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Am Fam Physician. 2005;72(8):1439-1440

Hurricane Katrina May Stall Pay-for-Performance Legislation

Congress has largely set aside its earlier legislative calendar to grapple with the aftermath of Hurricane Katrina, confirmation proceedings for U.S. Supreme Court chief justice nominee John Roberts, Jr., and other time-sensitive issues, according to Kevin Burke, director of the American Academy of Family Physicians’ (AAFP’s) Division of Government Relations. As a result, Congress may end up gathering spending and legislative priorities into an omnibus appropriations bill that would address funding requirements for poor and disaster-displaced patients but would defer or delete funds for programs that don’t affect that population directly. Bills containing pay-for-performance and health information technology provisions are likely to come up next year if they are not tackled this year. Two bills are at the forefront: the Medicare Value-Based Purchasing for Physicians’ Services Act (H.R. 3617) and the Wired for Health Care Quality Act (S. 1418). “The key to watch is the budget reconciliation process,” said Burke. “In the midst of the aftermath of Hurricane Katrina, the discussion will be very charged. There’s no definite direction—some legislators will focus on cutting the federal budget, while others will concentrate on improving financial support for programs that assist disaster victims. In between are the long-term funding issues that we’ve worked so hard on: Title VII (funding for family medicine training through Section 747 of Title VII of the Public Health Service Act), funding for the Agency for Healthcare Research and Quality (AHRQ), and, of course, reform of the formula governing Medicare payments to physicians.”

Medicare Deadline Flexible for Patients With ‘Creditable Coverage’

Under Medicare Part D regulations, most Medicare-eligible patients must enroll in a Part D prescription plan by May 15, 2006, or face an increase in premiums of 1 percent per month for every month they are eligible but not enrolled. However, Medicare-eligible patients are not required to enroll in the prescription program if they have “creditable coverage” under another health plan, according to Jamie Tyler, a Medicare counselor at the Centers for Medicare and Medicaid Services. The caveat allows disabled patients to postpone enrolling in Part D until they retire. With its focus on elderly patients, much of the Medicare Part D education effort focuses on persons who qualify for Medicare because of their age. However, young disabled persons also receive Medicare benefits as secondary coverage to their employer-sponsored plans. Others may be covered through insurance held by their spouse or parents. As a result, they may not plan to enroll in Part D for several years.

Research Finds Low EHR Adoption Rates for Physician Groups

A study by the Medical Group Management Association Center for Research and the University of Minnesota School of Public Health, Minneapolis, has captured the current state of adoption of electronic health records (EHR) by U.S. medical group practices. More than 3,300 medical group practices participated in the Assessing Adoption of Health Information Technology project, which was funded by AHRQ. The study shows that approximately 14 percent of all medical group practices use an EHR. Of those groups, 11.5 percent indicated that an EHR was fully implemented for all physicians and at all practice locations. More significantly, the research shows that only 12.5 percent of medical group practices with five or fewer full-time-equivalent physicians have adopted an EHR. The EHR adoption rate increased with the size of practice: groups with six to 10 full-time physicians reported a 15.2 percent adoption rate, groups with 11 to 20 full-time physicians reported an 18.9 percent adoption rate, and groups of 20 or more full-time physicians had a 19.5 percent adoption rate. Other data showed that approximately 13 percent of groups were in the process of implementing an EHR; about 14 percent said implementation is planned in the next year; and about 20 percent said implementation was planned in 13 to 24 months. The remaining groups have no immediate plans for EHR adoption. Among practices with no immediate plans for implementation, the difference between large and small groups is striking: 47.8 percent of practices with five or fewer full-time physicians compared with only 20.7 percent of practices with 21 or more physicians. The study results are highlighted in the September–October edition of Health Affairs.

2005 Match Results Point to Greater Diversity

As more international medical graduates enter primary care, they may offer a solution to some of the health care issues encountered by an increasing population of racial and ethnic minorities in the United States. A review of the 2005 National Resident Matching Program results, which was published in the September issue of Family Medicine, shows increasing diversity. The analysis, “Results of the 2005 National Resident Matching Program: Family Medicine,” said that of international medical graduates who matched in primary care specialties, 838 chose family medicine, 1,985 chose internal medicine, and 377 opted for pediatrics. Family medicine ranked seventh in the percentage of international graduates among the 24 major specialties of medicine. Among the 15 subspecialties of internal medicine, family medicine ranked 13th.

New AHRQ Booklet Explains Breast Cancer Surgery Options in Spanish

AHRQ has published a new booklet to help Hispanic women recently diagnosed with early-stage breast cancer. The booklet provides evidence-based information to help women choose between lumpectomy, a breast-sparing procedure followed by radiation therapy; mastectomy, or removal of the entire breast; and mastectomy with breast-reconstruction surgery. “Las primeras etapas del cáncer de seno. ¿Cuáles son sus opciones si tiene que operarse?” is the Spanish-language version of “Surgery Choices for Women with Early-Stage Breast Cancer,” which was published by the National Cancer Institute in cooperation with AHRQ, the U.S. Department of Health and Human Services’ Office on Women’s Health, and other public and private partners. Included in the booklet are side-by-side comparisons of questions and answers for each procedure, such as whether the type of surgery a woman chooses will affect how long she lives, what the chances are that her cancer will return after surgery, and what her breast will look like after surgery. The booklet is available online in Spanish at and in English at Free copies of the printed versions of the booklets can be ordered by calling the AHRQ Publications Clearinghouse at (800) 358–9295 or by e-mailing

AAFP Releases New Video Program on Bipolar Disorder

The AAFP has released a new video continuing medical education (CME) program on bipolar disorder. The program, which is the latest online offering from the 2005 Annual Clinical Focus on genomics, is designed to teach physicians how to help patients with bipolar disorder and their families understand the connection between the disorder and genetics. The Academy collaborated with the National Coalition for Health Professional Education in Genetics to develop the video. It includes physician and patient vignettes, a clinical presentation, illustrations and graphics, links to key information, a reference guide, and a Web tour of resources. Additional information, including a link to the video, is available online at

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