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Policy and Health Issues in the News
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Am Fam Physician. 2008 Jul 15;78(2):173-174.
AHIP Recommends Strategies to Cut $145 Billion in Health Care Costs by 2015
America's Health Insurance Plans (AHIP) has released a proposal with strategies to reduce total health care costs by $145 billion in the next seven years. The proposal, “A Shared Responsibility: Advancing Toward a More Accessible, Safe, and Affordable Health Care System for America,” focuses on five key principles that must be achieved. The principles include access to treatment comparison information, adoption of health information technology, medical liability reform, implementation of a value-based payment system, and strategies for chronic disease prevention and treatment. Critics say that although the principles are sound, the proposal lacks specific details. Medical Group Management Association's Senior Policy Advisor Robert Tennant agrees that health information technology is one area in which the United States can improve, with only 19 percent of U.S. physicians adopting the technology in their practices, compared with 83 percent in the United Kingdom. However, the UK government has invested billions of dollars in health technology in the past several years, whereas the United States has spent about $600 million. Tennant says health plans may need to boost their funding of technology in medical practices to make implementation viable for physicians. For more information, visit http://www.aafp.org/news-now/professional-issues/20080613ahipproposal.html or the AHIP Web site at http://www.ahip.org/content/default.aspx?docid=23427.
Medicare Beneficiaries Experience Disparity in Quality of Care Based on Location, Race
Medicare patients receive varying quality of care depending on their geographic location and race, according to a study of Medicare enrollment and claims data for patients 65 years and older. “Disparities in Health and Health Care Among Medicare Beneficiaries” found health care disparities in diabetes testing, breast cancer screening, and rates of leg amputations resulting from diabetes or peripheral vascular disease complications. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which commissioned the report, says the data illustrates the uneven quality of care in America. In Illinois and California, there was a 12 percent gap in mammography screening between white and black patients. The study also found a 17-point gap in mammography rates between patients in Maine, with the highest rate, and those in Mississippi, with the lowest. The gap in diabetes blood testing rates between white and black patients was widest in Colorado (84 and 66 percent, respectively). The study acknowledged the benefits of using primary care physicians to provide high-quality care. For more information, visit http://www.aafp.org/news-now/professional-issues/20080611medicare-dispar.html or http://www.dartmouthatlas.org/af4q/AF4Q_Disparities_Report.pdf.
Family Physicians More Likely to Follow NAEPP Guidelines for Asthma Care
Primary care physicians are more likely to follow asthma prescribing guidelines than subspecialists, according to a study published in the spring issue of Annals of Allergy, Asthma and Immunology. Study researchers tracked physician adherence to the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma, published by the National Asthma Education and Prevention Program (NAEPP). The guidelines recommend environmental control measures in conjunction with pharmacotherapy, including, long-term controller medications, short-term reliever medications, and anti-inflammatory medications. The study analyzed data from physician visits from 1998 through 2004. Although overall prescribing rates increased, the study also found that nonwhite and non-black patients had a 40 percent lower chance of receiving controller medications than white or black patients. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20080619naeppguidelines.html or http://oberon.annallergy.org/vl=12925213/cl=14/nw=1/rpsv/cw/acaai/10811206/v100n3/s8/p216 (subscription required).
New Medicare Bidding Program to Provide Savings on Durable Medical Equipment
Phase one of a competitive bidding program for Medicare durable medical equipment, prosthetics, orthotics, and supplies is set to launch, barring congressional action. In certain areas throughout the country, Medicare beneficiaries may save as much as 43 percent on some durable medical equipment. Products affected by the first round of bidding include oxygen supplies, power wheelchairs and scooters, mail-order diabetes supplies, walkers, and hospital beds. Congress added the program to curb spiraling costs of durable medical equipment. The Centers for Medicare and Medicaid Services (CMS) predicts a savings of around $1 billion per year when the program is fully implemented in 2010. Although CMS offered contracts to 325 out of 1,005 bidding companies, complaints from some suppliers who did not receive a contract have prompted proposed legislation that could delay the program's launch. For more information, visit http://www.aafp.org/news-now/practice-management/20080618dmeprogram.html.
