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Am Fam Physician. 2008;77(3):285-286

Bill Increases Funding for Some Primary Care Programs, Reduces Funding for Others

An omnibus spending bill for the 2008 fiscal year, signed by President Bush, includes a modest increase in funding for rural health programs and the Agency for Healthcare Research and Quality (AHRQ) and a slight reduction in funding for Title VII primary care training programs. The $555 billion spending bill reduces the budget for Title VII primary care training programs from nearly $49 million in the 2007 fiscal year to just under $48 million in the 2008 fiscal year. Under the same bill, funding for AHRQ will increase by $15.6 million from the 2007 fiscal year. President Bush vetoed an earlier spending bill passed by Congress citing the costs of the bill. Congress was able to pass the current bill by cutting $23 billion from the previous measure; these cuts led to a $6.3 billion reduction in spending on labor, health and human services, and education programs. President Bush had called for the elimination of the only federal grants for family physician training, which are provided under Title VII. Therefore, Teresa Baker, government relations representative for the American Academy of Family Physicians (AAFP), says that only a slight decrease in funding from last year is an achievement. Other notable items from the spending bill include a $328.65 million increase in funding for the National Institutes of Health, a $77 million increase for community health centers, and a $2.2 million decrease for the National Health Service Corps. For more information, visit

Foundation Releases Findings From its Report on Pay-for-Performance Initiatives

In a December 20, 2007, press conference, a panel presented findings from a report on pay-for-performance (P4P) initiatives. The report, released by the Robert Wood Johnson Foundation's Synthesis Project, focuses on the widespread interest in physician P4P, designs of current programs, performance measurement issues, physician perception of quality-incentive programs, and the impact of P4P initiatives. The report is intended to clarify P4P expectations for policy makers and purchasers and to assist in the implementation of P4P programs. Key findings include the following: (1) P4P programs show improvement in one or more quality indicators, although it is difficult to separate P4P impact from that of other quality-improvement efforts; (2) creating accurate and transparent methods to measure performance is an important challenge when designing P4P programs; and (3) although physicians support P4P, they are skeptical that payers will implement fair and effective programs. For more information, visit or the Foundation's Synthesis Project Web site at

MedWatch: FDA Warns of Potential Adverse Effects from Bisphosphonate Use

The U.S. Food and Drug Administration (FDA) has issued an alert to health care professionals and patients about adverse effects of bisphosphonate therapy, commonly prescribed for osteoporosis. The therapy may cause severe and sometimes incapacitating bone, joint, or muscle (musculoskeletal) pain. Although the drug label includes a warning about musculoskeletal pain, physicians may overlook this leading to a delay in the diagnosis of symptoms and the need for analgesics. Symptoms may occur from days to years after initiating therapy and should not be confused with the acute symptoms that may occur with the initial administration of bisphosphonates. Some patients report complete resolution of symptoms after discontinuation of therapy, whereas others report slow or incomplete resolution; risk factors for developing the symptoms are unknown. The FDA recommends that physicians assess whether musculoskeletal pain is associated with bisphosphonate use and consider temporarily or permanently discontinuing the therapy. For more information, visit or the FDA Web site at

New CPT Codes Added for Screening and Treatment Related to Substance Abuse

Two new current procedural terminology (CPT) codes, 99408 and 99409, have been added to cover services related to alcohol and drug abuse screening and treatment; tobacco abuse is covered under other codes. Services lasting 15 to 30 minutes can be billed under the 99408 code, and services lasting more than 30 minutes can be billed under the 99409 code. These codes can be billed in conjunction with an evaluation and management code, such as for a physician office visit. Deputy Director of the Office of National Drug Control Policy Bertha Madras, MD, contends that the new codes will strengthen physician-patient relationships and facilitate the assessment of drug and alcohol use. However, David Ellington, MD, Lexington, Va., AAFP's representative to the American Medical Association's CPT Advisory Committee, says that physicians should use these codes cautiously. Ellington warns that private sector health insurance companies may not pay for these codes, and Medicare has its own codes to cover virtually the same services. Because the codes are time-based, careful documentation must be taken at the time of office visits. For more information, visit

A Congressional Advisory Body Reports on Recent Medicare Patient-Access Trends

Representatives from the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, recently reported on findings from the National Ambulatory Medical Care Survey. The survey found that 80 percent of 300,000 office-based physicians accepted new Medicare patients in 2006; this rate is comparable to the acceptance rate for patients covered under noncapitated private insurance plans. MedPAC also reported on its own survey conducted between August and September 2007, which compared Medicare with privately insured patients in their access to physician services and ability to find physicians. The MedPAC survey found that out of 4,061 respondents who looked for a new physician, 353 were looking for a primary care physician and 626 were looking for a sub-specialist. Seventy percent of Medicare patients had no problem finding a new primary care physician compared with 82 percent of privately insured patients, whereas 17 percent of Medicare patients had a big problem finding a primary care physician compared with only 10 percent of privately insured patients. In addition, 85 percent of Medicare patients had no trouble finding a subspecialist compared with 79 percent of privately insured patients. John Richardson, MedPAC principal policy analyst, says that access to current and new physicians remains good for most beneficiaries. For more information, visit or the MedPAC Web site at

CMS Extends Deadline for Physicians to Decide on 2008 Medicare Participation

There is still time for physicians to decide their Medicare participation status for 2008. Because of last-minute adjustments to the Medicare physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) has extended the deadline for physicians to submit their CMS-460 forms to become Medicare participants to February 15, 2008. Forms were mailed to physicians in November as part of a CD, but can also be accessed on the CMS Web site ( Forms must be mailed to local Medicare contractors with a postmark on or before the deadline date. Physicians canceling their participation for 2008 must mail the request in a letter to their local contractor. For more information, visit

Study Reports That Employer Spending on Value-Based Health Care Is Limited

A study published in the November 21, 2007, issue of JAMA reported that many large employers are not using their health plan-related purchasing power to improve the quality of health care for their employees. Although a significant number of the employers surveyed said that they examine quality data on health plans, many reported that it is of low importance. Few employers use the data to reward provider performance or to influence employee choice of provider. Larger employers reported more activity than smaller employers, possibly because of the costs and low perceived benefits associated with health care quality-improvement initiatives. However, even larger employers are not adopting value-based purchasing strategies. The study suggests that skepticism about the benefits of value-based purchasing may be an important factor in why the practice is not more widespread. For more information, visit html or JAMA's Web site at

AAFP Online Video Series Describes the Benefits of Primary Care Physicians

Texas AFP and other AAFP constituent chapters have produced a series of online videos, aimed at physicians and patients, to advocate for family medicine and to lobby against Medicare payment cuts. The series arose from Texas AFP's weekly webcasts that covered the state legislature. Each five-minute, state-specific video includes interviews with physicians and local and federal legislators from that state. The primary goals of the video series are to motivate AAFP members and to educate policy makers about the importance of family medicine at a grassroots level. The series is funded by the Pharmaceutical Research and Manufacturers of America. For more information, visit


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