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Am Fam Physician. 2005;71(12):2233-2234

Medicaid Expected to Top States’ Health Care Agendas in 2005

The economic pressures of funding Medicaid appear to be at the top of state legislative agendas this year. Although state Medicaid budgets continue to improve somewhat from the severe shortfalls in 2002 and 2003, states still must fund ever-expanding Medicaid programs under severe budget constraints, according to the 2005 State Health Care Priorities report from the Health Policy Tracking Service (HPTS). Medicaid budgets continue to grow at double-digit rates because of increased eligibility and the increased cost of medical care, including prescription drugs. In response to this year’s survey, 40 states indicated that they will face some level of Medicaid budget shortfall by the end of fiscal year 2006. In addition to seeking pharmaceutical cost savings, state legislators will try to trim their Medicaid program costs by submitting or revising existing Medicaid waivers, reducing or freezing provider reimbursement rates, and reducing or freezing Medicaid eligibility levels. Specifically, legislative leaders in 24 states indicated that they expect their states to submit or revise existing Medicaid waivers, legislators in 22 states indicated they will try to reduce costs by lowering provider reimbursement rates, and respondents from 18 states may try to reduce or freeze eligibility levels. In addition to these three traditional cost-saving measures, legislators from 13 states indicated that their states will enact new taxes, fees, or assessments on health care providers to raise more funds to pay for their Medicaid programs. The full HPTS report is available online at

NRMP Rules Out Second Residency Match

The National Residency Matching Program (NRMP) Board of Directors has decided not to perform a second match for candidates choosing residency programs. In making its decision, the board noted that residency program directors, institutional officers, and medical school student affairs staff cited implementation problems associated with pursuing a second match, such as the requirement that unfilled programs participate in a second match and the rule that phase one match results would not be released until conclusion of phase two. Overall, only 44 percent of residency program directors and medical school officials surveyed favored a second match. The NRMP board also tabled a proposed policy change that would have required all institutions participating in the main residency match to try to fill all of their positions unless they were participating in other national residency matching programs. The board said that implementation of the plan would have unintended consequences, especially for programs that plan to include international medical graduates.

CMS Proposes New Rule on Hospice Care for Medicare Patients

The Centers for Medicare and Medicaid Services (CMS) has proposed new conditions of participation for hospices that are designed to ease the regulatory burden for hospice providers and improve the quality of care for all hospice patients, including the expanding population of Medicare patients choosing this benefit. Under the proposed rule, the hospice conditions of participation would provide more attention to meeting the specific needs of individual patients. Changes and additions to the current rule would include adding a patient assessment requirement to ensure that all patient needs are identified on a timely basis; replacing the quality assurance requirement with a more comprehensive quality assessment and performance improvement condition to enable hospices to take tailored proactive steps to ensure quality care; allowing hospices to contract for core services in certain situations; and removing the requirement that a registered nurse provide patient care in an inpatient facility on a 24-hour basis. Public comments on the proposed rule will be accepted until July 27, 2005.

Congressional Bill Encourages Use of Health Information Technology

A bill before the U.S. House of Representatives would help push the paper-based U.S. health care system into the world of health information technology. The 21st Century Health Information Act, H.R. 2234, introduced by Reps. Timothy Murphy, R-Pa., and Patrick Kennedy, D-R.I., authorizes the Department of Health and Human Services to make health information technology grants of up to $50 million in 2006, with additional grants available through 2010. The bill would also establish a national technical assistance center to help physicians in small practices implement electronic health systems. The full text of the bill is available online at

CDC Report Finds Visits to Emergency Departments Are at All-Time High

Visits to U.S. emergency departments reached a record high of nearly 114 million in 2003, but the number of departments decreased by 14 percent from 1993 to 2003, according to a new report from the Centers for Disease Control and Prevention (CDC). The report, which is based on data from the 2003 National Hospital Ambulatory Medical Care Survey, attributes the increase in emergency department visits to increased use by adults, especially those 65 years and older. Among people 65 to 74 years of age, the rate of visits to emergency departments was more than five times higher for those living in a nursing home or other institution compared with persons who did not live in an institutionalized setting. The report also found that Medicaid patients were four times more likely to seek treatment in an emergency department than patients with private insurance (81 visits per 100 Medicaid patients compared with 22 visits per 100 privately insured patients). The full report is available online at

New AAFP Program Offers PDA-Based CME

Physicians now have a new way to earn and record continuing medical education (CME) credit. The American Academy of Family Physicians (AAFP) recently launched the CME in Hand program, which offers evidence-based clinical modules for personal digital assistants (PDAs) on topics such as diabetes, pain, obesity, and asthma. Each module consists of a set of questions, with each question typically based on a short clinical case description. Correct and incorrect answers are verified and saved, and literature citations are provided. When the module is completed, responses may be transferred online for up to 0.75 CME credits. The first module, on hypertension, is free for a limited time. Future modules will cost $8 each. Instructions for downloading and installation are available online at The program currently is not available for Mac OS or Pocket PC users.

AHRQ Report Examines Standards of Care During Mass Casualty Events

Guidelines to help officials plan how health care should be provided during public health emergencies are now available from the Agency for Healthcare Quality and Research (AHRQ) and Office of Public Health Emergency Preparedness. The report, “Altered Standards of Care in Mass Casualty Events,” offers a framework for providing optimal care during a potential bioterrorism attack or other public health emergency involving thousands of victims and address what type of care should be given, to whom, by whom, and in which circumstances and places. The recommendations were developed by a 39-member panel of experts in bioethics, emergency medicine, emergency management, health administration, health law and policy, and public health. The report is available online at

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