CMS Provides an Additional $15 Million for Health Insurance Counseling Programs
CMS will be providing an additional $15 million to the State Health Insurance Assistance Programs (SHIPs) to help Medicare patients learn about their benefits. In all, SHIPs will receive more than $50 million from CMS in 2008, which is a $20 million increase from 2007. SHIPs use community-based networks to provide personalized assistance to beneficiaries who have questions about Medicare, prescription drug coverage, or other health insurance topics. The extra funding will help SHIPs work with patients with limited income who need additional help with prescription drug costs. For more information, visit http://www.cms.hhs.gov/apps/media/press_releases.asp or the SHIP Web site at http://www.shiptalk.org/Public/home.aspx?ReturnUrl=%2fdefault.aspx.
Georgia Family Medicine Residency Programs Receive Increase in Funding
The Georgia legislature has passed a state budget line item to increase funding to the state's 10 family medicine residency programs by $541,461. The measure, which is expected to take effect July 1, 2008, will provide an additional $2,600 for each family medicine resident. The Georgia AFP spent the past three years advocating for the increase, relying on residency “footprint” maps from the HealthLandscape Web site (http://www.healthlandscape.org/index.cfm) to back their case. The Primary Care Atlas map-making tool shows that family medicine residents tend to establish their practice near the place where they trained. Georgia AFP Executive Director Fay Fulton Brown, MHS, encourages other state chapters to speak with local legislators and policy makers to emphasize the importance of family medicine in the local community. For more information, visit http://www.aafp.org/news-now/resident-student-focus/20080624gafp-advoc.html.
Americans in Motion Assists Physicians with Conducting, Billing for Group Visits
Americans in Motion (AIM), an American Academy of Family Physicians initiative, has released a guide to help physicians conduct and bill for group visits with patients struggling with weight-related health problems. “A Guide to Group Visits for Chronic Conditions Affected by Overweight and Obesity” provides specific directions for billing for evaluation and management services, for services by other health care professionals, and for diabetes self-management. Additionally, the guide offers advice on working with Medicare and Medicaid, sample scripts for telephone calls to patients, sample visit invitation letters, confidentiality forms, checklists for staff members, and sample progress notes. The guide also instructs physicians on promoting healthy-eating habits and exercise. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20080617aimgroupguide.html or the AIM Web site at http://www.aafp.org/online/en/home/clinical/publichealth/aim/foryouroffice.html.
Study Shows Treating Hypertension May Reduce Risk of Mortality in Older Patients
A new study suggests that treating hypertension may reduce mortality in patients 80 years and older who are not frail. The study, published in the May 1, 2008, New England Journal of Medicine, found a 21 percent reduction in death rates from any cause in patients treated for hypertension. Patients were eligible for the study if they had a sustained systolic blood pressure of 160 mm Hg or higher. The study results also showed that among those receiving active treatment, the rate of fatal stroke was reduced by 39 percent, and the rate of death from cardiovascular causes was reduced by 23 percent. Almost 50 percent of patients who were treated met a target blood pressure of 150/80 mm Hg after two years. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20080612hyvetstudy.html or the New England Journal of Medicine Web site at http://content.nejm.org/cgi/content/abstract/358/18/1887.
FDA Calls for Warnings to be Added to Conventional Antipsychotic Medications
The U.S. Food and Drug Administration (FDA) has instructed the manufacturers of conventional antipsychotic drugs to add warnings to package labels about the risk of mortality in older patients being treated for dementia-related psychosis. This follows the introduction of similar warnings added to atypical antipsychotic drugs in 2005. Two studies of older Canadian patients found a slightly higher risk of mortality among patients taking conventional antipsychotic drugs compared with those taking atypical antipsychotic drugs. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20080618antipsych-risk.html or the FDA Web site at http://www.fda.gov/cder/drug/InfoSheets/HCP/antipsychotics_conventional.htm.
— AFP and AAFP NEWS NOW staff
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Copyright © 2008 by the American Academy of Family Physicians.
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