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Am Fam Physician. 2008;77(6):753-754

Senate Testimony Links Primary Care Shortages to Skewed Payment System

Recent testimony before the Senate Health Education, Labor, and Pensions Committee linked the fee-for-service Medicare payment system to primary care shortages. Primary care services are undervalued in the U.S. health care system, according to witnesses, leading to lower physician payments and, subsequently, fewer new primary care physicians. Seven witnesses from various facets of primary care participated in the Senate roundtable discussion about workforce issues. Bruce Steinwald, director of health care for the U.S. Government Accountability Office, testified that there are disparities in Medicare payments between primary care services and subspecialty services, which discourage students from choosing the primary care specialty. In addition, technologic advances have allowed subspecialists to offer complex services more quickly, which has compounded the problem. The witnesses contended that efforts to improve health care and reduce costs will fail if steps are not taken to increase the number of primary care physicians. For more information, visit

IOM Offers Blueprint for Standardizing Systematic Reviews of Clinical Effectiveness

A new report released by the Institute of Medicine (IOM) recommends that the federal government implement a program under the Department of Health and Human Services (HHS) to standardize systematic reviews of clinical effectiveness. The study, “Knowing What Works in Health Care: a Roadmap for the Nation,” looked at how various organizations review clinical data and how they determine which information the health care system should adopt. According to the report, the current system lacks universal criteria, creating competing practice guidelines and uncertainty about best practices. The program would give the HHS the authority to set priorities, fund and manage systematic reviews of clinical effectiveness, and develop common language and standards for conducting systematic reviews and generating clinical guidelines. The program would also provide a forum for addressing conflicting guidelines and a prioritization system for research that is based on national needs, not on the availability of funding. The authors of the report say that the program will ensure a transparent, reliable resource for information on the effectiveness of health care services. For more information, visit or the IOM Web site at

FSMB to Propose Guiding Principles for Physician Licensure Maintenance Process

The Federation of State Medical Boards (FSMB) has created guiding principles for adding accountability to the licensure maintenance process. This is in response to data showing that licensure and relicensure processes that are based on competency could improve safety in the health care system. In May, the FSMB is expected to ask its House of Delegates to approve the following guiding principles: maintenance programs should allow physicians to demonstrate a commitment to lifelong learning and practice improvement, allow for collaboration with many stakeholders, include requirements that focus on quality improvement and that are not punitive in nature, establish how physicians would access remediation programs if deficiencies are identified, and allow physicians to receive training and interventions without fear of punishment. If these principles are adopted, the FSMB would evaluate their potential impact by analyzing state medical board and stakeholder resources and implementing pilot projects and other studies. The American Board of Family Medicine says the FSMB initiative complements its own certification maintenance program. For more information, visit

Medicare Private Fee-for-Service Plans Are Burdensome for Many Medical Practices

Private fee-for-service plans offered under the Medicare Advantage managed care program now include 1.7 million beneficiaries, compared with 20,000 beneficiaries in 2005. This rapid growth has prompted concerns from the public and private sectors because these plans place financial and administrative burdens on many physician practices. Private fee-for-service plans are not required to provide enhanced coverage, negotiate with service providers, offer coordinated care networks, or submit quality care data; however, the federal government pays more for these plans than other plans to encourage enrollment. Witnesses recently testified before the Senate Finance Committee that many physicians consider private fee-for-service plans burdensome and less transparent than traditional plans, and that some practices will no longer treat patients covered under these plans. Executive Director of the Medicare Payment Advisory Commission, Mark Miller, PhD, says that the commission recommends payments that are neutral and produce efficiencies among all service providers. For more information, visit

Study Reports That Physicians Consider Formal Error-Reporting Systems Inadequate

A study published in the January/February issue of Health Affairs reports that although physicians want to report and learn from medical errors, many do not trust current formal error-reporting systems. The study, “Lost Opportunities: How Physicians Communicate About Medical Errors,” included a poll of 1,000 urban and rural physicians and surgeons. Most respondents said that they should report errors to their affiliated hospital or organization, and 83 percent said that they had used at least one formal reporting system. However, only 30 percent of respondents said that error-reporting systems are adequate, and physicians were more likely to discuss errors informally with colleagues than to formally report them. Respondents said that reporting systems should be nonpunitive, confidential, and quick to complete and should focus on system improvement. The authors of the study conclude that the low number of physicians who formally report errors creates lost opportunities to prevent future errors and that research is needed to increase formal error reporting. For more information, visit or the Health Affairs Web site at (subscription required).

Pennsylvania's New Chronic Care Plan Relies on Primary Care Coordination

Pennsylvania is expected to launch a revamped chronic care management program in several Philadelphia primary care practices in May before expanding it throughout the state in September. The program is based on a chronic care model developed in the 1990s by the MacColl Institute for Healthcare Innovation. Under the program, primary care physicians will head multidisciplinary teams that will coordinate the care of Pennsylvania residents with chronic conditions. Patient care will include managing the current condition and preventing other chronic illnesses. Additionally, the care teams will be connected to community resources, such as exercise groups. Practices will receive enhanced payments to help pay for resources needed for the program and will be eligible for pay-for-performance bonuses for improved patient outcomes. For more information, visit or

Online Reference Guide to Immunization Schedules Available as PDA Downloads

A quick reference guide to 2008 childhood and adolescent immunization schedules recommended by the Centers for Disease Control and Prevention, American Academy of Family Physicians (AAFP), and American Academy of Pediatrics can now be downloaded onto personal digital assistants (PDAs). The free download is provided by the Group on Immunization Education of the Society of Teachers of Family Medicine. The reference guide, “Shots 2008,” which was developed in cooperation with the CDC, includes additional resources such as high-risk indications, contraindications, administration specifics, catch-up information, and adverse reactions for specific vaccines. “Shots 2008” is also available as an online resource. For more information, visit or

National Media Campaign Aims to Curb Prescription Drug Abuse Among Teens

The White House Office of National Drug Control Policy (ONDCP) has launched a major federal campaign to educate parents about teen prescription drug abuse. The campaign launched in February and includes broadcast, print, and television advertising; community outreach; and print and online resources. The ONDCP has also enlisted several medical organizations, including AAFP, to sign onto open letters to parents and has released findings from “Prescription for Danger: a Report on Prescription and Over-the-Counter Drug Abuse Among the Nation's Teens,” which highlight the growing problem of teen prescription drug abuse. The campaign focuses on urging parents to safeguard medications in their homes, set clear rules, and talk to their teens about appropriate medication use. ONDCP Deputy Director Scott Burns, JD, says that family physicians also play an important role and recommends that they discuss prescription drug abuse with patients when writing prescriptions. For more information, visit or the ONDCP Web site at

–AFP and AAFP NEWS NOW staff

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