News Briefs: Government Updates

This roundup includes the following brief government updates:

The United States needs to start changing incentives to encourage more medical students to become primary care physicians, according to comments made by President Obama during a June 24 town hall meeting at the White House.

Increasingly, medical students are making decisions on where to practice because they are coming out of medical school with $200,000 with student loans, he said. "And if they become a primary care physician, oftentimes, they are going to make substantially less money and it's going to be much harder for them to repay their loans."

Obama said primary care is critical to bringing down costs and improving quality in the U.S. health care system. He added that his administration is looking at Medicare and Medicaid payments to primary care physicians and working with doctors and nurses to figure out how to "incentivize quality of care."

According to Obama, this entails a "team approach to care that will help raise and elevate the profile of family physicians and nurses as opposed to just the (sub)specialists who are typically going to make money if they are getting fee-for-service."

AAFP Past President Neil Brooks, M.D., of Vernon Rockville, Conn., who attended the town hall meeting, said, "President Obama is obviously well aware of the plight of primary care and, on several occasions, specifically mentioned the necessity of having family physicians in an affordable and high-quality system."

"The AAFP has clearly gotten its message across, and now we need to see the political will to accomplish what is necessary," he added.

In its latest report (297-page PDF; About PDFs) to Congress, the Medicare Payment Advisory Commission, or MedPAC, calls for payment policies that reward health care value rather than volume. The report also calls for improved care coordination and constraints on the cost of the Medicare program.

Recent studies show that the U.S. health care system is not buying enough recommended care and is buying too much unnecessary care, much of it at very high prices, according to the report. This results in a system that costs significantly more per capita. In the report, MedPAC assails the prevailing fee-for-service payment system as an "obstacle to effective care coordination."

"Traditional Medicare pays individual providers based on what they do in a visit or during an inpatient stay," says the report. "Payment does not depend on how well a provider coordinates the care provided in a visit or an inpatient stay with the care the patient received from other providers or in other settings. Many of the services required by individuals with chronic conditions or other complex needs, such as ongoing monitoring and education for self management, are not performed within the typical face-to-face visit."

The commission says there are several opportunities for modifying incentives to change the way the Medicare program delivers care, including via