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Fam Pract Manag. 2008;15(1):14-15

Congress delays potential cuts in Medicare pay for six months

The House and Senate spent much of December working out a plan to avoid a 10.1-percent cut in payments to physicians. They eventually arrived at a deal that seemed to please no one: a delay in the cuts for just six months, during which payments will increase 0.5 percent. Lawmakers had previously debated a one- or two-year suspension of the fee cuts but were unable to agree on ways to fund such a measure.

Some on Capitol Hill expect Congress to slap a similar payment patch on Medicare in June, although one prominent House Democrat would prefer to let the Medicare cuts happen. “I'm inclined to do nothing,” Rep. Pete Stark, D-Calif., told CongressDaily. “My colleagues, my staff say, ‘Oh, dear, the doctors would all drop Medicare.’ I don't believe it. I don't believe that doctors are willing to give up half their income.” Stark acknowledged his sentiments are in the minority among his colleagues.

This was the sixth year in a row that Congress had acted to halt cuts in Medicare payments to physicians that were required by the sustained growth rate (SGR) formula.

The Medicare deal also included an extension of funding for the State Children's Health Insurance Program (SCHIP) until March 2009, well after Election Day 2008. Democrats had wanted an extension until September 2008.

ACP backs single-payer system

The American College of Physicians (ACP) has taken a look at health care in the United States and in other countries, and it has decided that the former has a lot to learn from the latter. The ACP shared its conclusions in a position paper published this month in Annals of Internal Medicine.

The group observed that “well-functioning health systems guarantee that all residents have access to affordable health care.” As a result, the ACP is now pushing for universal health insurance in the United States, achieved with either a health system solely funded by the government or a system that includes a mix of public and private funding sources.

The idea of a single-payer health system has never before been publicly backed by such a large group of doctors, according to the ACP. (The AAFP has developed a policy for achieving health care coverage for all Americans but has not endorsed a single-payer system; see In making its recommendation, the ACP cited the following advantages of a single-payer system:

  • It is generally more equitable in providing care to a population.

  • It has lower administrative costs.

  • It has lower per capita health care expenditures.

  • It has high levels of patient satisfaction.

  • It has higher performance on quality and access measures.

The ACP also cited disadvantages of a single-payer system:

  • It has the potential for shortages of services subject to price controls.

  • It can create delays in obtaining elective procedures.

“The American College of Physicians does not want to replicate what other countries do,” said Joel S. Levine, MD, FACP, chair of ACP's Board of Regents. “We try to identify approaches that the evidence shows are more likely to be effective and that ultimately will result in a health care system that is fair, cost effective and efficient.”

Along with its recommendation to move toward universal health care, the ACP made two recommendations important to family physicians and other primary care physicians:

  1. Redirect federal health care policy toward supporting the patient-centered medical home.

  2. Provide financial incentives to physicians for care coordination, disease prevention, quality improvement and achievement of evidence-based performance standards.

Study examines doctors' professionalism

A survey sent to thousands of U.S. physicians found that although most supported professional standards backed by many professional societies, they did not always conform to those standards in their practice. For example, 96 percent of the survey's participants said they agreed that physicians should report impaired or incompetent colleagues, but 45 percent who encountered such colleagues had not reported them.

More than 3,500 physicians participated in the survey, which was published in the Annals of Internal Medicine. More than 90 percent agreed with statements about principles of fair distribution of finite resources, improving access to and quality of care, managing conflicts of interest, and professional self-regulation. Twenty-four percent disagreed that periodic recertification was desirable.

Family physicians and pediatricians were least likely to report having participated in a formal medical error reduction initiative. On the other hand, family physicians, pediatricians and internists were most likely to have undergone competency assessment in the past three years.

United Healthcare paying attention to image

After losing about 315,000 customers in 2007, United Healthcare announced to investors last month it would start treating patients and doctors better. The insurer reportedly plans to reimburse doctors more quickly, offer claims adjudication at the time of service, resolve billing issues within two days and provide greater incentives for its employees to focus on quality and patient advocacy.

United Healthcare has also agreed to finally begin paying for same-day evaluation and management (E/M) services. That topic was on the agenda when AAFP executives met with United Healthcare executives at AAFP headquarters in Leawood, Kan., on Nov. 26. United Healthcare had announced months ago that, starting Aug. 27, it would pay for same-day E/M services. But Aug. 27 came and went, and United Healthcare did not implement its announced policy. The delay, according to the payer, was related to systems issues. Although the AAFP asked United Healthcare to retroactively pay affected claims back to Aug. 27, the payer has agreed to pay affected claims back to Oct. 15 only, citing liability and human resources issues.


The number of primary care physicians practicing in the United States who received their undergraduate medical training in Nigeria. This was cited by the authors of a study on the ethical implications of employing a relatively large percentage of foreign-trained physicians in the United States when their home countries are, in many cases, poor and in need of better health care.

Source: Starfield B, Fryer GE Jr. The primary care physician workforce: ethical and policy implications. Ann Fam Med. 2007;5:486–491. Available at:

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