Senate Passes Health Care Reform Bill with Provisions Favorable to Primary Care

The Senate passed the Patient Protection and Affordable Care Act (H.R. 3590) on December 24, 2009, after more than three weeks of heated debate. The American Academy of Family Physicians (AAFP) Board Chair Ted Epperly, MD, said the legislation will give Americans expanded access to preventive, primary care and will increase the primary care physician workforce by improving primary care payment. The legislation would provide a 10 percent bonus for five years for physicians who provide more than 60 percent primary care health services in their practices. The AAFP has called on Congress to make the primary care bonus payment permanent and has urged that it apply to physicians who provide 50 percent primary care health services, not 60 percent, to allow more primary care physicians to qualify for the bonus. The legislation does not contain a permanent fix for the sustainable growth rate (SGR) formula, although the Senate has pledged to work on this issue. The bill also does not provide comprehensive tort reform, something the AAFP has long championed. It does, however, include funding for states to explore alternative dispute resolution systems. House and Senate conferees will now work to reconcile House- and Senate-passed versions of health care reform legislation. For more information, visit https://www.aafp.org/news-now/government-medicine/20091224senate-hcreform-bill.html.

Congress Approves Temporary SGR Payment Patch, CMS Revises Consultation Codes

In December 2009, Congress passed, and President Obama signed, a measure that extended the 2009 Medicare physician payment rate for two months, blocking a 21.2 percent reduction that was scheduled to go into effect on January 1, 2010, under the SGR formula. The two-month payment patch gives lawmakers more time to replace the SGR payment formula. With the short-term payment patch, the Centers for Medicare and Medicaid Services (CMS) also will be able to implement a 2010 payment rule that eliminates Medicare payments for consultation codes and redistributes the savings to office visits and selected other evaluation and management services. This will lead to higher payments for primary care physicians. As of January 1, 2010, CMS had deleted several consultation codes for payment of services provided to Medicare Part B beneficiaries. CMS published instructions for physicians on these revisions in a recent issue of MLN Matters (http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf). For more information, visit https://www.aafp.org/news-now/government-medicine/20091222tempsgrpatch.html and https://www.aafp.org/news-now/practice-management/20091223rev-cpt-codes.html.

Pneumococcal Infections Increase, CDC Advises Vaccination for At-Risk Patients

Anne Schuchat, MD, director of the Centers for Disease Control and Prevention's (CDC's) National Center for Immunization and Respiratory Diseases, said during a media briefing in November 2009 that the agency has seen an increase in serious pneumococcal infections across the country. According to Schuchat, vaccination is the best way to protect against serious pneumococcal infections, but only one fourth of high-risk adults younger than 65 years have received the pneumococcal polysaccharide vaccine. About 70 million Americans fall into at least one of several groups recommended to receive the vaccine, which include adults 65 years or older; persons two years or older with a chronic illness, weakened immune system, or dysfunctional spleen; and adults younger than 65 years who smoke cigarettes or have asthma. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20091223pneumo-vacc-flu.html.

FDA Launches Initiative That Targets Preventable Harms From Medications

The U.S. Food and Drug Administration (FDA) recently launched its Safe Use Initiative, a program intended to reduce the likelihood of preventable harm from over-the-counter and prescription drug use. The initiative will examine multiple sources of preventable harm, including unintentional misuse of medications, abuse, and attempts at self-harm. The FDA is seeking input from physicians and other stakeholders to identify drugs and classes of drugs linked to such events. The initiative involves a collaboration of patients, consumers, caregivers, health care professionals, pharmacists, health care systems, insurers, drug manufacturers, and other federal agencies to develop a list of specific problems, interventions for reducing harm from those problems, and metrics for judging success in meeting the goal of reducing preventable harm. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20100105safe-use.html and http://www.fda.gov/downloads/Drugs/DrugSafety/UCM188961.pdf.

Federal Government Issues New Regulations for Health Information Technology

On December 30, 2009, CMS and the Office of the National Coordinator for Health Information Technology (ONC) each issued a set of regulations aimed at improving the quality, efficiency, and safety of the nation's health care through the use of certified electronic health record (EHR) technology. The regulations will help implement government EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009. The proposed rule issued by CMS outlines provisions governing EHR incentive programs, including the definition of meaningful use of health information technology. The interim final regulation issued by the ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. For more information, visit https://www.aafp.org/news-now/government-medicine/20100106mean-use.html.

MedImmune Recalls 13 Lots of Intranasal H1N1 Vaccine After Failed Stability Testing

In December 2009, AstraZeneca's MedImmune biologics unit recalled 4.7 million doses of its live, attenuated intranasal novel influenza A (H1N1) vaccine after nine lots failed stability testing. Four other lots that still met specifications during testing also were recalled as a precautionary measure. The affected lots, which were distributed nationwide, are: 500751P, 500754P, 500756P, 500757P, 500758P, 500759P, 500760P, 500761P, 500762P, 500763P, 500764P, 500765P, and 500776P. All of the affected lots passed safety, purity, and potency tests before their release; vaccine potency was only slightly below specifications during follow-up tests; and there is no need to revaccinate those who received vaccine from these lots. MedImmune is notifying physicians who received doses from affected lots so they can return any unused vaccine. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20091223medimm-vacc-recll.html.

CMS Needs Feedback for Annual Medicare Contractor Provider Satisfaction Survey

CMS started conducting its annual Medicare Contractor Provider Satisfaction Survey in January 2010. The survey offers Medicare fee-for-service providers and suppliers an opportunity to analyze their interactions with Medicare contractors and provide feedback to CMS. More than 30,000 physicians and suppliers will be randomly selected to participate in the 2010 survey. Business functions covered in the survey are provider inquiries, provider outreach and education, claims processing, appeals, provider enrollment, medical review, and provider audit and reimbursement. The feedback helps CMS monitor trends and improve the Medicare program. For more information, visit https://www.aafp.org/news-now/practice-management/20100106cms-medicare-surv.html and http://www.cms.hhs.gov/MCPSS/.

Institute of Medicine Report Recommends Continuing Education System Changes

A new report from the Institute of Medicine, “Redesigning Continuing Educatio`n in the Health Professions,” cites several deficiencies with the current continuing education (CE) system for health professionals. According to the report, there are major flaws in the way CE currently is conducted, financed, regulated, and evaluated; the science behind CE for health professionals is fragmented and underdeveloped; CE efforts need to bring health professionals from various disciplines together in tailored learning environments; a new vision of professional development for health care professionals is needed to replace the current culture; and establishing a national, interprofessional public-private institute to foster improvements in CE may help improve the overall system. The report suggests that the federal government work with stakeholders to develop a public-private institute called the Continuing Professional Development Institute (CPDI), with recommendations for the CPDI to create national standards for regulation of continuing professional development and analyze its sources and adequacy of funding. For more information, visit https://www.aafp.org/news-now/cme-lifelong-learning/20091223iom-cme-report.html.

AAFP Collaborating with Other Medical Groups on Primary Care Physician Survey

The AAFP and four other medical organizations are collaborating with the Association of American Medical Colleges (AAMC) on a survey designed to assess the primary care workforce. Information from the survey will be used to help inform policy discussions. The AAMC sent the survey to selected physicians in December 2009. It asks about the physicians' professional medical activities, work preferences and arrangements, activity levels in the principal practice site, and other background information, as well as questions about the patient-centered medical home concept. For more information, visit https://www.aafp.org/news-now/professional-issues/20100105aamc-survey.html.

— AFP and AAFP NEWS NOW staff