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Am Fam Physician. 2008;78(11):1241-1242

AAFP Opposes Transition to ICD-10-CM Diagnosis Codes Scheduled for 2011

The American Academy of Family Physicians (AAFP) has voiced its opposition to the proposed adoption of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The Centers for Medicare and Medicaid Services (CMS) has set a tentative compliance deadline of October 1, 2011. If adopted, the number of outpatient diagnosis codes available to physicians would increase from 13,500 to 68,000. In a letter to CMS Acting Administrator Kerry Weems, AAFP Board Chair Jim King, MD, Selmer, Tenn., argued that CMS has not properly researched the effect that the ICD-10-CM transition would have on U.S. physicians. King urged an indefinite delay for the adoption of the new codes. Primary care physicians in particular would feel a significant impact because of the broad range of conditions they see in their practices. A cost analysis of the proposed transition found that switching to ICD-10-CM would cost $83,290 for practices with three physicians; $285,195 for those with 10 physicians; and $2.7 million for those with 100 physicians. Staff education and training, information technology system changes, increased documentation, and cash flow disruption would all contribute to the higher costs. For more information, visit or the proposed CMS rule at

Medicaid Spending Set to Outpace U.S. Economic Growth During the Next Decade

According to a report released by CMS, Medicaid spending will significantly outpace the growth of the U.S. economy during the next 10 years. Medicaid benefit expenditures are projected to reach $339 billion in 2008 and more than $673 billion by 2017. The report, “2008 Actuarial Report on the Financial Outlook for Medicaid,” predicts that Medicaid costs will grow by about 7.9 percent each year, compared with an annual average gross domestic product growth of 4.8 percent. The increase in costs was attributed to the number of persons insured, the increase in wages and price inflation in the medical sector, the provision of a wider array of health care services, and the development of more complicated and expensive services. Actuaries also reported that an average of 49.1 million patients were enrolled in Medicaid in 2007. However, at some point during that year, 61.9 million patients, or about one in five persons in the United States, were enrolled in Medicare. For more information, visit or the CMS Web site at

Residency Programs Fall Behind Expectations for Training Physicians

Medical residency programs are not adequately training residents to meet the needs of the nation's changing population base, according to Michael Whitcomb, MD, former senior vice president of medical education for the Association of American Medical Colleges. Testifying before the Medicare Payment Advisory Commission, Whitcomb addressed the challenge of providing high-quality care to patients with chronic illnesses. Instead of focusing on preventive care and management of chronic diseases, residencies are focusing on hospital-based and acute care. Whitcomb was also critical of the link between graduate medical education funding and hospital-based experiences, which currently dictate how residencies operate. In an effort to raise the standards for residency accreditation, the Accreditation Council for Graduate Medical Education (ACGME) has changed its accreditation process over the past 10 years by implementing specific criteria. The ACGME hopes this will help residencies focus on the future needs, rather than the immediate needs, of the public. For more information, visit

Panel Calls for Scrapping Current Payment System That Undermines Primary Care

An expert panel offered criticism of the Medicare fee-for-service payment structure during a recent forum sponsored by the Center for American Progress. The October 31, 2008, forum conducted in Washington, DC, focused on health care quality and the health delivery system. President of the Center for Studying Health System Change, Paul Ginsburg, MD, believes the current payment system is dramatically undermining primary care. He says that without payment reform, the country is in danger of losing primary care as a specialty altogether. Ginsburg suggested that payment reform include multi-provider, per-episode payments for acute care and major illnesses, and capitated payments for managing chronic disease. The panel agreed that payment reform would require a shift in resources, creating winners and losers in the overall payment scheme. However, the health care system cannot sustain the costs of doing nothing. For more information, visit

New Bill Provides Incentives for Medical Students Pursuing Primary Care Careers

The next Congress will have the opportunity to pass legislation that would reform the nation's Medicare system and promote primary care services. The Preserving Patient Access to Primary Care Act, H.R. 7192, would encourage medical students to pursue careers in primary care by establishing grants, scholarships, and loan forgiveness programs. The bill, which was introduced by Rep. Allyson Schwartz, D-Pa., would also provide enhanced monthly fees for physician practices that operate as qualified patient-centered medical homes. At the same time, the bill would establish higher payments for primary care physicians, and provide payment for services such as telephone and e-mail consultations. For more information, visit

Panel Expresses Concern About Disjointed Health Care System, Uninsured Americans

The National Summit of Clinicians for Healthcare Justice convened in Washington, DC, on October 23, 2008, to address the nation's fragmented health care system. Former U.S. Surgeon General and family physician David Satcher, MD, PhD, was one of three speakers on the panel. Satcher addressed the issue of the under-funded primary care infrastructure in the United States, which is unable to support all Americans. Satcher also emphasized the need to provide incentives for medical students to choose careers in primary care. The panel was critical of the growing number of uninsured and underinsured patients in the United States, which spends about $2.3 trillion per year on health expenditures. As many as 20,000 to 25,000 uninsured patients die each year because they lack access to health care services. For more information, visit or

CMS Postpones Deadline for Ban on Faxed Prescriptions by Three Years

Physicians will now be able to use computer-generated faxes to transmit prescriptions to pharmacies until January 1, 2012. CMS recently extended its deadline for banning faxed prescriptions in the interest of patient care and safety, and to encourage physicians to adopt electronic prescribing (e-prescribing). The deadline extension was included in the 2009 Medicare Physician Fee Schedule final rule, which was announced on October 30, 2008. Director of the AAFP's Center for Health Information Technology, Steven Waldren, MD, Leawood, Kan., said that postponing the ban will prevent some physicians from reverting back to paper-based prescriptions. Currently, many physicians initiate prescriptions through their electronic health record systems, and the computers generate a fax to the pharmacy. Waldren hopes that the three additional years will give physicians enough time to transition to true e-prescribing, which reduces medication errors and extra telephone calls from pharmacies. For more information, visit

NBME Clarifies Distinction Between Physicians and Nurses with DNP Degree

The AAFP recently met with members of the National Board of Medical Examiners (NBME) to discuss a new certification examination for candidates for the doctorate of nursing practice (DNP) degree. AAFP leaders and representatives from other medical organizations were concerned about the potential for misinterpretation of what the DNP represents. AAFP President Ted Epperly, MD, Boise, Idaho, worried that the DNP designation could cause confusion for patients and medical students. Epperly emphasized that DNP graduates are not equivalent to primary care physicians. The NBME agreed to work with the Council for the Advancement of Comprehensive Care to clarify to DNP candidates that the DNP certification examination is not equivalent to physician licensure. For more information, visit

Web Site Offers Videos for Physicians and Patients on Influenza Immunization

The Childhood Influenza Immunization Coalition (CIIC) has posted new influenza vaccination videos on its Web site aimed at family physicians, patients, and caregivers. The videos for physicians feature CIIC immunization experts answering questions about who should be vaccinated against influenza and why it is important. The videos for patients and caregivers feature CIIC members answering questions about the impact of influenza and how to prevent it. For more information, visit or the CIIC Web site at


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