.aafp.org/news-now/professional-issues/20070827amavoicecampaign.html.
AAFP Advocacy Efforts Address Retail Health Clinic Co-pays, Other Issues
In private sector advocacy efforts this summer the AAFP sent letters to 65 health insurance companies across the country. A letter to health plans in June asked them not to design benefit plans that offer patient co-pays for visits to retail or convenience health clinics that are lower than co-pays for a visit to their primary care physician. Another June letter asked payers to adopt the increase in relative value units for evaluation and management services set out in the 2007 Medicare physician fee schedule. In July, a letter to payers asked that health plans recognize family physicians with special training, as well as those who provide women's health services. The letter pointed out that family physicians can earn certificates of added qualifications in adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine, and stated that health plans must explicitly include family physicians in any reference to access to health services for women, children, and older persons. As a result of the AAFP's letter-writing campaign, UnitedHealthcare will now reimburse physicians for a preventive medicine service plus 50 percent of certain problem-oriented evaluation and management services. For more information, go to http://www.aafp.org/news-now/practice-management/20070829privadvocacy.html.
Report Finds Physicians Drawn to Mid-sized, Single-Specialty Practices
A report released in August by the Center for Studying Health System Change (HSC) found that fewer American physicians are working in solo and two-physician practices and that the number of physicians moving to mid-sized, single-specialty practices is increasing. The report represents findings from HSC community tracking surveys of 6,000 to 12,000 physicians conducted between 1996 and 2005. Researchers found that between 1996–1997 and 2004–2005 the proportion of physicians in solo and two-physician practices decreased from 40.7 to 32.5 percent. The proportion of physicians in three- to five-physician practices decreased from 12.2 to 9.8 percent, whereas physician groups of six to 50 physicians increased from 13.1 to 17.6 percent. For more information, go to http://www.aafp.org/news-now/professional-issues/20070904hscpracticesize.html. To access the report, visit http://www.hschange.org/CONTENT/941.
Practice Improvement Conference to Focus on Infectious Diseases
The 2007 Conference on Practice Improvement: Health Information and Patient Education will be conducted November 8-11 in Newport Beach, Calif., and will focus on infectious and communicable diseases. The conference is a joint presentation of the AAFP and the Society of Teachers of Family Medicine. Skills-building preconference workshops will be conducted on billing for patient education and on electronic health records. For more information and to download the conference brochure, go to http://www.aafp.org/news-now/practice-management/20070822practimprconf.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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