CMS Extends Grace Period for Medicare's PECOS Physician Enrollment Policy

Centers for Medicare and Medicaid Services (CMS) announced on November 23, 2009, that it would delay implementation of new rules that give Medicare the authority to reject claims for services or supplies when the ordering physician is not enrolled in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). CMS is delaying implementation of the new policy until April 5, 2010. The original grace period was scheduled to end on January 4, 2010. According to CMS, an extension of the implementation date will give physicians and other health care professionals sufficient time to enroll or, if necessary, reenroll in Medicare. CMS' decision to postpone the January deadline came on the heels of a November 16, 2009, letter sent to CMS Acting Administrator Charlene Frizzera by the American Medical Association, the American Academy of Family Physicians (AAFP), and more than 50 other medical organizations, in which the groups expressed concerns about the policy. For more information, visit https://www.aafp.org/news-now/practice-management/20091130pecos-delay.html.

USPSTF Chair Defends Breast Cancer Screening Recommendations

Family physician and Chairman of the U.S. Preventive Services Task Force (USPSTF) Ned Calonge, MD, MPH, defended the USPSTF's recently revised breast cancer screening recommendations before a House subcommittee on December 2, 2009. In its updated recommendations released November 17, 2009, the USPSTF recommended a shift from annual to biennial screening mammography in women 50 to 74 years of age, and recommended against routine screening mammography for women in their 40s who are not at increased risk of breast cancer. Calonge acknowledged that portions of the controversial recommendations were poorly phrased. He clarified the USPSTF's stance by saying that the decision to have a mammogram for women in their 40s should be based on a discussion between each woman and her doctor, that many women and their doctors will decide to start screening at 40 years of age, and that the USPSTF supports these decisions. The AAFP is in the process of reviewing the USPSTF's breast cancer screening recommendations, but was one of 11 health care organizations that signed a letter defending the USPSTF prior to the subcommittee hearing. The letter highlighted and addressed three false statements that have appeared in media reports: the USPSTF recommends that women in their 40s not receive mammograms; the USPSTF recommendations were intended to reduce costs; and members of the USPSTF are not qualified to make scientific recommendations, or have agendas that influence their recommendations. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20091202calonge-tstmny.html or https://www.aafp.org/news-now/clinical-care-research/20091203breast-ca-letter.html.

House Approves Legislation to Help Small Practices Purchase Health IT Systems

The House passed the Small Business Health Information Technology Act (H.R. 3014) on November 18, 2009. If approved by Congress, the bill would create a new lending program within the Small Business Administration to allow small and solo physician practices to obtain low-cost loans from their local banks for the purchase of health information technology (IT) systems. According to the legislation, the loans would be as much as 90 percent guaranteed and would carry a subsidized deferment period of up to three years. The loans are limited to hardware and software products and services to help physicians achieve “meaningful use” of health IT systems. It does not apply to health IT systems used solely for financial management, maintenance of supply inventories, or appointment scheduling. The legislation would complement the recently enacted American Recovery and Reinvestment Act of 2009 (ARRA), which authorizes $36 billion for health IT. However, the ARRA does not provide any up-front capital for purchasing health IT systems, which created the need for a bill to fill that void. For more information, visit https://www.aafp.org/news-now/government-medicine/20091125health-it-bill.html.

Medicare Adds HIV Infection Screening Tests to List of Covered Preventive Services

On December 8, 2009, CMS announced its final decision to immediately begin covering human immunodeficiency virus (HIV) infection screening for Medicare beneficiaries who are at increased risk of the infection. The coverage includes women who are pregnant and patients of any age who voluntarily request the service. Prior to the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Medicare could only cover additional preventive screening tests when Congress authorized it to do so. However, under MIPPA, CMS can now add to Medicare's list of covered preventive services, provided certain requirements are met. Among other requirements, the new services must have been “strongly recommended” or “recommended” by the USPSTF, which graded HIV screening as “strongly recommended” for certain groups. For more information, visit http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=229.

