Medicare Spending Proposal Includes Positives, Negatives for Primary Care

President Bush has proposed an initiative aimed at slowing projected Medicare spending. The Medicare Funding Warning Response Act of 2008 would ensure that by 2013 value-based or pay-for-performance measures are available for at least 50 percent of care provided under Medicare. It would also withhold a portion of physician payments based on quality and efficiency standards. Under the initiative, some quality-related provisions (e.g., those associated with electronic health records [EHRs], pricing transparency, and value-based purchasing) would not be implemented unless they reduce costs. Kevin Burke, director of the American Academy of Family Physician's (AAFP's) Government Relations Division, contends that much of the cost of meeting the pay-for-performance requirement would go to family physicians because many of these measures apply to primary care. He also says the initiative would make it difficult for physicians to receive payments based on the quality and efficiency of their performance. However, some measures in the initiative are positive for family physicians, such as a $250,000 cap on noneconomic damages for medical lawsuits and those related to the use of interoperable EHRs instead of only electronic prescribing and publicizing price and cost information to Medicare beneficiaries. For more information, visit https://www.aafp.org/news-now/government-medicine/20080227bushtrigger.html or www.hhs.gov/asl/medicarefundingwarningsummary.pdf.

Partnership Urges Congress to Block Tightening of Medicaid, SCHIP Eligibility

In a February letter to House and Senate leaders, the Partnership for Medicaid urges Congress to block current and proposed Centers for Medicare and Medicaid Services (CMS) regulations that would tighten eligibility requirements for Medicaid and the State Children's Health Insurance Program (SCHIP). The Partnership is particularly concerned by current and proposed regulations that would narrow the ability of states to disregard some family income, such as earnings or child care expenses, in determining Medicaid and SCHIP eligibility. According to the letter, this could significantly impact low-income patients' access to medical care. The Partnership also opposes regulations that would impose Medicaid funding cuts, including graduate medical education payment cuts and those that may lead safety-net providers to eliminate important community services. The Partnership for Medicaid is a coalition of safety-net physician organizations, including the AAFP. For more information, visit https://www.aafp.org/news-now/government-medicine/20080304partnermed.html or the Partnership for Medicaid Web site at http://www.clinicians.org/advocacy/Partnership_for_Medicaid.htm.

GAO Report Concludes Physician Payment System Undervalues Primary Care

A recent report from the U.S. Government Accountability Office (GAO) shows that an emphasis on primary care, including the patient-centered medical home, is key to improving quality of care and lowering costs. However, the fee-for-service Medicare payment system undervalues primary care while encouraging the growth of subspecialty services. The report cites a growing income gap between primary care physicians and subspecialists for the declining number of medical students entering primary care. Bruce Steinwald, director of health care for the GAO, says that payment system reforms should not only be about raising fees but also about recalibrating the value of all services, including subspecialty and primary care. Steinwald introduced the report before the Senate Committee on Health, Education, Labor, and Pensions as committee members prepared to consider reauthorization of Title VII health education programs. For more information, visit https://www.aafp.org/news-now/professional-issues/20080227gaoreport.html or http://www.gao.gov/new.items/d08472t.pdf.

New and Revised CPT Codes Cover Online-and Telephone-Related Patient Services

New and revised Current Procedural Terminology (CPT) codes focusing on non-face-to-face services took effect on January 1, 2008. The updates are based on a proposal by the AAFP, the American College of Physicians, and the American Academy of Pediatrics (AAP) that urged the recognition of changing communication patterns between physicians and patients. The January issue of Family Practice Management includes an overview of telephone and online service codes as well as other new codes (https://www.aafp.org/fpm/20080100/16cpt2.html). Three new codes are available for telephone services based on the amount of time spent discussing medical care; the old telephone CPT codes are no longer used. Another new code is available for online patient services, including all communications stemming from the online encounter (e.g., follow-up telephone calls; pharmacy, laboratory, and imaging orders). Although Medicare does not yet pay for these codes, two large health insurers, Aetna and Cigna HealthCare, are paying some physicians for online patient consultations. David Ellington, MD, AAFP's representative to the American Medical Association's CPT Advisory Committee, hopes that all insurers will recognize and pay for these new codes in the future. For more information, visit https://www.aafp.org/news-now/practice-management/20080229cptcodes. html, or https://www.aafp.org/online/en/home/policy/policies/p/reimbursnonfacetofacesvcs.html.

