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Am Fam Physician. 2009;80(11):1199-1200

AAFP Commends Congress on Passage of Affordable Health Care for America Act

American Academy of Family Physicians (AAFP) President Lori Heim, MD, of Vass, N.C., met with lawmakers on November 5, 2009, to reemphasize the importance of primary care and family medicine in health care reform. Heim focused on key issues in the meetings, including application of the patient-centered medical home (PCMH) to all population groups, graduate medical education funding reform, and increases in Medicare payments. The first iteration of the U.S. House of Representatives health care reform bill called for the creation of a community-based PCMH pilot project that would have pertained only to special needs populations. However, this language was expanded to include all population groups in the Affordable Health Care for America Act (H.R. 3962), which was narrowly approved by the House on November 7, 2009. After its passage, Heim commended the bill's provisions that would help reestablish primary medical care as the foundation of the U.S. health care system, and said that investment in primary care will lead to better, more efficient health care. The passed bill begins to address the payment disparity between primary care and subspecialty care physicians by providing a 5 or 10 percent bonus for Medicare practices that have more than 50 percent primary care services. Heim said that this bonus sends a signal that the nation recognizes the value of comprehensive care provided by family physicians. For more information, visit or

AMA Delegates Adopt Comprehensive Measure Supporting Health Care Reform

The American Medical Association (AMA) put its support behind health system reform on November 9, 2009, during the interim meeting of the AMA House of Delegates in Houston, Tex. AMA delegates adopted a comprehensive substitute measure, which states that the AMA is committed to working with Congress, the Obama administration, and other stakeholders to achieve health system reform that includes the following key components of AMA policy: health insurance coverage for all Americans; insurance market reforms that expand affordable coverage choices and eliminate coverage denials based on preexisting conditions or arbitrary caps; assurance that health care decisions will remain in the hands of patients and their physicians; investments in and incentives for quality improvement activities, and prevention and wellness initiatives; repeal of the sustainable growth rate–based Medicare physician payment formula; implementation of medical liability reforms to reduce the cost of defensive medicine; and implementation of streamlined and standardized insurance claims processing requirements to eliminate unnecessary costs and administrative burdens. The final resolution also specified that the AMA would actively oppose the inclusion of certain provisions to legislation, including reduced payments to physicians for failing to report quality data; redistribution of Medicare payments among health care professionals based on outcomes, quality, and risk-adjustment measurements that are not scientifically valid, verifiable, and accurate; and Medicare payment cuts across all physician services to partially offset bonuses paid to physicians in certain specialty fields at the expense of others. For more information, visit

CMS Tightens Rules for Physician Ordering and Patient Referring

As of October 5, 2009, physicians who participate in Medicare must include their names and National Provider Identifiers (NPIs) when ordering prescriptions, medical supplies, or medical services and when making patient referrals for service. Enrollment in Medicare will be checked against the Medicare Provider Enrollment, Chain and Ownership System (PECOS). Medicare claims that lack the proper information will continue to be processed if they are received by January 3, 2010. However, the provider or supplier will receive a warning on the remittance advice. The grace period ends on January 4, 2010. From that point forward, Medicare claims will be rejected if the ordering physician's NPI and active status in Medicare cannot be verified. It is also important for physicians to update their Medicare enrollment information if they have not done so during the past five years. Physicians can verify their enrollment in PECOS at any time at For more information, visit or

FDA Working to Revise Prescribing Information for Diabetes Medications

The U.S. Food and Drug Administration (FDA) is revising the prescribing information for the diabetes medications exenatide (Byetta) and sitagliptin (Januvia). The FDA received 62 reports of acute renal failure and 16 reports of renal insufficiency in patients using exenatide from April 2005 through October 2008. Some cases occurred in patients with preexisting kidney disease or in those with one or more risk factors for developing kidney problems. The FDA said physicians should avoid prescribing exenatide for patients with severe renal impairment or end-stage renal disease, use caution when initiating or increasing doses in patients with moderate renal impairment, monitor patients for the development of kidney dysfunction, and evaluate the continued need for exenatide if kidney dysfunction is suspected. The FDA also said that 88 post-marketing cases of acute pancreatitis, including hemorrhagic or necrotizing pancreatitis, were reported between October 16, 2006, and February 9, 2009, for the diabetes drugs sitagliptin and sitagliptin/metformin (Janumet). FDA officials are working with the drugs' manufacturer to include physician recommendations to monitor patients for the development of pancreatitis after initiation or dose increases of either drug and to discontinue use if pancreatitis is suspected. For more information, visit

Texas Enacts Loan Repayment Program for Primary Care in Underserved Areas

Texas has taken steps to increase the number of primary care physicians in underserved areas of the state with a generous medical school loan repayment program. The program will be funded at $60 million on a biannual basis and will award as much as $160,000 during a four-year period to physicians who agree to provide primary care services in federally designated health professional shortage areas. The program went into effect September 1, 2009, and will start awarding loan repayment money to participating physicians in January 2010. After the program is fully operational, it will provide $25,000 per primary care physician the first year he or she participates. That amount will increase by $10,000 each succeeding year, with a maximum payment of $55,000 in the fourth year of the program. The program does not require a time commitment on the part of physicians to participate, but they will have to practice for at least one year to start receiving repayments. Texas officials estimate that the program will lead to 225 new primary care physicians practicing in underserved areas in Texas every year. The state is funding the loan repayment program via a higher tax rate on smokeless tobacco products. For more information, visit

AAFP Offers Requested Guidance to FDA on Increased Tobacco Regulation

The AAFP has weighed in with numerous suggestions to a July 2009 request from the FDA for public input on how the agency should implement its newfound authority to regulate tobacco. In its comments, the AAFP lauded the FDA's recent ban on cigarettes with fruit, candy, or clove flavoring and suggested the agency go a step further by forcing manufacturers to remove menthol as a flavoring agent. The AAFP also recommended that the FDA ban single sales of little cigars to reduce initiation of smoking among adolescents; broaden restrictions on misleading information on cigarette packaging; implement pictorial warnings on packaging as a way to broaden communication about the hazards of tobacco use in other countries; restrict the use of colors, package design, and other attempts to appeal to smokers; diminish the appeal of tobacco at the point of sale; and help educate physicians, nurses, and other health care professionals about tobacco cessation and control. The AAFP also expressed hope that FDA officials would find a way to minimize the influence of three, nonvoting, tobacco industry representatives on the FDA's Tobacco Products Scientific Advisory Committee. The tobacco industry is guaranteed representation in the committee under new legislation, but the Academy cautioned the FDA to limit the role these representatives play. The FDA is accepting comments on its new regulatory authority through December 28, 2009. For more information, visit

Medical Organizations Endorse New Report on Treatment of Chronic Pain

Chronic pain costs the United States more than $100 billion a year in direct medical costs and lost productivity, and more than 50 million lost workdays annually, according to a new report from the Mayday Fund that has been endorsed by more than 30 medical organizations. The report stresses the importance of primary care and calls for all Americans with chronic pain to have access to a well-trained primary care physician who can coordinate high-quality, effective care. The report says that with 75 million baby boomers at or near retirement age, pain-related costs to the health care system likely will rise sharply in the near future. For more information, visit


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