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Policy and Health Issues in the News
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Am Fam Physician. 2009 Nov 15;80(10):1039-1040.
Legislation Providing Permanent SGR Formula Fix Fails to Reach Senate Floor
Senate leaders were unable to bring a bill to the floor that would have permanently fixed the sustainable growth rate (SGR) formula, which is used to determine Medicare's physician payment rates. Without a fix to the formula, physicians will face a 21 percent pay cut from Medicare in January 2010. The Medicare Physician Fairness Act of 2009 would have reset the SGR to zero and eliminated the $245 billion in debt that has accumulated from congressional fixes over the past six years. Senate Democrats only mustered 47 of the 60 votes needed to bring the bill to a vote. A number of senators objected to the bill because supporters of the legislation had not identified cost offsets to pay for the measure. The SGR formula determines annual Medicare payment rates for physicians by aligning actual spending rates with specified targets. In the past several years, spending has exceeded targeted rates. This has triggered steep reductions in physician payment rates, which have been averted only by last-minute congressional intervention. For more information, visit http://www.aafp.org/news-now/government-medicine/20091021sgr-defeat.html.
Harvard Study Suggests Cost for Universal Coverage May Be Less Than Expected
A new study by researchers at Harvard Medical School suggests that covering the uninsured population would be less expensive than initial estimates, if certain cost offsets are taken into consideration. For the report, which was published online by the Annals of Internal Medicine, the authors analyzed data from the Health and Retirement Study, a nationally representative longitudinal study that collects health insurance information from a large sample of adults. Specifically, the authors examined how health insurance coverage or a lack of coverage affected Medicare spending, The study found that patients who were continuously or intermittently uninsured between 51 and 64 years of age cost the Medicare program an additional $1,000 annually per person on average, compared to those who had continuous insurance coverage before 65 years of age. The increased costs were mostly from complications associated with cardiovascular disease and diabetes, and from delayed surgeries for arthritis. According to the study, offering universal coverage for all adults between 51 and 64 years of age has been estimated at $197 billion. However, extending coverage to this group would offset costs by $98 billion because of decreased spending when these patients become eligible for Medicare. This would lead to an overall net cost increase of $99 billion, rather than $197 billion. For more information, visit http://www.aafp.org/news-now/health-of-the-public/20091013harvardstudy.html or the Annals of Internal Medicine Web site at http://www.annals.org/cgi/content/full/0000605-200912010-00149v1.
CDC Survey Shows Gains in Overall Adolescent Vaccination Rates
Vaccination rates among U.S. adolescents 13 to 17 years of age showed significant increases in 2008, compared with the previous year. However, coverage still is less than 50 percent for three vaccines specifically recommended for preteens, according to survey findings from the Centers for Disease Control and Prevention (CDC) published in the September 18, 2009, Morbidity and Mortality Weekly Report. The survey showed that between 2007 and 2008, there was an increase in vaccination rates for the tetravalent meningococcal conjugate vaccine (MCV4); the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine; and the quadrivalent human papillomavirus (HPV) vaccine. However, fewer then 20 percent of girls had received all three recommended doses of the HPV vaccine. In addition to these three vaccines, the CDC's Advisory Committee on Immunization Practices recommends that adolescents receive the following vaccinations if they did not receive them during childhood: two doses of measles, mumps, and rubella vaccine; three doses of hepatitis B vaccine; and two doses of varicella vaccine. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20091021teen-vaccs.html or http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a2.htm.
AAFP Backs Bill to Increase Ranks of Rural Physicians Through Medical School Grants
The American Academy of Family Physicians (AAFP) is supporting a Senate bill that would give medical schools the resources to establish or expand rural physician training programs. The Rural Physician Pipeline Act of 2009 would award grants to medical schools for the establishment or support of existing programs that provide specialized training to students with an interest in serving rural communities. Although one fourth of the nation's population resides in rural areas, only about 10 percent of the country's physicians practice there. The bill would require medical schools to recruit students from rural areas who have a desire to practice in their hometowns or other rural communities. Medical schools would develop curriculum and training focused on medical issues that are prevalent in underserved rural communities, such as trauma, obstetrics, ultrasonography, oral health, and behavioral health. For more information, visit http://www.aafp.org/news-now/government-medicine/20091013ruralphysicianslegs.html.
