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Am Fam Physician. 2007;76(3):327-328

CMS Proposes Medicare Rule That Includes 9.9 Percent Payment Cut

The Centers for Medicare and Medicaid Services (CMS) has proposed revising Medicare payment rates, extending the length of a quality reporting program, and implementing a controversial provision to reduce Medicare physician payments by nearly 10 percent in 2008. The agency issued a proposed rule on July 2 that calls for several revisions in the Medicare physician fee schedule and an extension through next year of the Physician Quality Reporting Initiative, which pays physicians for participating in a voluntary quality reporting program under Medicare. In addition, the proposed rule contains a provision that would reduce physician payments under Medicare by 9.9 percent next year, as called for by the sustainable growth rate formula used to determine payment rates. Congress is expected to intercede before the payment cut takes place. For more information, visit, or

Level Funding Likely in 2008 for Primary Care Training Programs

The Senate Appropriations Committee passed a fiscal year 2008 spending bill in June that would continue funding Title VII primary care training programs at current levels, increasing the chances that the full Congress will approve level funding for the programs. The U.S. Senate Committee on Appropriations funded Title VII of the Public Health Service Act at $184.7 million, with primary care training programs accounting for $48.8 million—the same amount as in the 2007 budget. The House Appropriations Committee also approved $228.2 million for Title VII, a 23 percent increase over 2007. However, the House funded primary care training programs at the same level as the Senate. The Bush administration's 2008 budget requests only $10 million for Title VII for scholarships for disadvantaged students and seeks to eliminate funding for the rest of Title VII. For more information, visit

Family Medicine Alliance Protests CMS Proposal Regarding Education Costs

The Academic Family Medicine Advocacy Alliance has protested a proposed CMS rule that contends graduate medical education costs are not federally reimbursable under the Medicaid program. The proposed rule was issued by CMS in May, clarifying Title XIX of the Social Security Act. In a letter and 21-page legal analysis sent to Leslie Norwalk, acting administrator of CMS, the alliance stated that implementation of the rule would cost teaching hospitals $1.78 billion in funds used to defray the cost of medical education. In addition, the rule has no legal foundation and has been explicitly prohibited in recent legislation, the letter said. According to the legal analysis, CMS does not have the discretion under Medicaid law to refuse to federally match states' expenditures for medical education as part of their medical assistance programs. Such an action would require an amendment to Title XIX, the analysis stated. For more information, visit

Family Medicine Organizations Oppose Graduate Education Funding Policies

Several family medicine organizations have expressed their opposition to a final rule issued by CMS continuing the stipulation that teaching hospitals pay “all or substantially all” of the cost of resident education because they do not pay their community-based volunteer preceptors. The American Academy of Family Physicians (AAFP), the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine, and the North American Primary Care Research Group stated in a letter to CMS that the policy threatens the viability of residency training programs at a time when the nation needs more primary care physicians. The AAFP and other organizations have fought the volunteer preceptor rule with letters, personal meetings, and appeals to Congress. However, a final rule issued on May 11 continued the policy. For more information, visit

Study Shows Duty-Hour Limits Improve Some Outcomes

According to research in the July Annals of Internal Medicine, work-hour rules that limit residents to an average 80-hour workweek have resulted in fewer in-hospital transfers to intensive care, fewer pharmacist interventions to avoid medication errors, and more discharges to home or rehabilitation services. The study is among the first to examine the effects of duty-hour limitations implemented in July 2003. As a result of the limits, teaching hospitals had to reorganize work schedules, often sending residents home at night and turning patient care over to nonresident physicians who provided after-hours care. This increased the number of physicians involved in each patient's care, thereby increasing discontinuity in care. Researchers surmise that reduced fatigue among residents, greater clinical involvement by more senior physicians, and use of night-shift physicians with more clinical experience than residents could have contributed to the improved outcomes, despite the increased discontinuity. For more information, visit, or

Opinion Poll Shows Americans Support Universal Health Coverage

Americans support universal health coverage even if it means higher taxes, according to a study by Catholic Healthcare West, California's largest not-for-profit hospital system. Researchers gathered responses from 1,771 adults nationwide. The study reported that 89 percent of respondents are concerned about the number of uninsured Americans, 72 percent agreed that the time has come for universal health care, and 63 percent agreed the time has come even if it means increasing taxes. Almost two thirds of respondents said they worry about their ability to afford necessary health care services, and more than one third said they could not afford these services. The researchers also found that 20 percent of respondents had bypassed a recommended test or procedure due to an inability to pay, 65 percent were worried about their ability to manage a chronic disease, and 22 percent said they did not see a physician when they were sick because they could not afford the cost. For more information, visit, or

Researcher Outlines Risks of Dependence on Subspecialty Care

In a videoconference presentation sponsored by the Patient Centered Primary Care Collaborative, Johns Hopkins University and Medical Institutions professor Barbara Starfield, MD, MPH, warned that the nation's reliance on subspecialty care has put Americans at an increased risk of death and disease, leading to poorer health care outcomes and driving up health care expenditures. Starfield's data showed that countries with health care systems based on primary care have better health outcomes, lower costs, and greater equity in health care than the United States, which has a system based more on subspecialty care. In the United States, 60 to 80 percent of the population younger than 65 years visits a subspecialist each year, compared with 31 percent in Ontario, Canada; 16 percent in England; and about 33 percent in Spain. According to Starfield, all three countries have better health outcomes than the United States. For more information, visit

2007 AMA House of Delegates Debates P4P, Other Issues

Pay-for-performance (P4P) drew the lengthiest—and per-haps most contentious—testimony during the June meeting of the American Medical Association (AMA) House of Delegates in Chicago, but other topics also sparked debate. After members of the AAFP delegation to the AMA House pointed to the inevitability of P4P implementation and advocated a proactive approach to the issue, delegates directed the AMA to study P4P programs, collaborate in the development of future P4P initiatives, and work with medical specialty organizations to establish other ways to improve quality of care. The delegates also adopted recommendations from an AMA council report on the use of selective serotonin reuptake inhibitors by pregnant women, encouraging further research in this area. In addition, the house called for the AMA to oppose legislation to criminalize the provision of health care to undocumented residents, including measures requiring health professionals to obtain proof of citizenship as a prerequisite to care. For more information, visit

Google Recruits Health Care Experts for Advisory Council

Internet giant Google Inc. has announced the formation of the Google Health Advisory Council. Twenty-two individuals, including Douglas Henley, MD, executive vice president of the AAFP, have volunteered to serve one-year terms on the council. Group members, who will meet formally each quarter, have made individual commitments to supply Google with informal feedback and advice during their tenure. Council members include health care experts from physician-based organizations, provider organizations, consumer and disease-based groups, research institutions, and health care policy foundations. Google formed the council to obtain advice as the company tries to help people find the answers they need for health issues, said company vice president Adam Bosworth. For more information, visit


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