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Am Fam Physician. 1998;57(8):1751-1752

Evaluation and Management Documentation Guidelines Are Unacceptable to AAFP

Neil H. Brooks, M.D., Rockville, Conn., president of the American Academy of Family Physicians, testified before the Practicing Physicians Advisory Council, known as PPAC, that “the new evaluation and management document guidelines as currently constructed are unacceptable and cannot be fixed by minor alterations.” The March 16th meeting of the PPAC, at which witnesses from the AAFP, the American College of Physicians, the American Society of Internal Medicine and the American Medical Association testified, focused on the concerns of physicians with the new guidelines, which are scheduled for implementation on July 1, 1998. Dr. Brooks emphasized that the guidelines interfere with patient care, and because of the requirement that a physician document an extensive list of points and virtually all “negatives,” it may actually be more difficult for the physician to locate the pertinent clinical information in the record. His concerns were echoed by colleagues from other medical specialty societies. Dr. Brooks urged the Health Care Financing Association to recall the guidelines, suspend the July 1 implementation date and begin a collaborative process with the physician community to develop a workable proposal for documentation of evaluation and management services.

Initial Fill Rates for Family Practice Residency Programs Are Announced

Preliminary information available from the National Resident Matching Program (NRPM) indicates that the initial 1998 national fill rate for family practice residency programs is 2,814 positions filled out of 3,293 available positions (85.5 percent). In 1997, the initial number of students who selected family practice was 2,905 (89.1 percent of the 3,262 available positions). Ninety-one fewer positions (3.1 percent) were filled in 1998, compared with 1997. This is the first year since 1991 that fewer positions in family practice were filled through the NRMP than the year before. The percentage of students matching with family practice residencies has ranged from 65.0 percent in 1991 to the record of 90.5 percent in 1996. The 1998 figure, while down from 1997, is the third-highest match for family practice in history. “We are pleased that, in light of what many have called an environment of ‘primary care backlash,’ close to 3,000 residency applicants have elected family practice as their specialty of choice,” said AAFP President Neil Brooks, M.D.”

In addition to family practice, the three other primary care specialties experienced decreased numbers of students choosing their residency programs. These include pediatrics-primary, internal medicine-primary and internal medicine-pediatrics. However, for the fourth year in a row, more medical school seniors chose to go into primary care (56 percent) than into subspecialties. Detailed information on the 1998 residency match program can be found on the AAFP Web site ( or the Web site of the Association of American Medical Colleges (

Persons with Health Problems Still Face Barriers to Obtaining Insurance

A new study of the individual health insurance markets in 10 states has identified major barriers to obtaining health insurance for people with health problems. For many people who have health problems or who are approaching the age of retirement, coverage through the individual health insurance market may be too expensive or may be denied altogether, according to the report. Premiums in the individual markets vary significantly based on the age of the applicant. Six of the 10 states reviewed in the study allowed insurers to deny coverage to persons with a history of such health problems as rheumatoid arthritis, chronic headaches, kidney stones, angina, heart disease and stroke. The study was conducted by the Alpha Center for the Henry J. Kaiser Family Foundation. A report released by the General Accounting Office found similar barriers to health insurance coverage. At a news conference in March following publication of the reports, President Clinton chastised the insurance industry for such practices and vowed to strengthen the 1996 Health Insurance Portability and Accountability Act.

Health Care Spending Increased Slightly in 1996

Statistics released from the Department of Health and Human Services show that health care costs only increased 4.4 percent in 1996. This percentage of increase is the lowest in 37 years. Total national health care costs topped the $1 trillion mark for the first time in 1996, increasing from $991.4 billion in 1995 to $1.04 trillion. Medicare and Medicaid expenditures were $351 billion, more than one third of the total health care bill. The average amount spent per person in 1996 was $3,759. Health care spending as a share of gross domestic product remains at 13.6 percent, where it has been since 1993, after almost a decade of increases. The report appears on the Internet at

COLA Offers Guide to Simple Laboratory Testing

The Commission on Office Laboratory Accreditation (COLA), a national health care accreditation organization, has made available the “COLAGuide to Simple Laboratory Testing: Laboratory Education for Waived and PPM Testing,” a package of materials specifically directed to help waived and provider performed microscopy (PPM) laboratories improve the quality of their laboratory testing. The guide is available to all health care professionals for a fee. For more information about COLA or to purchase the guide, contact COLA at 800-981-9883 or visit the COLA Web site at

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Copyright © 1998 by the American Academy of Family Physicians.

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