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Am Fam Physician. 2009;80(12):1347-1348

AAFP Applauds House Passage of Bill to Fix Sustainable Growth Rate Formula

The American Academy of Family Physicians (AAFP) has hailed the U.S. House of Representative's passage of a bill that would provide a permanent fix for the sustainable growth rate (SGR) formula as a victory for Medicare patients and their physicians. The House passed H.R. 3961, the Medicare Physician Payment Reform Act of 2009, on November 19, 2009, by a vote of 243 to 183. The measure would replace the SGR formula with physician updates that are tied to inflation rather than specified targets. If enacted, the bill would block a 21.2 percent reduction in the Medicare physician payment rate scheduled to go into effect January 1, 2010. H.R. 3961 also would eliminate the accounting debt accumulated by the SGR formula, thus removing the primary obstacle in preventing the adoption of a reasonable formula to determine physician payment under Medicare. The bill passed with no Republican support; 11 Democrats also voted against the legislation. According to the Congressional Budget Office, if enacted, the legislation will cost about $210 billion during the next 10 years. Senate leaders were unable to bring a similar bill that would have permanently fixed the SGR formula to the floor in October 2009. House passage of H.R. 3961 means House members are likely to include an SGR fix in any negotiations with the Senate in a final health care reform bill, according to analysts. For more information, visit

Demand Outpacing Supply of Vaccines for H1N1 and Seasonal Flu

Most Americans who have tried to get vaccinated against the novel influenza A (H1N1) virus have been unable to do so, according to a recent Harvard poll. From October 30 to November 1, 2009, researchers at the Harvard School of Public Health in Boston, Mass., polled 1,073 persons 18 years and older. Of those polled, only 30 percent of adults who tried to get the vaccine for themselves succeeded in doing so, and only 34 percent of parents who sought vaccine for their children were successful. Overall, the researchers reported that 21 percent of high-priority persons said they tried to get the H1N1 vaccine, but only 34 percent of those who tried were able to do so. Nearly one half of the poll's respondents indicated they were unable to find information about the location of available H1N1 vaccine in their area. Meanwhile, the Centers for Disease Control and Prevention (CDC) said on November 9, 2009, that nearly 80 percent of seasonal flu vaccine already has been distributed to vaccine providers, and a surge in uptake may leave supplies short of demand. Vaccine for the 2009 to 2010 flu season was made available earlier than normal to make way for H1N1 immunizations. The CDC said that the early availability of the seasonal flu vaccine, combined with increased interest in vaccination, has led to increased uptake. CDC officials said seasonal flu strains usually do not increase until December through May; accordingly, there has been little seasonal flu activity reported to date, and H1N1 flu currently accounts for most of the circulating flu in the country. For more information, visit

USPSTF Makes Changes to Breast Cancer Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) updated its recommendations for breast cancer screening with some significant changes from their 2002 recommendations. The task force's statement, published in the November 17, 2009, issue of Annals of Internal Medicine, recommends against routine screening mammog-raphy for women 40 to 49 years of age who are not at increased risk of breast cancer. The task force explained that it encourages individualized, informed decision making about when to start mammography screening, and that the decision should take into account patient context. The USPSTF also recommended a switch from annual to biennial screening mammography in women 50 to 74 years of age, with the intent of reducing the potential harms of screening by nearly one half. The task force says evidence that screening with film mammography reduces breast cancer mortality is greater for women 50 to 74 years of age than those 40 to 49 years of age, and the strongest evidence of benefit occurs in women 60 to 69 years of age. In updating its recommendation, the USPSTF specifically assessed evidence on the effectiveness of reducing mortality from breast cancer by screening with film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging. The AAFP's Commission on Health of the Public and Science is reviewing the evidence for all of the task force recommendations regarding breast cancer screening. For more information, visit, or

CMS Extends 2010 Medicare Provider Participation Enrollment Period

The Centers for Medicare and Medicaid Services (CMS) has extended Medicare's 2010 provider participation enrollment end date to January 31, 2010. This gives physicians currently participating in Medicare or considering participation in 2010 one month beyond the normal December 31, 2009, cutoff to make a participation decision. CMS attributes the change to recent revisions in the 2010 Medicare Physician Fee Schedule. Medicare contractors will accept and process physicians' participation elections or withdrawals that are received or postmarked on or before January 31, 2010. Provider status changes made during the extension period are retroactive to January 1, 2010, and remain in effect throughout 2010. For more information, visit

AAFP and Other Medical Groups Respond to ACC's Attempts to Overturn CMS Rule

The AAFP, with nearly 20 other medical groups, has responded against calls by the American College of Cardiology (ACC) to overturn a new CMS rule that would provide a 5 to 8 percent increase in Medicare physician payment rates for primary care physicians during the next four years. CMS, which proposed the rule earlier this year, based its recommendations on a new physician practice information survey from the American Medical Association that was conducted in 2008 and carried out according to strict methodology requirements. The scientific data gathered in the survey also were validated by The Lewin Group, an independent survey firm. The rule attempts to correct the imbalances of the past by phasing in a redistribution of the payment pool based, in part, on the practice expense data from the survey. According to the ACC, however, the new rule is based on flawed survey data. The organization is lobbying members of Congress in protest against the CMS rule, prompting a response from the AAFP and other physician groups. The implementation of the new rule would end four years of Medicare payment reductions for primary care and other specialties that began in 2005 when CMS adopted external data from only a few subspecialties. For more information, visit and

More Federal Agencies Adopting Patient-Centered Medical Home Model

One of the messages that came out of the Patient-Centered Primary Care Collaborative (PCPCC) summit on October 22, 2009, is that several federal agencies are adopting the patient-centered medical home model as part of their overall health care transformation efforts. Data published by the PCPCC show dramatic results for health care systems that have implemented the model. Robert Kocher, M.D., a member of the National Economic Council and special assistant for health care to President Obama, said mounting evidence shows that if done right, medical homes are more cost-effective than traditional models of care and improve patient outcomes. More than 40 states have launched some type of medical home pilot project, he said. Kocher also pointed to a new medical home project launched by CMS in which Medicare will join with Medicaid and private insurers in state-based efforts to improve the way care is delivered using the medical home model. In addition, CMS is working to launch a medical home demonstration project for Medicare patients that will take place in eight states. The new project is expected to begin in January 2010 and last for three years. In the meantime, the assistant secretary of defense for health affairs has issued a memorandum stating that the patient-centered medical home will be the model of care for the Army, Navy, and Air Force. For more information, visit

MED WATCH: FDA Announces Warning on Plavix to Avoid Use with Prilosec

The U.S. Food and Drug Administration (FDA) issued a warning on November 17, 2009, concerning the use of the proton pump inhibitor (PPI) omeprazole (Prilosec) with the anticlotting drug clopidogrel (Plavix). New data suggest that Plavix's ability to block platelet aggregation may be reduced by approximately one half when taken with Prilosec. It is unknown how other PPIs may interact with Plavix. Other drugs that should not be used with Plavix because they may have a similar interaction include esomeprazole (Nexium), cimetidine (Tagamet), fluconazole (Diflucan), ketoconazole (Nizoral), voriconazole (Vfend), etravirine (Intelence), felbamate (Felbatol), fluoxetine (Prozac, Sarafem), fluoxetine/olanzapine (Symbyax), fluvoxamine (Luvox), and ticlopidine. The FDA will release any new recommendations after it has reviewed additional data. For more information, visit


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