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Am Fam Physician. 1999;59(1):13

Larry A. Green, M.D., Is Appointed To AHCPR Advisory Council

Larry A. Green, M.D., professor and Woodward-Chisholm Chair of Family Medicine at the University of Colorado, Denver, is one of seven new appointees to the National Advisory Council for Health Care Policy, Research and Evaluation, recently announced by Health and Human Services Secretary Donna E. Shalala. Dr. Green joins Nancy Dickey, M.D., as the other family physician on the 17-member panel. The council members include representatives from academia, health service researchers, health care professionals, consumers, and those familiar with the business, law and ethical aspects of health care. The committee advises the secretary and the administrator of the Agency for Health Care Policy and Research (AHCPR) on how to best enhance the quality and effectiveness of health care services and control their costs. Dr. Green was also recently chosen to head the new Policy Center of the American Academy of Family Physicians (AAFP) in Washington, D.C. (see AFP Newsletter, November 1).

Lawsuit Filed to Challenge HCFA Practice Expense Plan

The practice expense portion of each Medicare payment to a family physician is about 50 percent. Studies during the 1980s showed that the practice expenses of hospital procedures were overcompensated by Medicare and office visits were undercompensated. As a result, in the Balanced Budget Act of 1997, Congress approved a new method of computing practice expenses called “resource-based practice expenses” and mandated its full implementation in 2002. The new method increases payments for office visits. The Medicare income of a typical family physician is expected to increase 9 percent in 2002 over 1997 levels.

The years 1999 to 2001 are transition years. A group of 11 subspecialist organizations filed suit on November 4 to challenge the Health Care Financing Administration's (HCFA) plan for using 1998 as base year. They insist that a strict reading of the law requires that 1991 be used. If the “Base Year Coalition” suit is successful, the rate of change during the transition years will be greatly slowed. It is even possible that the start of implementation will be delayed. Hundreds of millions of dollars that should have been redirected to office visits will be lost. As a result, the AAFP, the American College of Physicians-American Society of Internal Medicine, the American Academy of Pediatrics and other medical groups plan to file an amicus brief in support of HCFA's transition plan, based on the view that a strict reading of the statute creates an illogical result that is contrary to sound public policy and the intent of Congress.

JCAHO and NCQA Call for the Protection of Patient Privacy

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA) have issued a report warning that patients who do not believe that their medical and personal health information is sufficiently protected may limit sharing medical information with health care professionals, and this may increase the risk of misdiagnosis and inappropriate treatment. The NCQA and JCAHO report, “Protecting Personal Health Information: A Framework for Meeting the Challenges in a Managed Care Environment,” includes recommendations regarding the demands for personal, sensitive health information now being made by managed care organizations, health care professionals, employers, quality oversight organizations, regulators and researchers. The two groups want the health care community and policymakers to ensure accountability, obtain consent to use a person's health information, educate patients, use technology as a solution, provide legislative support and monitor research. Copies of the report may be obtained from JCAHO at 630-792-5800 or NCQA at 202-955-5697. The report also is available on the JCAHO Web site at or the NCQA Web site at

The patient privacy issue will be an important one in Congress next year since the Health Insurance Portability and Accountability Act of 1997 requires congressional enactment of a national medical records privacy and confidentiality law by next August. The JCAHO and NCQA recommended standards go further in protecting patient privacy than many of the provisions in acts currently pending in Congress.

AHCPR Announces New Studies for Evidence-based Practice Centers

The Agency for Health Care Policy and Research (AHCPR) has announced the next topics to be investigated by the AHCPR's evidence-based practice centers. The new topics include use of erythropoietin in hematology and oncology, management of acute chronic obstructive pulmonary disease, treatment of acne, management of cancer pain, criteria for determining disability in patients with end-stage renal disease, management of pre-term labor, anesthesia management during cataract surgery, management of chronic hypertension during pregnancy and management of unstable angina. The practice centers will conduct comprehensive reviews of the relevant scientific literature on these topics, including meta-analyses and cost analyses, if appropriate. Their findings will be published as evidence reports or technology assessments. The AHCPR Web site address is

Osteoporosis Resource Center Receives Funding from Federal Partners

The Osteoporosis and Related Bone Diseases National Resource Center of the National Institutes of Health has received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and six other agencies of the Department of Health and Human Services. The resource center will collect, develop and disseminate information to health care professionals and the public on a variety of bone disorders. The funding was the result of a cooperative agreement that links the efforts of the resource center with those of the National Osteoporosis Foundation, the Paget Foundation for Paget's Disease of Bone and Related Disorders, and the Osteogenesis Imperfecta Foundation. The resource center, based in Washington, D.C., was first established five years ago and will be led by Bess Dawson-Hughes, M.D., Tufts University, Boston Mass. The resource center may be contacted at 1150 17th St. N.W., Ste. 500, Washington, D.C. 20036-4603; telephone: 202-223-0344, 800-624-BONE; fax: 202-223-2237.

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Copyright © 1999 by the American Academy of Family Physicians.

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