ACEP Issues Comments, Concerns on the Patient-Centered Medical Home Concept

The American College of Emergency Physicians (ACEP) recently issued a position statement on the patient-centered medical home (PC-MH). The statement acknowledged the importance of primary care and the need for each patient to have access to a personal physician who can help the patient navigate the health care system. Additionally, the ACEP statement recognized that improved access to a personal physician could reduce the number of unnecessary visits to the emergency department. American Academy of Family Physicians (AAFP) leadership had a mixed response to the statement. The AAFP questioned the ACEP's concern that more research on the PC-MH is needed before it can be widely adopted. Executive Vice President of the AAFP, Douglas Henley, MD, Leawood, Kan., said that the PC-MH concept has already demonstrated improvements in the quality and cost-effectiveness of care. The ACEP also expressed concern that widespread implementation of the PC-MH would divert resources from the emergency medical care system; however, the AAFP believes that greater focus on primary care and fewer emergency visits will make more money available for the PC-MH, but not shift funds from emergency services. Both organizations agree that performance measurements, evidence-based medicine, information technology, and payment reform are needed to make the PC-MH model successful. For more information, visit https://www.aafp.org/news-now/professional-issues/20080909acep-pc-mh.html or the ACEP statement at http://www.acep.org/practres.aspx?id=40804.

CMS Delays Enforcing Directive that Would Restrict Public Health Insurance for Children

The Bush administration has postponed the enforcement of a directive that prohibits states from expanding health insurance coverage for children. The directive was issued by the Centers for Medicare and Medicaid Services (CMS) to restrict federal matching funds under the State Children's Health Insurance Program (SCHIP). If enforced, the directive would prevent states from receiving federal funding for children whose families have incomes above 250 percent of the federal poverty level. This would affect more than 20 states that have expanded or are considering expanding their SCHIP eligibility requirements to cover more children. A recent study from the Robert Wood Johnson Foundation described public health insurance coverage from SCHIP and Medicaid as a lifeline for millions of children. The study found that children covered by a public health program are more likely to visit a physician's office during the year and are more likely to receive care for chronic health conditions than children without insurance. For more information, visit https://www.aafp.org/news-now/government-medicine/20080903schip-expan.html or the Robert Wood Johnson Foundation study at http://covertheuninsured.org/pdf/ANeededLifeline.pdf.

Residents Learn Basic Dental Skills to Help Patients Without Access to Dental Care

The Maine-Dartmouth Family Medicine Residency has added a new component to its program to teach residents basic oral and dental health skills. The program provides residents with the skills to treat patients who do not have access to dental care. During two or three assignments at the dental clinic, residents learn to identify periodontal disease, tooth decay, and mouth lesions, referring to dentists and oral surgeons when appropriate. A July 2008 report released by the Center for Studying Health System Change (HSC) concluded that dental care is difficult for low-income patients to obtain. “Community Efforts to Expand Dental Services for Low-Income People” found that the number of practicing dentists has not matched the growth of the population. In the past three and a half years, residents at the Maine-Dartmouth program have provided dental care to nearly 200 patients in two locations. Harry Colt, MD, residency director at Maine-Dartmouth, believes more residencies should offer basic dental health training to prepare residents for what they will encounter in their practices. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20080826dentalhealth.html or the HSC report at http://www.hschange.com/CONTENT/1000/.

Immunization Rates Improve Despite Lingering Concerns About Thimerosal

Vaccination rates for children 19 to 35 months of age continue to increase, according to an August 31, 2007, article in Morbidity and Mortality Weekly Report(MMWR). Despite these improvements, national immunization rates remain below the target levels set by the Healthy People 2010 initiative. Some parents may still have concerns about the presence of the preservative thimerosal in vaccines, which allegedly has been linked to autism. Physicians can reassure parents that since the removal of thimerosal from the majority of vaccines, the rates of autism have not changed. Only two vaccines recommended for children younger than six years still contain thimerosal in very small amounts. For more information, visit https://www.aafp.org/news-now/2006-annual-clinical-focus/20080903autism-thimer.html or the MMWR article at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a2.htm.

