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Am Fam Physician. 2007;76(10):1439-1440

AAFP Denounces President Bush's Veto of SCHIP Legislation

President Bush recently vetoed legislation that would have improved health coverage for children under the State Children's Health Insurance Program (SCHIP). The American Academy of Family Physician's (AAFP's) Board Chair Rick Kellerman, MD, Wichita, Kan., criticized the president's decision to veto the bipartisan Children's Health Insurance Program Reauthorization Act (H.R. 976), stating that the veto hurts children of low-income families who do not have access to health insurance. The Academy spent months meeting with policy makers and urging them to support an expansion of the SCHIP program. The final legislation, which passed the House and Senate, called for a $35 billion expansion during the next five years, increasing SCHIP-covered patients to nearly 10 million. The expansion was higher than a previous proposal by President Bush that would have increased SCHIP funding by $5 billion during the next five years. Although the Senate passed the bill by a veto-proof margin, the House was not able to override the veto. Both houses of Congress are expected to immediately begin work on new SCHIP legislation, and the president has said he is willing to negotiate a plan for the future of the program. For more information, visit

Legislation Would Publicize Medical Industry Gifts to Physicians

Under proposed legislation, names and practice addresses of physicians who receive gifts from pharmaceutical or medical device companies would appear in a publicly accessible national database. The Physician Payments Sunshine Act (S.B. 2029) would require companies that manufacture medical products to report gifts given to physicians that exceed $25. The legislation covers honoraria, travel and other rewards, drug samples, and research funding. The legislation aims to allow patients to decide for themselves whether their physician may be influenced by medical companies. Guidelines from the American Medical Association's (AMA's) Council on Ethical and Judicial Affairs recommend that physicians not accept industry gifts that are of substantial value or that are conditional ( Acceptable gifts include those that benefit patients or that are related to the physician's work. The U.S. Department of Health and Human Services (HHS) would create and maintain the database, and companies would be fined $10,000 to $100,000 for each incidence of noncompliance. The legislation would augment, not preempt, state measures already in place to regulate industry gifts to physicians. For more information, visit

Major Insurers Join Patient-Centered Primary Care Collaborative

Seven large insurance companies have joined the initiative to implement multipayer, patient-centered medical home demonstration projects and to contribute to the evidence that the new model of care is better for patients. Aetna, BlueCross BlueShield Association, CIGNA, Humana, MVP Health Care, UnitedHealthcare, and WellPoint, Inc., recently became part of the Patient-Centered Primary Care Collaborative (PCPCC). The collaborative is made up of dozens of medical organizations, including AAFP, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. PCPCC leaders say the addition of the seven insurers will increase the collaborative's influence in the national health care reform debate. The PCPCC contends that a successful shift to the patient-centered medical home model relies on insurers restructuring payment systems to reward physicians for providing primary care and for practicing under the new model. For more information, visit

Survey Results Show Demand Growing for Primary Care Physicians

According to a new survey, the need for primary care physicians outweighs the need for physicians in other subspecialties. Between April 2006 and April 2007, Merritt Hawkins & Associates, a national search company that recruits physicians for hospitals and medical groups, conducted 3,016 searches in more than 70 subspecialties. Of these searches, the demand was greatest for primary care physicians, followed by general internists, physicians without defined subspecialties, radiologists, and orthopedic surgeons. Primary care physicians ranked second in the 2005 to 2006 survey and fourth in the two previous surveys, demonstrating the increasing demand for family physicians. This demand plus an overall shortage of physicians in primary care has created more opportunities for family physicians, including increased salaries and benefits. The average salary or income-guarantee offered to family physicians increased by 11 percent between 2005 and 2007, whereas other subspecialties remained relatively even. For more information, visit or

Ruling Requires AMA to Release Data on Medicare Payments

The Consumers' Checkbook/Center for the Study of Services (CSS) has won a freedom-of-information lawsuit against the HHS. The ruling requires the AMA to provide Consumers' Checkbook/CSS with information on all physician claims that have been paid by Medicare to the consumer group. The group plans to make this information, which would identify physicians but not patients, available on the Internet. The president of Consumers' Checkbook/CSS says that the data would provide patients with more information to determine the quality of a physician's care and would provide physicians with feedback on how well they are doing. The AMA, however, is concerned about the unregulated release of sensitive health data. The association argues that the data could be misleading and could have privacy implications for patients. For more information, visit

Graham Center to Study Effects of Student Debt, Primary Care Training

AAFP's Robert Graham Center in Washington, DC, has received a one-year grant from the Josiah Macy Jr. Foundation, New York, N.Y., to study what influences medical students' decisions when choosing which subspecialty to pursue. Although previous studies have examined how individual factors influence student career choices, this will be the first to look at what roll debt at medical school graduation plays in these choices. The study will also determine whether medical students were exposed to primary care or worked with under-served populations during their training and whether these experiences influenced their career choices. The study will specifically examine the effectiveness of Title VII primary care training programs and whether they affect student debt. The Graham Center director hopes that the study will reinforce the importance of primary care training in medical school, but concedes that student debt and higher salaries in other subspecialties may deter students from choosing to practice in the primary care field. The University of California, San Francisco; Dartmouth College, Hanover, N.H.; and New York University, New York, will help conduct the study. Results are expected late next year. For more information, visit

Family Physicians Inconsistent in Adherance to Depression Care Guidelines

A new study published in the September 4, 2007, issue of Annals of Internal Medicine examined how well primary care physicians adhere to depression guidelines. One half of the 20 depression care quality measures studied had low adherence rates; however, one third of the measures had high adherence rates. All physicians studied provided patient education, and, overall, physicians recognized patients with depression and adequately monitored them for several months. Generally, treatments met patient needs and preferences, and patients received the recommended level of follow-up within six months of their diagnosis. Physicians did less well in other areas, including following clinical quality indicators, ensuring that patients completed minimum treatments, and following up with patients whose symptoms had resolved. The measures with the lowest adherence rates were related to adjusting treatment in patients who did not respond to therapy, managing suicidality, and treating older patients. For more information, visit or the Annals of Internal Medicine Web site at

New METRIC Module Focuses on Preventive Care for Older Patients

AAFP has added a fifth module to its METRIC (Measuring, Evaluating, Translating Research Into Care) program. Although the first four modules in the performance improvement program's menu focus on clinical conditions, the new module covers preventive medicine in a specific population—older patients. The Geriatrics: Improving Patient Care module, which is supported by an educational grant from the AAFP Foundation, was implemented in response to the growing number of older persons in the United States. The module includes tools and resources to help physicians address topics important in the care of older patients, including medication use, fall risk, advance care planning, urinary incontinence in women, and influenza vaccination. For more information, visit


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