AMA Launches Comprehensive Patient Flu Health-Assessment Web Site
The American Medical Association (AMA) has launched a comprehensive influenza health-assessment Web site designed to help patients determine the severity of their symptoms. Users can sign up for a free account, enabling them to subscribe to personalized, interactive health service programs. The Web site offers physician-designed tools to help patients evaluate their risk of the novel influenza A (H1N1) virus or the seasonal influenza virus, and decide whether they should get vaccinated. Additionally, patients can share their information with their physician or family members through the Web site. For more information, visit http://www.amafluhelp.org.
U.S. Physicians Underprepared to Participate in Pay-for-Performance Programs
Family physicians in the United Kingdom are more prepared to participate in pay-for-performance programs than family physicians in the United States, according to a study published online by Family Practice. The study compared the quality of chronic illness care, specifically for diabetes and coronary artery disease, among 60 family physician practices in the United Kingdom and 55 practices in the United States. Researchers found that practices in the United Kingdom were likely to be better prepared to participate in pay-for-performance programs based on a higher level of care coordination, greater standardization of care and documentation, and more widespread use of electronic health record systems. The authors attributed the findings to investments made by the U.K. government in a primary care infrastructure that focuses on improving quality and access to care. For more information, visit http://www.aafp.org/news-now/practice-management/20091019us-uk-p4p.html.
Mayo Clinic Study Finds Resident Fatigue and Distress Lead to Medical Errors
A recent study from the Mayo Clinic found that medical residents who experienced high levels of fatigue or distress were more likely to report making a medical error. The study, which appeared in the September 23/30, 2009, issue of the Journal of the American Medical Association (JAMA), analyzed data from 380 internal medicine residents. Residents were surveyed about their current rotations, coping strategies for dealing with stress, and self-perceived medical errors. In February 2009, the AAFP expressed opposition to additional restrictions on residents' duty hours as proposed by the Institute of Medicine. The AAFP said that if implemented, the recommendations would hurt patient care and increase medical training costs. According to AAFP Board Chair Ted Epperly, MD, of Boise, Idaho, it is the responsibility of residency program directors to help trainees manage their sleep needs and general well-being. Epperly reiterated that more research is needed on the relationship between resident fatigue and patient care. For more information, visit http://www.aafp.org/news-now/resident-student-focus/20091020resid-fatigue.html or the JAMA Web site at http://jama.ama-assn.org/cgi/content/abstract/302/12/1294.
AAFP Offers Primer to Help Physicians Interpret HHS' Breach Notification Rules
The AAFP has developed a new resource to help family physicians interpret regulations from the U.S. Department of Health and Human Services (HHS) that require covered entities to notify patients if their health information is breached. AAFP members can visit the Center for Health Information Technology Web site for a summary of the regulations most likely to affect family physician practices. For more information, visit http://www.aafp.org/news-now/practice-management/20091012breach-help.html or http://www.centerforhit.org.
FDA Approves HPV Vaccine Gardasil for Prevention of Genital Warts in Males
The U.S. Food and Drug Administration (FDA) has approved use of the quadrivalent HPV vaccine Gar-dasil to prevent genital warts in boys and men nine to 26 years of age. The agency has also approved a bivalent HPV vaccine for girls and young women. According to an October 16, 2009, news release, the FDA found that in clinical trials of more than 4,000 males, Gardasil was nearly 90 percent effective in preventing genital warts caused by infection with HPV types 6 and 11. Gardasil was approved in 2006 for use in girls and young women nine to 26 years of age for the prevention of cervical cancer, vulvar cancer, vaginal cancer, and precancers caused by HPV types 16 and 18; genital warts caused by HPV types 6 and 11; and precancerous or dysplastic lesions caused by HPV types 6, 11, 16, and 18. For more information, visit http://www.aafp.org/news-now/clinical-care-research/20091019hpvmen-bivalgsk.html.
— AFP and AAFP NEWS NOW staff
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Copyright © 2009 by the American Academy of Family Physicians.
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