Pay-for-performance Programs Can Be Costly for Primary Care Practices

A report in the November/December issue of Annals of Family Medicine that analyzed medical practice costs associated with pay-for-performance programs found that participation in quality-reporting programs requires resources with measurable costs, particularly for small practices. The study looked at eight practices in North Carolina that were participating in at least one of four quality-reporting programs. The Agency for Healthcare Research and Quality (AHRQ) provided funding for the study. In 2006, AHRQ identified practice costs as one of the barriers holding back quality data reporting in primary care. The study found that pay-for-performance program costs per full-time physician ranged from less than $1,000 to about $11,000 during the implementation phase, and from less than $100 to about $4,300 during the maintenance phase. Practice costs varied by program characteristics, the level of on-site assistance provided, the experience level of practice personnel, and the extent of data system problems encountered. The study's corresponding author, Jacqueline Halladay, MD, MPH, said the study created “cost categories” to help physicians judge potential costs before committing to any quality-reporting initiative. Halladay advised physicians to consider quality improvement organizations willing to shoulder some of the work and costs. For example, some programs offer to train office staff on the use of computer systems or teach staff about quality improvement principles. For more information, visit https://www.aafp.org/news-now/practice-management/20091201p4p-costs.html or the Annals of Family Medicine Web site at http://www.annfammed.org/cgi/content/full/7/6/495.

Family Medicine Residencies Declining Despite Rise in Medical School Enrollment

First-year enrollment in U.S. medical schools grew again in 2009 because of the launch of four new schools in Florida, Texas, and Pennsylvania, as well as notable expansions in class sizes at a dozen more schools, according to the Association of American Medical Colleges (AAMC). In an October 20, 2009, press release, the AAMC said first-year enrollment in U.S. medical schools increased by 2 percent compared with 2008. The AAMC also reported some increases in racial and ethnic diversity among enrollees. However, even as the overall number of first-year medical students continues to grow, the number of family medicine residencies is declining, with 30 family medicine residency programs closing from academic year 2003–2004 to 2007–2008. A recent example of this is the announcement that Baylor College of Medicine/Kelsey-Seybold Clinic Family Medicine Residency Program in Houston, Tex., will close July 1, 2011, because of cuts in stipends and other financial issues. Although Kelsey-Seybold's current second- and third-year residents will be able to complete their training at the residency, the program's first-year residents will need new positions beginning in July 2010. Medical school expansion and graduate medical education (GME) funding are addressed in the AAFP's new policy on family physician workforce reform. The policy's recommendations include establishing a national commission to develop a plan to align GME policy with the country's needs, creating a public-private entity to allocate funding for GME positions, and ensuring that medical school expansion targets primary care in rural and underserved areas. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20091124medschoolenroll.html or https://www.aafp.org/news-now/resident-student-focus/20091130kelsey-seybold.html.

CDC Releases Estimates on Prevalence of H1N1 Illness, Vaccine Safety Data

According to updated estimates from the Centers for Disease Control and Prevention (CDC), there were 22 million novel influenza A (H1N1) illnesses in the United States from April 2009 to mid-October 2009, with 98,000 hospitalizations and 3,900 deaths. The CDC estimates that 8 million children had contracted the virus as of October 17, 2009, with about 36,000 hospitalizations and 540 deaths. Persons with diabetes represent a large percentage of those with H1N1 infection, accounting for 19 percent of adults and 12 percent of all patients hospitalized with the infection during this period. To assess the safety profile of H1N1 vaccines, the CDC reviewed reports of adverse effects in the first two months of reporting. No substantial differences between H1N1 and seasonal influenza vaccines were noted in the proportion or types of serious adverse events reported. Data showed 82 adverse events reports per 1 million H1N1 vaccination doses as of November 24, 2009. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20091202h1n1-estimates.html or http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5848a4.htm.

— AFP and AAFP NEWS NOW staff