ABFM Registry Collects Quality Measures Data from Physicians for Incentive Program

Diplomates of the American Board of Family Medicine (ABFM) may begin using the ABFM's Performance in Practice Registry to submit data to CMS for the Physician Quality Reporting Initiative (PQRI). As of September 2008, ABFM diplomates began using the diabetes module to submit data on 15 or 30 consecutive patients with type 1 or 2 diabetes. Physicians who submit the required quality measures data for 30 patients will receive a bonus payment of 1.5 percent of their allowed charges for covered services provided during 2008. Physicians who submit data for 15 patients will receive a payment of 1.5 percent of charges for services provided from July 1, 2008, to December 31, 2008. Incentive payments are scheduled to be paid in mid-2009. For more information, visit the CMS Web site at http://www.cms.hhs.gov/PQRI/Downloads/PQRIQualifiedRegistries.pdf or the ABFM Web site at https://www.theabfm.org/.

New AAFP Newsletter Shares Physicians' International Medical Experiences

The AAFP's Center for International Health Initiatives has launched a biannual Web-based newsletter to share the global medical experiences of physicians, faculty members, students, and residents. The first issue of International Update was released in the summer of 2008, with the next issue scheduled for January 2009. The nine articles in the first issue covered a wide range of topics, and physicians and students shared stories from visits to Vietnam, Romania, Cameroon, and Zambia, among other countries. The newsletter is currently seeking submissions for its second issue. For more information, visit https://www.aafp.org/news-now/inside-aafp/20080827intl-newsltr.html or download the first issue at https://www.aafp.org/international/newsletter.

Medicare Introduces New Authentication Process for Communications with CMS

Physicians will need to retrieve their Medicare Provider Transaction Access Number for future communication with CMS. Beginning March 1, 2009, physicians will be required to provide the formerly retired numbers when making written or telephone inquiries to CMS' customer service or interactive voice response system. Physicians will also need to provide their National Provider Identifier and the last five digits of their tax identification number. CMS is introducing the enhanced provider authentication process to protect Medicare patients' health information. To get answers to questions on claims status, beneficiary eligibility, and other provider-related questions, physicians must be prepared with all three numbers. The Provider Transaction Access Number should be clearly identified on past Medicare remittance advice. For more information, visit https://www.aafp.org/news-now/practice-management/20080829keep-ptans.html.

Study Shows Colorectal Cancer Screening Rates Have Room for Improvement

Americans 50 years and older are not getting recommended colorectal cancer screenings, according to a study in the July 2008 issue of Cancer Epidemiology, Biomarkers and Prevention. Only 12 percent of adults reported having a fecal occult blood test within the past year, and 45.2 percent reported undergoing endoscopy within the previous 10 years. Screening rates were highest among adults with a family history of colorectal cancer and those who had military health coverage. The National Colorectal Cancer Roundtable (NCCRT) has developed a guide for physicians to help encourage patients to get screened. “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician's Evidence-Based Toolbox and Guide” is available from the NCCRT Web site at http://www.nccrt.org. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080904colo-ca.html or the study Web site at http://cebp.aacrjournals.org/cgi/content/abstract/17/7/1623 (subscription required).

AHRQ Guide Advises Physicians on Fracture Prevention Treatments for Women

The Agency for Healthcare Research and Quality (AHRQ) has developed a new guide titled “Fracture Prevention Treatments for Postmenopausal Women with Osteoporosis.” The guide offers a level of confidence rating for the effectiveness of several treatments, including bisphosphonates, selective estrogen receptor modulators, hormonal medications, calcium, and vitamin D. It also addresses possible adverse effects of treatments, and suggests tips for improving adherence rates. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080903ahrq-osteo.html or the AHRQ Web site at http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&ProcessID=8&DocID=95.

— AFP and AAFP NEWS NOW staff