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Am Fam Physician. 2007;76(4):487-488

House Bill Would Eliminate SGR-Based Payment System by 2010

A House bill would eliminate the sustainable growth rate (SGR) formula by 2010, while providing slight increases in Medicare physician payment rates for the next two years, as an alternative to steep payment cuts called for under the SGR formula. The House Energy and Commerce Committee and the House Ways and Means Committee have drafted legislation to reauthorize the State Children's Health Insurance Program (SCHIP), and have included a provision in that bill to repeal the SGR and provide a 0.5 percent increase in physician payment rates under Medicare in 2008 and 2009. The proposal would negate a 9.9 percent cut in physician payment rates in 2008 and another 5 percent reduction in 2009 called for under the SGR formula used to determine Medicare physician payment levels. During a series of meetings on Capitol Hill in July, Rick Kellerman, MD (Wichita, Kan.), president of the American Academy of Family Physicians (AAFP), urged congressional leaders to stop the scheduled reduction in Medicare payment rates and to provide positive payment updates in 2008 and 2009. For more information, visit and

SCHIP Legislation May Promote Patient-Centered Medical Home

Congress will have an opportunity to include a provision for a patient-centered medical home as part of legislation that reauthorizes the SCHIP, said Rep. Patrick Kennedy, D-R.I., during a June 28 congressional briefing in Washington, D.C. Congress is expected to reauthorize SCHIP this year, giving lawmakers an opportunity to include the patient-centered medical home in a reauthorization bill and to use the legislation to “get the medical home moving” on Capitol Hill, said Kennedy in a briefing for congressional staff sponsored by the Patient Centered Primary Care Collaborative (PCPCC). The PCPCC, a coalition that includes the AAFP, other health groups, and major employers, has sent legislative proposals to Capitol Hill asking lawmakers to give financial support to states wanting to make patient-centered medical homes a part of their SCHIPs. Kennedy endorsed a letter sent by the PCPCC to the chairman and ranking members of the House Energy and Commerce Committee asking for inclusion of a patient-centered medical home in the SCHIP reauthorization bill. For more information, visit

Law to Make Prescriptions Tamper-resistant Raises Concerns

Newly passed legislation intended to mitigate Medicaid prescription fraud will require physicians to begin using electronic prescribing or tamper-resistant prescription pads for their Medicaid patients as of October 1. The legislation, which is part of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, will deny federal reimbursement to states for Medicaid patients' prescriptions that are not written on tamper-resistant pads. However, the law cannot be implemented until final regulations from the Centers for Medicare and Medicaid Services have been published. Physician and pharmacy advocates raised early red flags on the requirement, warning that the law provides too little time to prepare for implementation, may result in additional administrative burdens and costs for physicians and pharmacists, and could discourage physicians from caring for Medicaid patients. For more information, visit

State Scorecard Offers Models for Improving Health Care System

A recent Commonwealth Fund report found that the United States can vastly improve its health care system by using tools that are already in place. The report used quality indicators to rank states' health systems in the general areas of access, quality, potentially avoidable use of hospitals and costs of care, equity, and residents' ability to live long and healthy lives. It also identified policies and programs that boosted outcomes in high-performing states. The report found that if all states reached the levels of the top-ranked states, there would be substantial improvement in access to care and health care quality, reduced costs, and healthier lives. In general, states with the most uninsured residents scored lowest in the areas of access, unnecessary hospitalizations and costs of care, and healthy lives. However, several states operate programs that expand health care coverage, improve access, increase quality, reduce costs, and ease equity gaps. If lower-performing states were to implement such programs, the nation would save lives and money, according to the authors of the report. For more information, visit

Medical Home Model Found to Help Eliminate Health Care Disparities

The patient-centered medical home is key to eliminating racial and ethnic disparities in health care quality and access while improving the care and management of chronic conditions for all patients, according to a new report by the Commonwealth Fund. The report, which is based on a 2006 survey of more than 2,800 adults between the ages of 18 and 64, gauges the level of health care access and quality, especially among minority and low-income patients. It found that linking minority patients to a patient-centered medical home helps eliminate barriers to care, creates greater access to preventive care services, and leads to better management of chronic conditions. In the process, it helps eliminate racial and ethnic disparities in health care. For more information, visit

P4 Initiative Produces “Radical” Approaches to Residency Training

Fourteen family medicine residency programs this summer are launching what have been called radical approaches to training residents. The 14 programs, participants in the Preparing the Personal Physician for Practice (P4) initiative, expect to reorder students' understanding of family medicine, other specialties' assessments of family medicine, and residents' own perceptions of themselves as physicians. They're doing so by restructuring their programs to focus on comprehensive—but still community-based—care that builds relationships with nonphysician and subspecialist health professionals. Under the innovations taking shape in the P4 programs, family medicine educators will instill a solid family physician identity among residents, become a more integral part of other departments' functions, and train future leaders in medicine and community advocacy. For more information, visit

AMA Advised to Make Medical Home Focus of Health System Change

Members of the AAFP's delegation to the American Medical Association (AMA) House of Delegates said that any national health care policy agenda the AMA promulgates should be founded on the primary-care-based medical home and should incorporate a payment model that comprises a fee-for-service component and a per-patient care-management stipend. The AAFP delegates offered that advice during an open forum in Chicago at the annual meeting of the AMA house. More than 300 delegates, alternates, and other stakeholders participated in the June 25th forum, which was convened to solicit comments on a draft policy agenda document the AMA plans to finalize by this fall. In its current form, the AMA draft agenda is divided into five main content areas, including the health care environment, clinical excellence, health of the public, physician practice viability and patient access, and physician education and professionalism. For more information, visit

Survey Shows Number of FPs Using EHRs Continues to Climb

Results from a recent AAFP survey indicate that the number of family physicians using electronic health records (EHRs) has risen consistently since the Academy began measuring members' usage in 2003. One half of the 459 respondents to the survey said they either had fully implemented (37 percent) or were in the process of implementing (13 percent) an EHR system in their practices. By comparison, in 2005 about 30 percent of AAFP EHR survey respondents reported that they were using EHRs in their practices. According to the 2007 survey, physicians who were most likely to have a fully implemented EHR practiced in an urban area, had practiced for seven or fewer years, did not own their practices, and worked in practices with at least two other physicians. For more information, visit

National Immunization Program Web Site Gets Updated Look

The National Center for Immunization and Respiratory Diseases has redesigned the National Immunization Program Web site. The site features an easy-to-read format and gives a listing of the types of information available. Topics include immunization schedules, recommendations and guidelines, vaccines and preventable diseases, statistics and surveillance, calendars, news resources, publications, tools, and training. Individual sections provide materials and resources targeted to health care professionals, program managers, parents, and specific patient populations. For more information, visit or


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Copyright © 2007 by the American Academy of Family Physicians.

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