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Am Fam Physician. 2009;80(2):127-128

Congress Begins Drafting Legislation for Comprehensive Health Care Reform

Congress could pass a comprehensive health care reform bill this year that provides a payment increase for primary care physicians under Medicare. Five congressional committees, including two in the Senate and three in the House, are responsible for drafting proposals for the legislation. Obama administration officials and key members of Congress have repeatedly cited the importance of primary care in any major health care reform initiative, describing it as a way to improve quality and contain costs. However, the extent of the reform, and any subsequent payment increases, will be determined in large part by the state of the U.S. economy and the size of the federal deficit this summer and fall. The economy will also determine whether Congress can eliminate the sustainable growth rate (SGR) formula, which has triggered steep reductions in Medicare physician payment rates in recent years. Congress has stepped in each time to block pending SGR cuts, but it is not clear whether lawmakers plan to eliminate the SGR or provide a payment patch for the next few years. Subspecialists could also play a role in determining payment increases for primary care physicians, depending on whether they are asked to forgo payment to make the increases possible. For more information, visit

AAFP Lobbies for Health Care Reform, Payment Increase for Primary Care

The American Academy of Family Physicians (AAFP) continues to lobby for health care reform, pressing lawmakers to move toward a primary care–based health care system that would address problems with fragmented care, high costs, and decreased access to physicians. AAFP President Ted Epperly, MD, of Boise, Idaho, recently spoke during a Capitol Hill press briefing to advocate for health care reform, including a 30 percent payment increase for primary care physicians under Medicare over the next five years, and a repeal of the SGR formula. Epperly paired that message with calls to bolster the primary care workforce through graduate medical education policies that support medical students' choice of careers in primary care, and to revamp the health insurance system so that Americans can access needed health care services. Epperly joined with leaders from the American College of Physicians and the American Osteopathic Association for the event. Together, the three organizations represent more than 300,000 U.S. primary care physicians and care for the majority of the nation's Medicare patients. For more information, visit

Survey Reports Impact of Recession on Family Physicians and Patients

The current economic climate is forcing some patients to forgo health care needs, according to a recent online survey by the AAFP. Members were asked to share their experiences since January 2008. Of the 505 family physicians who responded, 54 percent reported seeing fewer patients; 58 percent reported more appointment cancellations; and 60 percent reported an increase in health problems caused by patients forgoing preventive care. Nearly 90 percent of respondents said that more patients were concerned about paying for their care. To keep their practices afloat during the recession, family physicians are finding ways to cut operating costs. For example, physicians are ordering immunizations on an as-needed basis rather than stocking vaccines that may not be used; sending patients to local clinics for less common requests, such as travel immunizations; eliminating equipment repair costs by referring patients to subspecialists for certain procedures; reducing staff benefits by offering partial insurance rather than full coverage; and giving office staff cash bonuses rather than pay raises. For more information, visit or the AAFP survey results at

H1N1 Influenza Outbreak Reveals Flaws in Nation's Pandemic Preparedness

A report from the Trust for America's Health organization praised U.S. public health officials for successfully communicating, coordinating, and adapting to a rapidly changing situation during the recent outbreak of H1N1 influenza. However, the report also found that the nation's public health system is unprepared for a more severe or widespread outbreak. Public health departments lack staffing and other resources needed to track, investigate, and contain a larger outbreak. According to the report, the United States has 50,000 fewer public health workers than it did 20 years ago. Also of concern is the increasing number of U.S. health care workers with confirmed or probable cases of H1N1 influenza. This could be caused by some workers' failure to follow guidelines from the Centers for Disease Control and Prevention (CDC) on protecting themselves from infectious disease. The CDC urges health care workers to use fit-tested respirators, gloves, and eye protection when caring for patients with probable H1N1 infection. For more information, visit or

Obama Emphasizes Importance of Primary Care Before AMA House of Delegates

President Obama recently addressed physicians at the annual meeting of the American Medical Association (AMA) House of Delegates, calling for a greater investment in primary care. During his speech, Obama criticized the current fee-for-service payment system, calling it a model that rewards the quantity of care rather than the quality of care. He emphasized his administration's support of a health care system that rewards best practices and focuses on patient care. Obama also discussed the need to make medical education more affordable and the importance of using electronic health records to track patients' personal health information. In defense of his administration's proposed public plan option to provide health care coverage for more Americans, Obama stressed that it would give patients a broader range of options and inject competition into the marketplace. For more information, visit

Survey Shows Care Coordination Problems Among Adults Who See Multiple Physicians

Americans report experiencing problems with coordination of care among different physicians, according to a survey issued by the Kaiser Family Foundation, the Harvard School of Public Health, and National Public Radio. Of the 1,238 adults who responded to the survey, seven in 10 reported seeing at least two health care professionals in the previous two years, and three in 10 reported seeing at least four health care professionals during that time. Of those who had seen four or more health care professionals, 67 percent reported experiencing at least one problem, such as receiving conflicting information from different physicians; needing to redo a test because the physician did not have their previous test results; or needing to reschedule an appointment because the physician did not have their medical information available. Among respondents who reported experiencing at least three coordination-of-care issues, 63 percent said overtreatment was a major problem. Patients with coordination-of-care issues also said they were more likely to receive tests and treatments they probably did not need. For more information, visit or the complete survey results at

AAFP Voices Support for Conducting Comparative Effectiveness Research

In a recent letter to the Senate committee on Health, Education, Labor, and Pensions, AAFP Board Chair Jim King, MD, of Selmer, Tenn., reiterated the AAFP's support for high-quality comparative effectiveness research. The committee recently introduced the Affordable Health Choices Act, a health care reform bill that would establish a Center for Health Outcomes Research and Evaluation. The center would conduct and synthesize research on health care services and procedures, focusing on ways to effectively prevent, diagnose, treat, and clinically manage diseases. According to King, the center will help bridge the gap between what physicians currently know and what they need to know to provide optimal care. King also emphasized the importance of practice-based network research, which, when used in tandem with randomized clinical trials, can produce real-world information that physicians can use in their practices. For more information, visit

AMA Report on Industry Funding of CME Receives Referral for Further Study

An AAFP-supported report aimed at guiding physicians and continuing medical education (CME) providers in managing their industry relationships was referred for more study during the AMA's 2009 annual meeting. The report, “Financial Relationships with Industry in Continuing Medical Education,” was developed by the AMA Council on Ethical and Judicial Affairs as a framework for identifying potential conflicts of interest in the context of CME. In the report, the council recommended categorizing CME activities as “ethically preferable” or “ethically permissible.” Ethically preferable CME would accept funding only from sources with no direct financial interest in the subject matter or clinical recommendations of the activity, whereas ethically permissible CME would allow funding from industry sources if certain criteria were met. The two terms will likely be further defined and clarified in the next iteration of the report. For more information, visit


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Copyright © 2009 by the American Academy of Family Physicians.

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