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Am Fam Physician. 2008;77(4):423-424

Analysts Predict No Major Nationwide Health Care Reform in the Near Future

According to analysts, budget and tax debates may hold up federal health care reform initiatives in 2009. The new presidential administration and Congress will have to focus their attention on urgent budget issues, such as the federal deficit, national debt, and the end to President Bush's tax cuts in 2010. Therefore, incremental changes are more likely than major health care reform, says Richard Wender, MD, chair of Thomas Jefferson University Hospital of Philadelphia's Department of Family and Community Medicine. This leaves sweeping reform initiatives up to state governments. Some states have already addressed health care reform by expanding health insurance coverage, implementing quality incentives, and allocating more money for primary care services. Wender and other analysts contend that the success of national health care reform also depends on new collaborations, such as input from insurance companies and large employers, and on the restructuring of the Medicare payment system. For more information, visit

Congressional Advisory Body to Submit Medicare-Related Recommendations

The Medicare Payment Advisory Commission (Med-PAC) has approved a two-part recommendation that it plans to submit to Congress in March. The first part of the recommendation calls for a 1.1 percent increase in Medicare physician payment rates in 2009 to counteract a 5 percent reduction expected to occur under the sustainable growth rate (SGR) formula. However, committee members caution that the recommended rate increase is not a long-term solution to inflation and rising medical costs. MedPAC Chair Glenn Hackbarth, JD, says that difficult issues remain regarding the payment system's impact on physicians. MedPAC recommends that Congress override the SGR in 2009 and, instead, base payment rates on input prices and productivity growth, which results in a 1.1 percent payment increase. The second part of the recommendation calls for legislation that requires the Centers for Medicare and Medicaid Services (CMS) to implement a system for confidentially measuring and reporting the use of physician resources for two years. The system is aimed at giving physicians feedback on their care of patients and the resources they use to care for patients compared with other physicians. For more information, visit or the MedPAC Web site at

CDC, AAFP, and AAP Update Immunization Schedules for Children and Adolescents

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices, in collaboration with the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP), has released updated immunization schedules for children and adolescents. An article on the revised schedules appears in the January 11, 2008, issue of Morbidity and Mortality Weekly Report ( The revised schedules do not include additional immunizations, but there are some changes from the 2007 schedules. Notable changes include expanding the use of the live, attenuated influenza vaccine to children two to five years of age (it was previously limited to children five years and older), and recommending that children younger than nine years who are receiving their first influenza vaccine or who received their first vaccine last season but received a single dose receive two doses at least four weeks apart. Protocols for the quadrivalent meningococcal conjugate vaccine have also changed, including an expanded age range. The schedules do not take into account the U.S. Food and Drug Administration's (FDA's) interim guidelines for the administration of the Haemophilus influenzae type b (Hib) vaccine, which was recently released in response to possible shortages. Until the shortage issue is resolved, physicians should follow the FDA's interim guidelines for the administration of the Hib vaccine. For more information, visit or Practice Guidelines in the January 1, 2008, issue of AFP at

Despite Increase, Funding for Antitobacco Programs Fall Short of Recommendations

Funding for tobacco prevention and cessation programs have increased one decade after a multistate tobacco settlement expected to total $246 billion over 25 years was handed down; however, most states are still below funding levels recommended by the CDC. According to a report sponsored by the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association, and the American Cancer Society, states overall have increased funding for antitobacco programs by 20 percent to about $717 million in the 2008 fiscal year, which is the highest level in six years. However, only three states (Maine, Delaware, and Colorado) are meeting CDC recommended funding levels for tobacco prevention programs. Thirty states and the District of Columbia are spending less than one half of the recommended amount. However, the 1998 tobacco settlement allows for bonuses over 10 years totaling nearly $1 billion per year starting in April 2008. These bonuses will give states another chance to adequately fund antitobacco programs. For more information, visit or the Campaign for Tobacco-Free Kids Web site at

Amendment to SCHIP Bill Cuts Physician Payment for Point-of-Care A1C Test Kits

An amendment to the Medicare, Medicaid, and State Children's Insurance Program (SCHIP) Act of 2007 (S. 2499) cuts Medicare payment for the use of A1C test kits at the point of care. Under the bill, which was passed in mid-December, payment will decrease from $21.00 to $13.50 beginning April 1, 2008. Payment for using the test kits will now be the same as for using more expensive analyzers in the office or laboratory, which is not affected by the bill. The average list price for the point-of-care test kit is about $13; however, physicians incur additional costs because of shipping, overhead, and staff expenses. In 2006, the AAFP convinced the CMS to increase physician payment for the use of the lower-cost test kits, arguing that the increase would encourage more point-of-care testing and allow physicians to better monitor patients with diabetes. For more information, visit

Online Tool Helps Physicians Align with Patient-Centered Medical Home Model

TransforMED has launched an online questionnaire to help physicians align their practices with the patient-centered medical home model. Although TransforMED is developing a comprehensive assessment tool, the current 12-question survey, TMED Medical Home Vitals, is a self-education tool for physicians and not a formal assessment tool. TransforMED's practice metrics manager Elaine Skoch, RN, says that the questionnaire helps physicians identify elements of the medical home that already exist in their practices, including access to care, team-based care that adheres to evidence-based treatment guidelines, information technology, and processes for patient feedback. Upon completion of the questionnaire, physicians receive a score that indicates the practice's level of advancement toward the medical home model. For more information, visit or the TransforMED Web site at

FDA Warns Against Giving Young Children Over-the-Counter Cough, Cold Medicines

Over-the-counter cough and cold medicines can cause serious and potentially life-threatening adverse effects in children younger than two years, according to a recent FDA advisory. The FDA released the public advisory after the FDA's Nonprescription Drugs Advisory and Pediatric Advisory Committees reviewed published data on the use of these medications. Although the committees' review of cough and cold medication use in older children is ongoing, the current advisory includes the following recommendations for children two to 11 years of age: check the active ingredients to make sure the product does not include more ingredients than is indicated for a child's symptoms, exercise added caution when administering more than one product, follow the dosing instructions carefully, use only the measuring implement included with the product, never use these products to sedate a child, and contact a health care professional if there are questions about the use of these products. For more information, visit or

Recent Study Compares Family Physician, Hospitalist, and Generalist Inpatient Care

According to a study published in the December 20, 2007, issue of the New England Journal of Medicine, the use of hospitalists for inpatient care may reduce the length of hospitalizations and costs compared with generalist or family physician care. However, these reductions were modest. The reduced length of hospitalization may be related to on-site availability or alignment of incentives with the hospital. Hospitalist care is also associated with a higher risk of medical errors and adverse events, possibly because different physicians care for the patient at admission and discharge. Death and readmission rates are similar among the three groups. For more information, visit or


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