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Am Fam Physician. 2014;90(5):278

IOM Calls for Restructuring of GME System

The Institute of Medicine (IOM) has made several recommendations that would change how the U.S. graduate medical education (GME) system is governed and financed. An IOM committee noted in a July 29 report that the current GME financing system lacks transparency and accountability, and is not producing the types of physicians the country needs. It urged a 10-year transition from the current system to full implementation of its recommendations. Specifically, the IOM recommends the following: (1) maintain Medicare GME funding at its current level, while modernizing GME payment methods based on performance and working to ensure program oversight and accountability; (2) build a GME policy and financing infrastructure that includes creating a GME policy council and establishing a GME center within the Centers for Medicare and Medicaid Services; (3) create one Medicare GME fund that includes subsidiary funds to distribute ongoing support for currently funded residency training positions, and to finance initiatives to develop new GME programs and determine appropriate GME performance measures; (4) modernize Medicare GME payment methodology by replacing the direct and indirect Medicare GME payments with a single-payment process in which funding would be paid on a per-resident basis to organizations that sponsor GME programs; and (5) keep Medicaid GME funding in the control of individual states, but require the same level of transparency and accountability that would be required of Medicare GME. For more information, go to

Study: ACOs Flourishing in 2014

As newly insured patients were entering the U.S. health care system at the beginning of 2014, physician practices were moving at an accelerated pace to join accountable care organizations (ACOs). Family medicine and other primary care practices seem to be one of several factors behind the rapid growth of ACOs in the past six months, according to a recent report from the health care intelligence company Leavitt Partners. An estimated 20.5 million persons are now covered by ACOs, compared with an estimated 15 million at the beginning of 2014. Compared with the 491 ACOs as of September 2013, there are now 626 ACOs in the United States. A total of 329 ACOs reported having government contracts, 210 said they have commercial contracts, and 74 said they have government and commercial contracts. Thirteen ACOs had not released final information about their payment contracts when the Leavitt report was published. Of the six major types of ACOs, independent physician group ACOs are typically made up of primary care practices. Such groups include a single ownership unit that does not contract with other specialists and is most often paid solely through the Medicare Shared Savings Program. Larger private insurance agencies are showing a preference for working with larger, multispecialty ACOs that typically have a hospital affiliation. For more information, go to

FDA Warns Against Use of Powdered Caffeine Products

The U.S. Food and Drug Administration (FDA) has issued a warning about powdered pure caffeine that is being marketed directly to consumers, and recommends avoiding these products. In particular, the FDA is concerned about powdered pure caffeine sold in bulk bags over the Internet. At least one death has been linked to these products. Pure caffeine is a powerful stimulant, and very small amounts may cause accidental overdose. Symptoms of caffeine overdose can include rapid or erratic heartbeat, seizures, vomiting, diarrhea, stupor, disorientation, and death. Adverse events related to the use of these products should be reported to the FDA (telephone: 240-402-2405; e-mail:

AAFP Supports Campaign for Dental Health

The American Academy of Family Physicians (AAFP) has joined more than 70 other organizations in supporting the American Academy of Pediatrics' Campaign for Dental Health, which aims to raise public awareness about general oral health, an increasing incidence of dental caries, and the benefits of water fluoridation. The campaign's website offers a section for health care professionals that includes downloadable information guides for clinicians, patients, parents, and caregivers on topics such as fluorosis and fluoride. According to the campaign, children with healthy teeth do better in school and are more likely to become happy and successful adults. For more information, go to

— AFP and AAFP NEWS staff

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