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Am Fam Physician. 2009;79(9):733-734

NACHC Finds Steep Increase in Number of Patients Without Access to Primary Care

A report from the National Association of Community Health Centers (NACHC) found that the number of medically disenfranchised Americans, or those without a regular source of primary health care, grew by 4 million people during the past two years. According to “Primary Care Access: An Essential Building Block of Health Reform,” this brings the total number of medically disenfranchised Americans to 60 million. Because this population has a difficult time finding primary care physicians, many of these patients rely on community health centers (CHCs), which provide primary care services to more than 18 million Americans in 7,000 communities across the United States. However, CHCs are struggling to keep pace with the escalating demand for care during the current economic times. The report recommends four steps to improving the accessibility and quality of care for patients, including providing a primary health care home for all Americans; investing in the primary care workforce; developing a new payment system that rewards quality-of-care improvements; and stimulating capital investment in the primary care safety net. For more information, visit or the NACHC report at

Study Shows Patients Who See Family Physicians Receive Cost-Effective Care

Compared with subspecialists or other physicians in primary care specialties, family physicians provide a more cost-effective usual source of care, according to a study in the March/April 2009 issue of Health Affairs. A study conducted by the American Academy of Family Physicians' (AAFPs') Robert Graham Center examined Medical Expenditure Panel Survey data from 2001–04 to determine health care costs based on who patients cited as their physician. Patients who used a family physician as their usual source of care spent an average of $1,430 less per year than patients who used subspecialists as their usual source of care, and $1,201 less per year than patients who used a general internist. One potential explanation for the difference in costs between internists and family physicians is that more internists are trained in acute care or inpatient settings, rather than primary care settings. The study also found that spending on office-based services and prescription drugs were lower for patients who used family physicians. For more information, visit or the Health Affairs Web site at (subscription required).

Retail Health Clinic Chain Offers Free Acute Care Services to Newly Unemployed

Americans who have lost their jobs since March 31, 2009, may qualify for free treatment for acute illnesses and injuries at Take Care Clinics, an owned subsidiary of Walgreens. To qualify for the Take Care Recovery Plan, consumers must have no health insurance, and they or one of their dependents must have previously been a patient of the clinic before becoming unemployed. AAFP President Ted Epperly, MD, of Boise, Idaho, expressed mixed feelings about Take Care's plan, which runs through the end of 2009. Although the plan assists patients who are struggling financially, Epperly believes it is also a marketing strategy to capture lost revenue caused by low patient volume. Epperly said the majority of consumers who visit the clinic will also get their prescriptions filled at the store, and maybe buy other products at Walgreens while they are there. Epperly emphasized that Take Care's plan should not be seen as a substitute for integrated primary care, noting that the free health care offer does not apply to wellness, preventive, or ongoing chronic disease care that family physicians provide. He also pointed out that many family physicians have procedures in place to help patients through tough financial times. For more information, visit

Health Insurer Implements New Fee Schedule Methodology Using 2008 RVUs

Beginning April 1, 2009, insurance company United-Healthcare (UHC) implemented a new fee schedule methodology for physician contracts that bases payment on Medicare's 2008 resource-based relative value units (RVUs). Under this rule, nearly 14,000 family physicians with UHC contracts will receive almost 8 percent less for reporting Current Procedural Terminology code 99213 than if UHC had used Medicare's 2009 RVUs. The AAFP and four other medical specialty organizations have sent a letter to UHC accusing the insurer of taking advantage of Medicare-adjusted work RVUs even though UHC is not bound by the same budget-neutrality requirements as Medicare. The organizations are also critical of UHC for freezing payment rates at 2008 levels unless physicians renegotiate their contract, and for ignoring physicians' increasing practice costs. The five organizations have asked UHC to publicize the number of physicians who have successfully negotiated their contracts, and to add a cost-of-living adjustment to physician fee schedules to account for inflation. For more information, visit

MedPAC Chair Urges Congress to Increase Medicare Physician Payment Rates in 2010

Glenn Hackbarth, JD, Chair of the Medicare Payment Advisory Commission (MedPAC), recently urged Congress to revise Medicare payment policies to reward primary care physicians. Hackbarth testified before the House Ways and Means Subcommittee on March 17, 2009, to present MedPAC's 2009 Medicare Payment Policy Report to Congress. The report asked Congress to provide a 1.1 percent increase for physician payment rates in 2010 and a 1.3 percent productivity growth offset. Hackbarth told the subcommittee that the current payment system undervalues primary care despite evidence that it produces better outcomes and lower costs. Additionally, Hackbarth said the declining number of medical students choosing a career in primary care is a direct result of public and private payment systems. Instead of the current fee-for-service model, Hackbarth proposed a system that rewards care coordination and outcomes. For more information, visit

Med Watch: Company Recalls Psoriasis Drug, FDA Issues Warning on Skin Patches

Drug company Genentech has announced a voluntary recall on Raptiva (efalizumab) from the U.S. market. Patients who take Raptiva, which is a once-weekly injection for moderate to severe plaque psoriasis, are at risk of developing progressive multifocal leukoencephalopathy, a progressive neurologic disease. Raptiva will be removed from the market by June 8, 2009. Physicians are asked not to prescribe Raptiva for new patients, and to discuss alternative therapies for patients currently taking it. Additionally, the U.S. Food and Drug Administration (FDA) has issued a public health advisory on transdermal drug patches that contain aluminum or other metals on their backing. If worn during a magnetic resonance imaging (MRI) scan, the metal can conduct electricity and generate heat, which may burn the skin. The FDA found that some patches did not have warnings on their labels to alert patients to this risk. After reviewing all transdermal products to verify those that contain metal, the FDA will require manufacturers to print a warning directly on the patches that instructs patients to remove them before an MRI. For more information, visit or

Primary Care Physicians Miss Opportunities to Discuss Health Issues with Teen Patients

Primary care professionals are not doing their part to address health-related issues with adolescent patients, according to a December 2008 study in the Journal of Adolescent Health. Researchers at the University of California—San Francisco analyzed data from the Adolescent California Health Interview Survey during a nine-month period in 2003. A random subsample of 2,192 adolescents from 12 to 17 years of age indicated whether any of nine health topics were discussed at their most recent physical exam. The topics included tobacco use, alcohol use, drug use, sexually-transmitted diseases, seat belt use, helmet use, violence, physical activity, and nutrition. Although the rates of discussion for all topics were low, 76.4 percent of the teenagers reported talking with their physician about nutrition, and 75.7 percent reported talking about physical activity. Only 15.4 percent of the teenagers reported discussing violence with their physician. For more information, visit or the Journal of Adolescent Health Web site at

New Programs Aim to Increase HPV Vaccination Among Eligible Patients

According to the Centers for Disease Control and Prevention, only about 10 percent of eligible, privately insured women 18 to 26 years of age have received the first dose of Gardasil, the quadrivalent human papillomavirus (HPV) vaccine manufactured by Merck & Co., Inc. To help physicians identify eligible patients, Merck has created the Confidence in Coverage Status program to provide physicians with patients' benefit information before office visits. Physicians can submit patients' names, birth dates, and insurance information to Merck, and receive a coverage status report within three to five days. Additionally, Merck has launched a rebate program for patients who receive Gardasil doses between April 1, 2009, and April 30, 2010. Patients can receive a rebate when their out-of-pocket costs for the vaccine exceed $30 per dose, with a maximum rebate of $130 per dose. For more information, visit


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