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Am Fam Physician. 2008;77(5):583-584

Budget Proposal Calls for Funding Cuts, Elimination of Health Care Initiatives

President Bush's final budget proposal calls for deep reductions in funding for Medicare and Medicaid programs as well as the elimination of health care initiatives important to primary care. The proposal, which is part of the 2009 fiscal year budget, includes eliminating funding for graduate medical education in Medicaid programs and duplicate Medicare Advantage payments to teaching hospitals for indirect medical education. The budget also proposes the elimination of Title VII training programs. Although it is standard for the President to call for the elimination of Title VII primary care training programs, says American Academy of Family Physician's (AAFP's) President Jim King, MD, Selmer, Tenn., the budget crunch may not allow Congress to reinstate it. Bush's budget proposal also reduces funding for the Agency for Healthcare Research and Quality by $9 million, eliminates funding for the Preventive Health Block Grants, reduces funding for the Health Resources and Services Administration by $1 billion, reduces funding for mental health and substance abuse programs by $198 million, and freezes spending for the National Institutes of Health at $29.5 billion. However, the budget also proposes a $19.7 billion increase in funding for the State Children's Health Insurance Program for five years. For more information, visit

Program Recognizes Practices That Follow Patient-Centered Medical Home Model

The National Committee for Quality Assurance (NCQA) recently implemented the Physician Practice Connections—Patient-Centered Medical Home recognition program. The program recognizes physician practices that meet standards aligned with the joint principles of the medical home created by the AAFP, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. To be considered for the recognition program, physicians must complete an online survey and provide documentation to validate their responses. The NCQA evaluates the practices using a point system, and practices can increase their level of recognition as they achieve additional requirements. There is an $80 licensing cost to purchase the NCQA survey tool and a $450 or $2,700 application fee, depending on the size of the practice. For more information, visit or the NCQA Web site at

HHS Secretary Announces Launch of Electronic Health Records Pilot Project

The U.S. Department of Health and Human Services (HHS) has launched a five-year, $150 million initiative to increase the use of electronic health records (EHRs). The program will fund a national EHR Demonstration Project that includes physicians who use EHR systems certified by the Certification Commission for Health-care Information Technology, report quality data to the Centers for Medicare and Medicaid Services (CMS), and deliver high-quality health care based on national standards. HHS Secretary Michael Leavitt says that the initial costs associated with EHRs, which can total $30,000 to $40,000, is the major barrier preventing physicians from implementing EHR systems. The federal initiative will provide core incentives based on performance related to quality measures and physician bonuses based on how well the systems are used to manage patient care. Leavitt says that although physicians are now being rewarded for using EHRs, the systems will eventually be required for some physician reimbursements. For more information, visit or the CMS Web site at

State Health Insurance Initiative Reflects Importance of Access to Primary Care

In 2006, Massachusetts became the first state to require residents to carry health insurance, which has brought more than 300,000 previously uninsured residents into the health care system. However, the Massachusetts Health Care Reform Plan has created a demand for primary health care services, which the state is struggling to meet because of a physician shortage. Although Massachusetts AFP President Patricia Sereno, MD, Stoneham, says the health care plan comes close to providing universal access, it cannot work without an adequate supply of primary care physicians. A physician shortage creates a gap between coverage and provision of services. The Massachusetts Medical Society's 2007 Physician Workforce Study shows that patients may have to wait weeks and sometimes months to see a primary care physician, prompting some patients to turn to subspecialists for care. Sereno says that this undermines the true intent of the Massachusetts plan and increases costs. For more information, visit

HHS Awards Grant for Transition of Health Information Technology Collaboration

The HHS has provided a grant to LMI Consulting, McLean, Va., in conjunction with the Brookings Institute, to establish a successor to the the American Health Information Community (AHIC) by December 2008. The AHIC advises the HHS secretary on how to accelerate the development of health information technology. The successor, AHIC 2.0, will be a self-sustaining, public-private partnership that is based in the private sector. Leavitt calls the transition a key milestone in health information technology. The grant provides funding in two stages. The first stage includes $2 million for stakeholder outreach and the development of governing documents, and the second stage includes $3 million for the establishment of AHIC 2.0. For more information, visit or the HHS Web site at

Indiana Restructures the State's Medicaid Program to Focus on Primary Care Services

Indiana government leaders are working toward making primary care the cornerstone of the state's Medicaid program. The Indiana Check-Up-Plan, passed by the Indiana General Assembly in 2007, provides bonuses and increased payments to primary care physicians who participate in the state's Medicaid program. A permanent 25 percent rate increase was also enacted for physicians who provide certain primary care services, such as preventive care, some evaluation and management procedures, early periodic screening, and diagnosis and treatment. Other states have taken notice of Indiana's restructured Medicaid program. Joe Neller, director of government relations for Michigan AFP, says that other states can point to Indiana to show that such initiatives provide a large return by increasing payments. For more information, visit

Small Practice Owners Are Struggling to Provide Health Insurance for Employees

Small business owners, including one family physician, testified before the House Committee on Small Business that rising health insurance costs are forcing small business owners to limit or drop coverage for their employees. Stephen Eby, MD, owner of Western Family Physicians in Cincinnati, Ohio, said that physicians are unable to provide adequate health insurance for their employers while health plans report record profits. The problem is compounded by physician payment rates that have not kept up with rising medical costs. Eby called on committee members to recognize the need for an updated Medicare payment system and the importance of the patient-centered medical home. For more information, visit

New Medicare Policy Allows Physicians to Charge Patients for Missed Appointments

A change in Medicare's billing requirements now allows physicians to charge Medicare beneficiaries for missing appointments, as long as non-Medicare patients are charged the same amount for missing appointments. Many physicians are unaware of the policy, which became effective in October. According to Medicare, the charge is for a missed business opportunity. Therefore, although physicians should not submit claims to Medicare for services related to the missed appointment, Medicare regulations do not preclude physicians from charging patients directly. For more information, visit or the CMS Web site at

Med Watch: FDA Alerts Physicians to New Prescribing Information for Varenicline

The U.S. Food and Drug Administration (FDA) has issued a public health advisory to inform patients, physicians, and caregivers about important changes in the varenicline prescribing information. New warnings and precautions have been added after the FDA concluded that varenicline, a smoking cessation drug, is increasingly likely to cause severe mood and behavior changes. The new safety information includes the following: patients should disclose any history of psychiatric illness to their physicians before starting varenicline therapy; physicians, patients, and caregivers should be alert to changes in mood and behavior after the patient begins therapy; and patients should immediately report such changes to their physicians. In addition to the updated prescribing information, the FDA is working with Pfizer, the manufacturer of varenicline, to finalize a medication guide for patients. For more information, visit the FDA Web site at


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