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Am Fam Physician. 2010;81(10):1193-1194

AAFP Board Adopts CMSS Code of Standards for Business Interactions

The American Academy of Family Physicians (AAFP) Board of Directors has adopted as official policy a new code of standards for working with for-profit companies in the health care sector. The Council of Medical Specialty Societies (CMSS) developed the voluntary CMSS Code for Interactions with Companies. Key areas covered by the code include conflicts of interest, financial disclosure, and independent program development. It calls for independent and transparent interactions between medical specialty organizations and industry, and it states that any collaboration with a for-profit company in the health care sector should advance medical care for the benefit of patients. It also offers detailed guidance on implementation. The AAFP is one of 14 CMSS member organizations to initially sign on to the code and will work toward adherence to the code within six months of CMSS' April 17, 2010, adoption date. For more information, visit and

MedPAC Report Addresses Medical Malpractice Reform Approaches

A report from the Medicare Payment Advisory Commission (MedPAC) says the current medical malpractice system has led to an increase in direct and indirect medical costs, prompting consideration of alternative malpractice initiatives at the state and federal levels. The report's findings were presented in April 2010 by senior MedPAC analyst Ariel Winter, MPP, during a MedPAC meeting in Washington, DC. According to the Congressional Budget Office, the amount spent on direct medical costs (i.e., malpractice premiums and related legal costs) in 2009 was $35 billion, or about 2 percent of total health care spending. Indirect costs include additional services ordered by physicians in response to liability risk (i.e., defensive medicine), which are difficult to quantify in terms of total cost. Periodic spikes in malpractice premiums have reduced the affordability and availability of coverage, further contributing to direct and indirect medical costs. Winter said that the current system has not reduced medical errors or done a good job of compensating patients who are harmed by medical negligence, and the current malpractice climate may reduce efforts to improve patient safety by discouraging transparency of medical errors. She discussed reform approaches that include modifications to the current system and alternative compensation systems. Some of the state reforms outlined in the report were caps on non-economic damages, pretrial screening panels, attorney fee limits, periodic payments, and statutes of limitations. For more information, visit

FDA Issues Final Rule to Phase Out All Chlorofluorocarbon Inhalers

Nearly three years ago, the U.S. Food and Drug Administration (FDA) proposed the elimination of ozone-depleting chlorofluorocarbon (CFC) inhalers, and a final rule affecting the seven remaining CFC-based inhalers was published April 14, 2010, in the Federal Register. In an April 13, 2010, news release, FDA officials said that three CFC inhalers will be phased out during the next three years: flunisolide (Aerobid); combination albuterol/ipratropium (Combivent); and pirbuterol (Maxair). Flunisolide will not be available after June 30, 2011; albuterol/ipratropium and pirbuterol will not be available after December 31, 2013. Manufacturers already have ceased production of four CFC inhalers that are being phased out of the market by the end of this year: nedocromil (Tilade) and metaproterenol (formerly Alupent) will not be available after June 14, 2010; and triamcinolone (formerly Azmacort) and cromolyn (formerly Intal) will not be available after December 31, 2010. The FDA said patients should continue using their CFC inhalers until they have talked with their physicians about switching to an alternative medication, such as inhalers that use the propellant hydrofluoroalkane, dry powder inhalers that do not use propellants, and liquids that are used with a nebulizer machine. For more information, visit and

IOM Report Says Average Sodium Intake Is Too High and Urges FDA to Set Standards

The Institute of Medicine (IOM) is calling on the FDA to set mandatory national standards for the sodium content in foods. In a report released April 20, 2010, the IOM said Americans average a daily intake of more than 3,400 mg of sodium chloride (about 1.5 teaspoons), which is substantially higher than the daily maximum value of 2,300 mg (about 1 teaspoon) established in 2005 dietary guidelines from the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture. Those 2005 guidelines set an even lower maximum of 1,500 mg per day for at-risk groups, including persons with hypertension, blacks, and middle-aged and older adults. The IOM report, which was developed by a committee convened at the request of Congress in 2008, notes that a daily intake of 1,500 mg of sodium is adequate for most adults, with those 50 years or older needing even less. The report suggests that health care professionals, government agencies, public health and consumer organizations, the food industry, and public-private partnerships should continue or expand efforts to support behavior changes in consumers to help reduce their sodium intake. For more information, visit

MedPAC Recommends Establishment of a New Performance-Based GME Program

MedPAC has approved five recommendations aimed at improving graduate medical education (GME) through Medicare payments to teaching hospitals. Its primary recommendation is that Congress should authorize HHS to establish a performance-based GME program that would begin in three years. Currently, Medicare payments to teaching hospitals do not vary based on the performance of residency programs or their supporting institutions in fostering the workforce skills needed in a health care delivery system that holds costs in check while maintaining or improving quality. In addition to recommending the performance-based GME program, MedPAC recommended that HHS publish an annual report that shows Medicare medical education payments received by each hospital plus each hospital's associated costs; conduct a workforce analysis to determine the number of residency positions needed by specialty; report to Congress on how residency programs affect the financial performance of their sponsoring institutions, whether programs in all specialties should be supported equally, and whether certain residency programs are sustainable without federal support; and study and report on strategies to increase the diversity of the health professional workforce. For more information, visit

AAFP Urges Congress to Fund Primary Care-Related Programs in 2011

As the federal government prepares to implement provisions of the newly enacted health care reform law, known as the Patient Protection and Affordable Care Act, the AAFP has asked the House and Senate appropriations subcommittees to increase funding for key programs related to primary care in fiscal year 2011 (FY11). The AAFP has long championed Section 747 of Title VII, which provides the only federal grants for training family physicians. In written testimony submitted to House and Senate appropriations subcommittee members, AAFP President Lori Heim, MD, of Vass, N.C., urged the committees to provide $170 million for Title VII, Section 747, in FY11, an increase of $116 million from FY10. Heim also asked the committees to provide an appropriation of at least $600 million for all of the health professions training programs authorized under Title VII in FY11, an increase of $346 million from the current fiscal year level. Heim also requested increased funding for the National Health Service Corps and the Agency for Healthcare Research and Quality. For more information, visit

Research Shows EHR ‘Meaningful Use’ Criteria Could Slow Physician Productivity

Many physician practices say they expect to experience a productivity drop during the coming months as they attempt to meet new government regulations for “meaningful use” of electronic health records (EHRs), according to new research from the Medical Group Management Association. Nearly 68 percent of 450 physician practices that responded to a questionnaire said that changes in practice operations necessary to meet the criteria would slow physicians' daily work; 31 percent said productivity would decrease by more than 10 percent. Physicians have a financial stake in meeting the federal criteria for EHRs because doing so will make them eligible for Medicare and Medicaid incentive payments beginning in 2011. However, just more than 61 percent of practices said the incentive payments would help their practice establish or upgrade its EHR systems. Nearly 82 percent of respondents said they planned to implement an EHR during the next six to 36 months. For more information, visit and

Long-Time AFP Contributor's Online Magazine Celebrates Second Anniversary

Online medical writings magazine, Pulse (, celebrated its second anniversary in April 2010. Its editor-in-chief, Paul Gross, MD, was a long-time contributor to the popular AFP column, Diary from a Week in Practice. Gross said an important part of Pulse's mission is to bring the story of family medicine to a larger audience.


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