New Year Brings New Medicare Benefits

New Medicare health benefits went into effect on January 1, offering improved coverage of some preventive services. Yearly screening mammograms now are available for women ages 40 and above. Screening Papanicolaou smears will be covered every three years, along with pelvic and breast examinations. Medicare beneficiaries do not have to pay a deductible for these services. For women at high risk of cervical or vaginal cancer, Pap tests and pelvic examinations will be covered on a yearly basis. Also in January, the program began coverage of colorectal cancer screening. Beginning July 1, 1998, the program will cover glucose monitoring as well as diabetes education for people with diabetes and bone mass measurement. And, in the year 2000, Medicare will begin paying for a yearly prostate screening for men over age 50.

Institute of Medicine Recommends Improving Care at the End of Life

A newly published report from the Institute of Medicine (IOM) maintains that good and compassionate care at the end of life is an attainable and urgent goal but points out that it will require many changes in attitudes, policies and actions. “Approaching Death: Improving Care at the End of Life” was developed by the IOM's Committee on Care at the End of Life, chaired by Christine Cassell, M.D., Mt. Sinai Medical Center, New York. The committee studied what we know and do not know about the experience of dying and the conditions that help people maintain dignity and find comfort and meaning as they approach death. As part of this examination, the committee heard from a number of medical organizations, including the American Academy of Family Physicians, at a series of hearings during the spring of 1996 in Washington, D.C. The report includes seven recommendations addressing different decision makers and different deficiencies in care at the end of life. Information about ordering the report may be obtained by calling 800-624-6242.

New Hot Line Provides Counseling for Exposure to Blood-Borne Pathogens

A new hot line has been established to provide health care professionals with advice on treating occupational exposure to blood-borne pathogens. The National Clinician's Post-Exposure Prophylaxis Hotline (PEPline) will give around-the-clock information, counseling and treatment recommendations. Advice will be provided by the University of California-San Francisco/San Francisco General Hospital medical staff who have expertise in human immunodeficiency virus (HIV) and exposure management. The number for the hot line is 888-HIV-4911 (888-448-4911). The PEPline is jointly sponsored by the Health Resources and Services Administration, the Centers for Disease Control and Prevention and the Department of Health and Human Services in collaboration with the San Francisco Department of Public Health and the University of California-San Francisco.

Major Initiative Launched to Increase Organ Donations

The AAFP has joined with the Department of Health and Human Services in an effort to lower the number of Americans who die each year while waiting for an organ transplant. The AAFP's partnership in the National Organ and Tissue Donation Initiative was noted in a Washington, D.C., briefing by Vice President Albert Gore in late December. “The Academy has long advocated the importance of patients talking with their family members and personal physician about organ donation and other end-of-life issues, and we commend efforts of the Department of Health and Human Services to increase this dialogue,” said AAFP President Neil H. Brooks, M.D.

Millions of Americans Face Barriers to Obtaining Medical Care

According to data published by the Agency for Health Care Policy and Research (AHCPR), nearly 13 million of the approximately 110 million families in the United States (11.6 percent) had difficulty in obtaining medical care or did not get the care they needed during 1996. According to the AHCPR, 60 percent of those reporting difficulty with access to medical care could not afford the care they needed. Other barriers included insurance-related problems, transportation problems or child care problems. In addition, more than 46 million Americans had no usual source of health care in 1996. Data are from the 1996 Medical Expenditure Panel Survey. Detailed findings are in “Access to Health Care in American—1996, MEPS Highlights 3” (AHCPR Publication No. 98-0002) and “Access to Health Care in America—Sources and Barriers: 1996, MEPS Research Findings 3” (AHCPR Publication No. 98-0001). Both publications are available from the AHCPR Clearinghouse by calling 800-358-9295. The text of the publications is also on the Internet at http://www.ahcpr.gov/.

Study Reveals Many Americans Are Concerned About Subspecialist Referrals

A study undertaken by the Center for Studying Health System Change and reported in the December 15, 1997, issue of AMNews shows that 16 percent of Americans are concerned that their physician might not refer them to a subspecialist when necessary, although 83 percent were confident that their physician would do so. Correlating data revealed that 82 percent of primary care physicians believed that they were able to refer their patients to high-quality subspecialists, but 18 percent felt that they could not always obtain such referrals. Causes for the concerns reported in the study included the growth of managed care. The physician survey included 9,264 physicians, and the household survey was based on data from 43,771 people.