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Am Fam Physician. 2007;75(11):1609-1610

Legislation Seeks to Enhance Access to Cancer Screenings

President Bush signed legislation intended to increase the number of screenings for breast and cervical cancer available to low-income uninsured and underinsured women. The legislation reauthorizes and increases funding for the National Breast and Cervical Cancer Early Detection program, which provides screenings for low-income women with little or no insurance. The legislation also gives states greater flexibility to reach more women who qualify for the program. It reauthorizes the program through fiscal year 2012 and increases funding levels to $275 million a year by 2012, enough to serve approximately 150,000 more women annually. The program includes an outreach component and case management services for women who are diagnosed with cancer as a result of the screenings. For more information, visit, or

Alaska Medicare Environment Highlights Payment Crisis

Alaska is already dealing with a serious primary care physician shortage, and now many physicians are refusing new Medicare patients. Some are dropping Medicare participation altogether or are discontinuing current patients when the patients turn 65. Many Alaskan physicians have testified to the state legislature that Medicare pays less than 50 percent of what it costs to treat their patients. In addition, the state's cost-of-living index historically has been significantly higher than those seen in the lower 48 states. In 2006, a federal program that added 4 percent to physician payment rates in Alaska ended, and it has been reported that rates are now so low that some clinics are closing. In response, the Alaska Senate has passed a resolution calling on the U.S. Department of Health and Human Services and Congress to rewrite the formulas used to develop Medicare reimbursement rates for Alaska and the nation. For more information, visit

Speakers Say Medicare Payment Rates Major Reason for Physician Shortages

Medicare's payment system has contributed to the decreasing interest in primary care careers in the United States and to deterioration in the nation's primary care infrastructure, said a family medicine professor and medical researcher during an April 13 panel presentation before the Medicare Payment Advisory Commission. Kevin Grumbach, MD, professor and chair of the Department of Family and Community Medicine at the University of California, San Francisco, said Medicare's payment structure has made subspecialty practices much more lucrative for physicians, which is an important reason why there will soon be a decline in the number of primary care physicians per capita in the United States. Grumbach said that, under Medicare, primary care physicians receive substantially less in compensation than subspecialists, earning about $82 per half-hour for evaluation and management services compared with about $683 per half-hour for ophthalmologists who perform cataract surgery and about $286 per half-hour for gastroenterologists who provide colonoscopies. For more information, visit

AAFP Asks CMS to Increase Estimation of Notice of Noncoverage Burdens

The Centers for Medicare and Medicaid Services’ (CMS’) estimation of the financial burdens placed on family physicians who supply Medicare patients with Advance Beneficiary Notice of Noncoverage (ABN) forms is too low, according to the American Academy of Family Physicians (AAFP). In a letter to CMS, the AAFP states that the current estimate of about $69 per notifier per year to provide and complete ABN forms should be increased to nearer $275 to take into account staff time and other resources. The AAFP also suggests that CMS increase 50- to 100-fold the number of ABNs it estimates individual family physicians generate each year. In addition, CMS should consider physician-friendly changes to the ABN form, such as avoiding overuse of regional policies developed by local Medicare carriers and national policies developed by CMS. For more information, visit

Former House Speaker, Others Endorse Medical Home Concept

The medical home will become a major component of managing patient care as the nation's health care system moves toward integrating innovative technologies and places a greater emphasis on preventive care, said former Speaker of the House Newt Gingrich and others during a Capitol Hill briefing for health care industry leaders in April. Gingrich said that the nation's health care system is moving from an acute care, post-crisis model to a preventive health care paradigm in which patients will be aware of their propensity for certain diseases long before they might be affected. In this environment, patients will need the advantages of a medical home to help manage their health care, said Gingrich. He likened the medical home to a health care coordinator capable of helping patients understand the implications and impact of genetic testing and other health care advances on their care. For more information, visit

Joint Commission Report Examines Physician-Patient Communication

The Joint Commission released a public policy report that emphasizes the dangers of inadequate communication between physicians and their patients. “‘What Did the Doctor Say?’: Improving Health Literacy to Protect Patient Safety” uses personal vignettes to illustrate communication problems, possible causes, and solutions. According to the Joint Commission, communication is a cornerstone of patient safety, and if patients do not understand their conditions or the treatments prescribed, they may be harmed. The Joint Commission recommends 35 actions to improve communication with patients and increase patient literacy, including training and using interpreters for patients with limited or no English proficiency, using established patient communication methods, redesigning informed consent forms and revamping the informed consent process, integrating patient communication as a priority into pay-for-performance programs, and providing medical liability insurance discounts for physicians who apply patient-centered communication techniques. For more information, visit, or

Study Shows Canadian Physician Workforce Depleted by Emigration

Canada has emerged as a major supplier of physicians to the United States in the past several years, according to a study in the April 10 Canadian Medical Association Journal. During the past 30 years, about 19,000 physicians trained in Canada have crossed the border into the United States, depleting the Canadian supply of physicians in the process, says “The Canadian Contribution to the U.S. Physician Workforce.” In 2006, there were 8,162 Canadian-educated physicians providing direct patient care in the United States—about one in nine Canadian-trained physicians. Canada now has a severe shortage of physicians; in many parts of Canada, people are unable to find a family physician because so many of them have moved to the United States. The study was conducted by the Robert Graham Center in Washing-ton, D.C., and two universities. For more information, visit or

Technology Expert Calls for Standard Rules, Regulations on EHRs

The federal government needs to develop a uniform policy for protecting the confidentiality and security of electronic health records (EHRs) before the current system of data management becomes even more unmanageable and difficult to navigate, said David C. Kibbe, MD, MBA, senior adviser to the AAFP's Center for Health Information Technology. Testifying before the Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health Statistics on April 17, Kibbe said widespread confusion exists about the privacy and confidentiality of EHRs and other electronic systems. He noted that government officials still are unable to answer several basic questions about data ownership and access, and offered principles to reform the government's approach to privacy. For more information, visit

Medicare Carrier Removes Wound Debridement Restrictions

Medicare carrier TrailBlazer Health Enterprises has removed restrictive language it had proposed in its draft local coverage determination on wound care. The move affects family physicians in Delaware, Maryland, Texas, Virginia, and the District of Columbia. The company had proposed that wound debridement coverage be limited to three debridements of a given wound. The AAFP, however, pointed out that language in the carrier's own local coverage determination stated that although repetitive debridement of an individual wound is uncommon, sometimes, as with osteomyelitis, serial debridement is the only option. The offending language was removed from the “Utilization Guidelines” section of TrailBlazer's final policy. For more information, visit


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