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Am Fam Physician. 2008;78(8):919-920

Primary Care Physicians Urge Congress to Repair Broken Medicare Payment System

The Medicare physician payment system is profoundly broken and in need of a complete overhaul, according to witnesses who testified on September 11, 2008, before the House Ways and Means Subcommittee on Health. Witnesses described the current system, which is based on the sustainable growth rate, as one that devalues primary care services relative to services provided by subspecialists. Bruce Vladeck, PhD, a former administrator of the Health Care Financing Administration, testified that primary care services reduce patients' needs for more expensive acute services; however, without adequate payment, it is becoming more difficult for physicians to provide these services. The current Medicare payment rate is set to expire on January 1, 2010. Without intervention from Congress, this will lead to a 20 percent payment reduction for physicians. Witnesses urged members of the subcommittee to ask Congress to develop a new coding system or payment model that rewards physicians for providing high-quality, comprehensive care. Several witnesses pushed for Congress to adopt the Medicare Payment Advisory Commission's recommendation, which calls for adjusting the current fee schedule to increase payments for primary care services. For more information, visit

Presidential Candidates Offer Contrasting Proposals for Reforming Health Care

With health care spending now consuming 17 percent of the median family income, paying for health care is a growing concern for many Americans. Presidential candidates Sen. John McCain, R-Ariz., and Sen. Barack Obama, D-Ill., have offered two contrasting visions for reforming health care in the United States. McCain's plan focuses on providing tax credits for individuals and families to purchase affordable health insurance policies on the open market. The plan would eliminate tax exclusions for employer-sponsored health insurance, which could discourage some employers from offering health insurance to employees. Obama's plan calls for universal health coverage, including mandatory coverage for children. Under his proposal, the federal government would establish a new national health plan that would cover individuals without access to employer-sponsored health care or other public programs. Employers that choose not to offer health insurance to employees would be required to contribute to the national health plan. For more information, visit or

Retail Health Clinics Provide Acute Care to Patients Without a Primary Care Physician

A recent study in the September/October 2008 issue of Health Affairs reports that retail health clinics play an important role for patients who have no other access to care. “Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients' Visits” found that only 39 percent of patients who visit retail health clinics have a primary care physician. With more than 1,000 retail health clinics now operating across the country, primary care physicians often express concern about the scope of services offered in the clinics and the potential disruption of the primary care relationship. However, the study argues that for most patients, there is no primary care relationship to disrupt. The study also concluded that 90 percent of visits to retail clinics are for simple acute conditions that likely do not require the level of training of a physician, such as sinusitis, bronchitis, and urinary tract infections. Jim King, MD, Selmer, Tenn., board chair of the American Academy of Family Physicians (AAFP) and former AAFP President, stressed that although retail clinics may provide short-term acute care, they cannot replace the patient-centered medical home. For more information, visit, or the Health Affairs Web site at

Onerous PQRI Reporting Processes Frustrate Physicians, Delay Payments

The Centers for Medicare and Medicaid Services (CMS) is not receiving much positive feedback from physicians about its Physician Quality Reporting Initiative (PQRI). According to a recent study from the Medical Group Management Association (MGMA), the inefficient PQRI reporting process is creating numerous administrative burdens for practices. About 63 percent of study respondents had moderate to extreme difficulty with capturing and submitting data, almost 70 percent of respondents received little or no guidance in improving patient outcomes, and more than 90 percent had trouble obtaining their feedback report from 2007. Without timely feedback, physicians continue to make mistakes filing their data, which delays the arrival of their incentive bonus. CMS hopes to improve the process of accessing reports, which is controlled by federal security measures. Once physicians clear the initial hurdle of setting up their secure-access account, CMS says it should become easier to obtain reports. For more information, visit or the MGMA Web site at

AAFP Congress of Delegates Calls for Two Resolutions to Fix Inequities in the RUC

Attendees of the AAFP Congress of Delegates at the 2008 Scientific Assembly in San Diego, Calif., were critical of CMS' continued failure to appropriately value evaluation and management services. Many of the physicians who testified before the Reference Committee on Practice Enhancement blamed the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) for the problems with the current payment system. The RUC is responsible for making recommendations to CMS for the payment of physician services based on the resource-based relative value scale. The delegates referred two resolutions to the AAFP Board of Directors on strategies for fixing the RUC. The first resolution calls for making the voting in the RUC proportional to the number of physicians who make up the constituent voting organizations. If this is unsuccessful, the resolution recommends that AAFP disengage from the RUC and consider other options for creating a separate compensation system. The second resolution calls for CMS to create a Relative Value Scale Advisory Board with membership that represents the current physician workforce caring for Medicare beneficiaries; or to restructure the RUC to ensure that a fair number of primary care physicians are represented. For more information, visit

Study Shows Title VII Funding Encourages Physicians to Work in Underserved Areas

Federal grants for training family physicians help lead physicians to work in underserved areas of the United States, according to a study in the September/October 2008 issue of Annals of Family Medicine. Section 747 of Title VII provides the only federal grants to medical schools and residency programs that train family physicians. The study found that physicians who graduated from U.S. medical schools funded under Title VII were up to 50 percent more likely to be practicing at a community health center in 2001–2003. The authors believe these findings suggest that exposure to Title VII training influences physicians' practice decisions. Although the AAFP continues to advocate for increased Title VII funding, the grants have been cut by nearly $45 million since 2003, from $92.4 million to $48 million. For more information, visit or the Annals of Family Medicine Web site at

Current Measles Outbreak Affects Children Without Proper Immunizations

As of July 31, 2008, the number of reported measles cases in the United States reached 131—the highest year-to-date total in 12 years, according to the Centers for Disease Control and Prevention (CDC). An update in the August 22, 2008, issue of Morbidity and Mortality Weekly Report (MMWR) found that 116 of the 131 cases were linked to virus importation from outside the United States. Many of the importation-associated cases are in school-age children who were not vaccinated because their parents chose not to vaccinate them. Family physician Doug Campos-Outcalt, MD, MPA, Phoenix, Ariz., serves as the AAFP liaison to the CDC's Advisory Committee on Immunization Practices, and believes family physicians must talk to parents about their vaccination concerns. Physicians should be prepared to direct parents to evidence-based resources, such as the “Parents: What You Need to Know” Web page, available on the CDC Web site at For more information, visit or the MMWR report at

Physicians Defeat Measure but Share Concerns About Performance Reporting

Physicians at the AAFP Congress of Delegates voted not to oppose insurers' practice of physician performance measurement. Also known as physician profiling or tiering, insurers use the measurements to guide patients to physicians who provide high-quality, low-cost care. However, some physicians are concerned that insurers assign rankings based only on costs without considering the quality of care. Delegates chose not to flatly oppose the performance reporting because the practice is unlikely to stop, and the AAFP has already collaborated with insurers to make the process more accurate. For more information, visit


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