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Am Fam Physician. 2008;78(12):1333-1334

AMA Delegates Adopt Joint Principles of the Patient-Centered Medical Home

Delegates of the American Medical Association (AMA) recently adopted the “Joint Principles of the Patient-Centered Medical Home” during their 2008 interim meeting. The document was developed by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. The joint principles address characteristics of the patient-centered medical home, including coordination of care to enhance the patient-physician relationship, a focus on quality and safety, enhanced access to care, and a payment system that recognizes the value of coordinated services and pays physicians appropriately. AAFP President Ted Epperly, MD, Boise, Idaho, called the adoption of the principles historic for the AAFP because it demonstrates the AMA's support of a health care delivery system that emphasizes primary care. Epperly also testified during a reference committee hearing that several state, national, and international studies have shown that the medical home model increases quality and decreases costs. For more information, visit

Health Care Consumers Express Mixed Feelings about Electronic Health Records

Although many health care consumers support the use of electronic health records (EHRs) to store personal health information, a recent study reveals lingering concern about confidentiality. The 2008 Health Confidence Survey was conducted by the Employee Benefit Research Institute (EBRI) from May 24 to June 30, 2008. More than 55 percent of 1,000 consumers said it was important for health care providers to use EHRs rather than paper records, and 60 percent said it was important that authorized providers have electronic access to their health information. However, 62 percent of respondents were concerned that personal health records stored in an EHR and shared online would not remain private. According to Steven Waldren, MD, Leawood, Kan., director of the AAFP's Center for Health Information Technology, there is a misunderstanding among patients about how personal health information is stored and used in an EHR. Waldren explained that patients will be able to choose how much of their information is shared, and whether they are notified when their information is accessed and exchanged. For more information, visit or the EBRI survey at

CMS Announces Tentative Payments for Medical Home Demonstration Project

The Centers for Medicare and Medicaid Services (CMS) has announced tentative payments for its three-year medical home demonstration project. The per-member, per-month management fee will be set at about $40 or $52, depending on a practice's level of medical home capability. The fee, which is based on recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee, may be adjusted up or down depending on a patient's severity of illness. Created as part of the Tax Relief and Health Care Act of 2006, the medical home demonstration project will be conducted in eight states and will involve approximately 400 practices; 2,000 physicians; and 400,000 Medicare beneficiaries. Applications for participation will be accepted from January through March 2009. CMS will pay the management fee from January 2010 through the end of 2012. For more information, visit or

Study Shows the Majority of Health Care Leaders Support New Payment System

According to a recent study, health care leaders support a revision to the current Medicare payment system to provide more money for primary care and the patient-centered medical home. The online Health Care Opinion Leaders Survey was conducted on behalf of the Commonwealth Fund and in partnership with Modern Healthcare. Respondents consisted of leaders in the health care delivery, policy, and financing fields. Of the 222 respondents, 85 percent supported revising the system to increase payments for primary care, and 74 percent favored paying practices a monthly per-patient fee for serving as a medical home. Most respondents endorsed a blended payment system that would combine fee-for-service with bundled payments, which would consist of one payment for all services provided to a patient during the year. The survey reports that the current fee-for-service system creates incentives to provide more expensive and more technical services rather than encouraging more effective, higher quality care. For more information, visit or

AAFP Objects to Proposed Adjustments to the Geographic Practice Cost Indices

AAFP leadership voiced strong objection to a recent report from CMS that proposes adjustments to the geographic practice cost indices (GPCIs). The report, “Review of Alternative GPCI Payment Locality Structures,” outlines four potential alternatives to the current payment locality structure that is used in the Medicare physician fee schedule. AAFP Board Chair Jim King, MD, Selmer, Tenn., said the AAFP supports the elimination of all geographic adjustment factors from the fee schedule except those that are designed to achieve public policy goals. In a letter to CMS, King expressed concern that the proposed adjustments favor urban areas, and do not consider the true costs of providing health care in rural areas. King explained that the potential changes could reinforce the current maldistribution of physicians, which would have a negative effect on Medicare beneficiaries in rural areas. CMS may propose a rule on the payment locality structure in 2009. For more information, visit or the CMS report at

MedPAC Approves Recommendations for Disclosing Financial Relationships

The Medicare Payment Advisory Commission (MedPAC) is set to recommend that Congress require disclosures from drug and device manufacturers about their financial ties with physicians and other health care providers. The intent of the disclosures is to discourage inappropriate financial arrangements and to address any perceived conflicts of interest between physicians and other entities. MedPAC will also recommend that Congress ask the U.S. Department of Health and Human Services to post information about financial relationships in a searchable format on a public Web site, and to report the types and prevalence of financial relationships between physicians and hospitals. MedPAC plans to submit these and other financial-dislosure recommendations to Congress as part of its annual report in March 2009. For more information, visit

AAFP Provides Template Letters for Communicating with Third-Party Payers

AAFP members who have a problem with a third-party payer can download four new letter templates from the AAFP's Private Sector Advocacy Web page at Members can choose the appropriate letter to communicate directly with health insurers about coverage and fair payment for immunization purchase and administration, payment for group visits, or payment for providing behavioral and mental health services. The letters are designed to help members address issues that impede their ability to provide high-quality care to patients. For more information, visit

First-Year Medical Student Enrollment Hits Record Number in 2008

New data from the Association of American Medical Colleges (AAMC) show that first-year enrollment at U.S. medical schools reached an all-time high in 2008. The total increased nearly 2 percent to 18,036 compared with 2007. However, this does not necessarily translate into good news for family medicine. Perry Pugno, MD, MPH, Leawood, Kan., director of the AAFP Division of Medical Education, believes the impact on family medicine will be small. However, according to student applications, there is an increased involvement in community service, as demonstrated by medical and nonmedical volunteer experiences. Pugno explained that community service involvement tends to correlate with a student's choice of specialty, which could help primary care. For more information, visit or the AAMC data at

FDA Report Indicates Bisphosphonates Not Linked to Atrial Fibrillation

The U.S. Food and Drug Administration (FDA) reports that, based on results of clinical trials, there is no clear association between bisphosphonates and atrial fibrillation. In October 2007, the FDA reported a potential for increased risk of atrial fibrillation in patients taking bisphosphonates to treat osteoporosis. New studies show that increasing the dosage and duration of treatment did not increase the rate of atrial fibrillation. The FDA says it will continue to track postmarketing reports of atrial fibrillation. For more information, visit or the FDA Web site at

— AFP and AAFP NEWS NOW staff

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Copyright © 2008 by the American Academy of Family Physicians.

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