Targeted Medical School Programs Could Improve Rural Physician Shortage

A recent study shows that medical school programs aimed at encouraging students to practice in rural areas could significantly increase the number of rural physicians. According to the study published in the March issue of Academic Medicine, U.S. medical schools could more than double the number of rural physicians annually by implementing programs that emphasize rural medical practice. In the six U.S. medical schools identified in the study as providing comprehensive training programs for rural physicians, more than 50 percent of graduates from these programs over the past three decades have become rural physicians. This is compared with the 3 percent of students overall who say they plan to become rural physicians and the 9 percent of physicians who currently practice in rural areas. Graduates from the six schools also stayed in their rural practice for longer than graduates of other schools. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20080312ruralpipeline.html or the Academic Medicine Web site at http://www.academicmedicine.org/pt/re/acmed/fulltext.00001888-200803000-00005.htm.

CMS Releases Preliminary Data on Progress of the Physician Quality Reporting Initiative

The CMS reports that 15.74 percent (99,319 providers) of eligible health care professionals attempted to participate in the 2007 Physician Quality Reporting Initiative (PQRI), and 92,218 successfully submitted at least one measure. On average, participants attempted to report approximately three measures. The report also shows where errors in the reporting system have occurred, which can guide future educational efforts. So far, nearly one half of participants appear to be on track to receive bonuses in 2008 based on their PQRI participation. The report includes preliminary data, and many more claims need to be processed. However, CMS Spokesperson Ellen Griffith says that CMS is encouraged by the participation rate so far and intends to continue working with physicians and organizations to strengthen the program. For more information, visit https://www.aafp.org/news-now/practice-management/20080305pqrireport.html or the CMS Web site at http://www.cms.hhs.gov/PQRI/33_2007_General_Info.asp.

‘Get Connected’ Program Assists Physicians in Implementing E-Prescribing Systems

The AAFP in collaboration with several other national physician organizations has launched a new program aimed at encouraging physicians to use electronic prescribing (e-prescribing) technology. The program focuses on physicians who have EHR systems, but who are not using the e-prescribing function. The ‘Get Connected’ program is one of the first major initiatives from the Center for Improving Medication Management, which was created by the AAFP, the AAP, the American College of Cardiology, the American College of Obstetricians and Gynecologists, and the Medical Group Management Association. The Get Connected Web site includes an e-prescribing readiness assessment, recommendations for incorporating e-prescribing into practices, and assistance with connecting to pharmacies. The Web site also allows physicians to calculate how much time and resources they put into their phone- and fax-based prescription systems. For more information, visit https://www.aafp.org/news-now/practice-management/20080306getconnected.html or the Get Connected Web site at http://www.getrxconnected.com.

NIH Provides Online Resource to Educate Older Patients About High Cholesterol

The National Institutes of Health (NIH) has added a new resource to its informational Web site for older patients (http://nihseniorhealth.gov) that is aimed at helping users understand the value of cholesterol screening. The resource includes information about what causes high cholesterol levels and about how to diagnose and treat the condition. Users can find answers to typical questions (e.g., What is the difference between types of cholesterol?, What is “good” cholesterol?) and links to MedlinePlus for more information. The Web site is a collaboration of the NIH's National Institute on Aging and the National Library of Medicine. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080310nihseniorbp.html or http://nihseniorhealth.gov/highbloodcholesterol/toc.html.

AFP and AAFP NEWS NOW staff