Family physicians tell volunteers for smallpox vaccination to get facts first

Smallpox vaccine recipients should understand the medical and legal issues surrounding the vaccinations, according to a statement by AAFP President James Martin, M.D., Dec. 17. Below is his statement.

“The American Academy of Family Physicians agrees with President Bush that smallpox vaccination of the general public should not be recommended at this time, but that voluntary immunization of smallpox emergency response teams should begin. This is consistent with AAFP policy, www.aafp.org/x10636.xml, issued in June 2002.

"The AAFP does not support immunization of the general public because the federal government has clearly stated there is no reason to believe that smallpox presents an imminent threat. Given the potential for significant, even fatal, side effects from this immunization, the AAFP finds that the risks of immunizing the general public at this time outweigh the benefits. Additional information on the disease, the vaccine, contraindications and adverse effects can be found on the CDC Web site, www.bt.cdc.gov/agent/smallpox/index.asp. Your family physician is also an excellent source of information on smallpox and other contagious diseases.

"It is very important for all those who receive the vaccination to be fully informed about the medical and legal issues involved. Individuals who have any of the following medical conditions, or live with someone who does, should not get the smallpox vaccine unless they have been exposed to the smallpox virus: eczema or atopic dermatitis; skin conditions such as burns, chickenpox, shingles, impetigo, herpes, severe acne or psoriasis; weakened immune systems; and pregnancy or plans to become pregnant within one month of vaccination. Your family physician can be helpful in making those decisions by providing necessary information and advice.

"Legal issues include whether the vaccine recipients' health insurance will cover treatment for adverse effects, whether employers will grant paid leave for those suffering side effects, and what liability coverage is provided for secondary infection of others.

"This immunization program must be closely monitored and knowledge gained must inform future decisions."

AAFP: Congress has last chance to reverse 2003 Medicare cuts

The U.S. Senate adjourned in November without passing legislation needed to stop expected Medicare payment cuts in 2003. The Senate’s failure to take action to fix Medicare’s fee schedule problems in the previous legislative session has left physicians and patients with a small window of time to voice objections and help pass effective legislation.

“We rely on Congress to find a way to address and correct the problem, but they have let us down and they have let our patients down,” says AAFP President James C. Martin, M.D.

On Oct. 31, the Centers for Medicare and Medicaid Services confirmed that if immediate action is not taken by Congress, physicians will face a 4.4 percent cut in payments in 2003 on top of the 5.4 percent cuts made in 2002. AAFP attributes Medicare payment cuts to what it calls an outdated and dysfunctional Medicare payment formula. The 2002 cut marks the fourth time in 11 years Medicare physician payment rates have been reduced. Action must be taken by Feb. 2, or the projected cuts for 2003 will become a reality.

Medicare payments have not kept up with the cost of providing health care in the past. According to AAFP, physician costs have gone up an average of 2.2 percent per year for the last 11 years, while Medicare reimbursement rates have increased an average of 1.1 percent per year during that same time. Reimbursement rates are now 13 percent behind practice costs. If the problem is not corrected, the academy says payment rates in 2005 will be equivalent to those in 1991. A $30 to $40 billion drop in physician service payments between 2002 and 2005 is expected, amounting to an anticipated 12 percent cut over the next three years.

Medicare patients are already having trouble finding physician care and once an update is announced, physicians will be forced to make the difficult decision of accepting or rejecting Medicare patients in 2003.

“More and more family physicians simply cannot afford to provide health care while Medicare payments continue to decline. Patients will suffer most,” Martin says.

“Now seniors will pay a heavy price: dwindling health care options, longer waits for fewer available physicians and other health care providers, longer trips to more distant health care facilities and more out-of-pocket expenses,” Martin says.

AAFP has issued a call to action involving physicians and patients. Physicians are urged to directly contact their lawmakers and bring this important issue to the attention of their patients but if action is not taken by Feb. 2, it may be too late.

Perry selects Hawkins to head HHS

Gov. Rick Perry appointed Albert Hawkins, an aide to President Bush, as the next Health and Human Services commissioner.

As commissioner, Hawkins will oversee an annual budget of more than $8 billion, 625 employees and several key state programs, including CHIP and the Texas Medicaid Program.

"Albert brings a strong level of state and federal budget expertise, along with a commitment to improving the quality of services delivered through government, to his new role," Perry said. "He also shares my commitment to building on the successes the commission has seen over the past several years, such as the creation and growth of the Children's Health Insurance Program."

Hawkins will replace Commissioner Don Gilbert at the Health and Human Services Commission, which also has oversight responsibility for 11 health and human services agencies. Gilbert is retiring after almost four years as the head of the commission and 30 years of state service.

"I want to acknowledge the outstanding work done by Don Gilbert," Perry said. "Over the years, I have enjoyed working directly with him on numerous issues. He leaves a legacy of service to Texans that will be difficult to match."

Hawkins has served in the Bush administration since January, 2001. He is the primary liaison between the president and the cabinet members, and he chairs a working group responsible for making recommendations on race-related policies to the president. Hawkins joined the Legislative Budget Board in 1978, and he became the board's deputy director in 1994. In 1995, then-Gov. Bush appointed Hawkins as the director of the Governor's Office of Budget and Planning. He has a master's degree from the Lyndon B. Johnson School of Public Affairs.