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Am Fam Physician. 2008;78(9):1021-1022

Medical Societies Lobby to Reinstate Popular Student Loan Repayment Program

The American Academy of Family Physicians (AAFP) is urging the U.S. Department of Education to reinstate a loan repayment program that allows qualifying residents to postpone the repayment of their federal student loans. Joining 96 other medical societies, the AAFP signed a letter asking the department to revive the 20/220 pathway, which refers to the debt-to-income ratio that determines residents' eligibility for payment deferral. Under the 20/220 pathway, residents may postpone repayment for up to three years without accruing interest on the subsidized portion of their loans. In September 2007, President Bush signed into law the College Cost Reduction and Access Act, which created two new loan programs, but did not renew the 20/220 pathway. The new income-based repayment program, which is scheduled to take effect July 1, 2009, will require residents to make payments on their loans after graduating from medical school. Any payment deferments will accrue interest charges. Residents and students at the AAFP's 2008 National Conference of Family Medicine Residents and Students expressed concern that the loss of the 20/220 pathway will discourage students from entering primary care at a time when primary care physicians are most needed. For more information, visit

AMA Urges Congress to Revise Antitrust Policies and Permit Joint Contracting

The American Medical Association (AMA) is pushing for the federal government to update its antitrust policies, which would allow physicians to participate in joint contracting when negotiating with insurance companies. During testimony before the House Committee on Small Business, orthopedic surgeon William Hazel Jr., MD, Fairfax, Va., explained that a more flexible approach to joint contracting would increase competition in the insurance market. A revised policy would also make it easier for physicians to reject contracts that do not promote optimal patient care. In a recent letter to congressional leaders, the AAFP emphasized that easing current restrictions would be especially beneficial to primary care physicians. The current rules make contract negotiations particularly difficult for small offices that do not have the time or resources to analyze detailed payer contracts. Hazel also testified that joint negotiations would lead to cost savings that physicians could use to implement health information technology. For more information, visit

ACIP Issues Influenza Vaccination Recommendations for 2008–2009 Season

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) has issued its recommendations for the 2008–2009 influenza season. This year, ACIP has expanded the targeted age group for immunization to include all children six months to 18 years of age. The influenza vaccine supply, estimated to top 130 million doses, is expected to cover all patients recommended for immunization. According to ACIP member and family physician Jonathan Temte, MD, PhD, Madison, Wis., physicians should begin offering vaccinations soon after the vaccine is available. Temte emphasizes that the biggest predictor of patients getting vaccinated is whether their physician recommends it. Another focus during this year's influenza season is the vaccination of health care workers. Currently, only 40 percent of this population receives an annual influenza vaccine. If health care workers arrive at work ill, they have the opportunity to spread the virus to patients. The CDC offers free influenza resources for physicians and patients at For more information, visit or the CDC Web site at

Medicare Part B Premiums to Remain Stable for the Majority of Beneficiaries in 2009

For the first time since 2000, Medicare beneficiaries will not see an increase in their monthly outpatient care premiums in 2009. According to the Centers for Medicare and Medicaid Services (CMS), the Medicare Part B premium will remain at $96.40 per month, and the out-patient deductible will remain at $135 per month. These rates will apply to 95 percent of Medicare beneficiaries, which includes individuals making less than $85,000 per year and couples making less than $170,000 per year. Patients whose incomes exceed these levels will see slight increases in their premiums. Although Part B premiums usually increase at the same rate as Part B expenditures, the assets in the Part B trust fund account are sufficient to negate premium increases in 2009. Because most patients' premiums will remain stable, physicians are likely to see a greater demand for Part B services at a time when they are already struggling with inadequate Medicare payments. Physicians will face a 20 percent reduction in Medicare payment fees beginning January 1, 2010, unless Congress intervenes. For more information, visit

Compliance Dispute Forms Allow Physicians to File Complaints with Insurance Company

Physicians who have a dispute with Blue Cross and Blue Shield (BCBS) regarding a 2007 class action lawsuit now have an outlet to voice their complaints. A new compliance dispute form is available online for any physician who did not opt out of the settlement agreement. The form may be downloaded at Forms must be completed and submitted no later than 90 days after the compliance dispute arose or reasonably could have been known by the physician. Under the terms of the settlement, BCBS must pay “clean” claims within 15 days if submitted electronically and 30 days if submitted on paper. The company also agrees to pay for the cost and administration of recommended vaccines; to establish an independent external review board for resolving billing disputes; to provide 90 days' notice for policy changes; to use clinical guidelines based on credible scientific evidence; and to provide physicians with access to an independent, medical necessity external review process. Full terms of the settlement are available at . For more information, visit

Emergency Department Visits Climb as Primary Care Physician Shortage Grows

A recent study from the CDC shows that emergency departments are the main source of health care for a growing number of U.S. patients. In 2006, visits to emergency departments exceeded 119 million, a 32 percent increase from 1996. The percentage of non-obstetric hospital admissions coming through emergency departments increased from 36 to 50 percent during the same period. The findings suggest that the increase in emergency department use is related to the shortage of primary care physicians. Patients are more likely to visit the emergency department if they do not have access to a regular source of care. The study also reported that patients with Medicaid use the emergency department more than patients with private insurance. The rate of visits was higher for blacks than whites, but was lower for Hispanics than whites. Additionally, the study cited fever, cough, and vomiting as the three main reasons children and teenagers younger than 15 years visited the emergency department. For patients 15 years and older, the main reasons for visits included chest pain and related symptoms, and stomach and abdominal pain. For more information, visit or download the CDC study at

AAFP Congress of Delegates Adopts Measure to Secure Funding for Tar Wars

During the AAFP's 2008 meeting of the Congress of Delegates, members of the Reference Committee on Health of the Public and Science heard testimony concerning future funding for the Tar Wars tobacco cessation program. After the 2007 Congress convened, the AAFP Foundation determined that securing long-term funding for Tar Wars and expanding the program would be best accomplished through a large, one-time grant. This would allow the foundation to establish an endowment program. However, the most likely source of funding would be corporate-giving programs funded by tobacco companies. After listening to delegates lobby for and against receiving money from tobacco companies, the Congress of Delegates adopted a measure to seek funding for a one-time endowment from private and corporate foundations in a manner consistent with current AAFP funding guidelines. For more information, visit

CMS Reminds Physicians to Report Enrollment Changes to Contractors

To avoid potential claims processing and payment delays from Medicare, physicians must report enrollment changes to their designated Medicare contractors within 90 days of the change. CMS has posted three new fact sheets on its Web site for physician group practices, individual physicians, and nonphysician providers. Changes that must be reported with CMS form 8551 include changes to legal business names or tax identification numbers, practice locations, or adverse legal actions. For more information, visit or the CMS Web site at


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