News Roundup: SGR's Days Are Numbered; Drug Shortage Persists

The end of the sustainable growth rate formula is finally in sight, but the nation's primary care shortage and persistent drug shortage also made headlines this week.

The biggest news story affecting physicians over the past week was the long-awaited announcement that a bipartisan deal has been reached to repeal and replace the sustainable growth rate formula. Once Congress figures out how to pay for it, the doc fix will done.

While that story rightly got most of the media spotlight, other developments affecting physicians should not go unnoticed:

UT Bill Seeks 'Pipeline' to Primary Care
New Mexico Senator Tom Udall, a Democrat, has introduced federal legislation aimed at increasing the number of primary care services in his state. Only one county in the southwest state is not federally recognized as having a shortage of PCPs.

Udall's bill calls for what he calls a "pipeline" that would supply more primary care services to underserved areas. It's a mix of incentives for medical students to pursue providing care in a rural setting, funding centers that focus on rural healthcare, and "refocusing" funding for graduate medical education.

The pipeline strategy Udall wants to use is one that the American Academy of Family Physicians has recommended, too. Ted Epperly, MD, former AAFP president, suggested at a recent rural healthcare forum in Washington D.C. that developing a future workforce of physicians who want to work in rural areas could begin very early—with K-12 students.

The AAFP also wants to protect funding and increases for the Rural Training Track program, which offers medical training in both rural and urban areas. More than 70% of graduates who go through the RTT program end up practicing in a rural setting. RTT programs are paid for through federal, state, grant, hospital, and other intermediary sources, which are not stable.

Udall's bill includes reauthorizing the Teaching Health Center program, which is a community-based ambulatory center that serves as a primary are residency site.

UnitedHealth Loses in Federal Court, Again
The country's largest provider of Medicare Advantage plans was dealt another blow in federal court over cutting 2,200 MA doctors from its network in Connecticut.

UnitedHealthcare lost its appeal to dismiss the lawsuit initiated by the Fairfield County Medical Association and the Hartford County Medical Association. The associations content the insurer has violated federal law with the cuts because no explanation was offered to the physicians.

The three-judge federal appeals court panel last week also changed the terms of the restraining order UnitedHealthcare has been operating under since December. The court previously halted the cuts, but now says that the affected physicians have 30 days to appeal UnitedHealthcare's decision.

It's the second time a federal court has sided with the medical associations. In January, the court ordered both sides to mediation. UnitedHealthcare had requested that the temporary restraining order be lifted. Earlier this year, UnitedHealthcare spokeswoman Jessica Pappas, said the reason the insurer's MA physicians were being cut was due an increase in quality standards.

The Medical Society of the State of New York, as well as other medical associations, are watching the court case in Connecticut closely because of UnitedHealthcare's vast reach into the Medicare Advantage market. Any forced changed into how it designs, changes, or protects its MA network has implications nationwide.

Quality Problems Still a Factor in Drug Shortages
A report from the Government Accountability Office shows quality as a major contributing factor to drug shortages. The report analyzed data from the FDA, and the University of Utah Drug Information Service between 2007 and 2013.

The drug shortage peaked in 2011, and the GAO issued a reporting recommending that the FDA strengthen its oversight and enforcement of drug manufacturers. New FDA requirements were issued in 2012 based on the GAO's recommendations.

Based on feedback from individual drug manufacturers, the GAO has determined that quality is the main reason for the shortages. An audit of FDA data shows 40% of the drug shortages between January 1, 2011, and June 30, 2013, are due to quality concerns. Additional reasons for the shortages include manufacturing capacity, discontinuing products, availability of raw materials, and increased demand.

The GAO report recommends the FDA improve its internal processes to better analyze drug shortage data and well as being more proactive to mitigate the drug shortage risk factors.