1. ACP says food insecurity a threat to public health in the United States
New position paper makes recommendations for strengthening the nation’s food insecurity response
Abstract: https://www.acpjournals.org/doi/10.7326/M22-0390
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In a new position paper, the American College of Physicians (ACP) says inadequate access to nutritious food negatively impacts the health of many Americans, which in turn can significantly exacerbate food and nutritional insecurity and other social factors impacting health. The paper says that more needs to be done comprehensively address food and nutrition insecurity and bolster public health. Strengthening Food and Nutrition Security to Promote U.S. Public Health: A Position Paper from the American College of Physicians is published in Annals of Internal Medicine .
In the United States, about 10% of the population experiences food insecurity, which is associated with a wide range of health issues, including higher risks of birth defects, anemia, lower nutrient intakes, cognitive problems, asthma, and worse oral health, as well as increased risk of mental and behavioral health problems among children. For non-senior adults, food insecurity has been associated with lower nutrient intakes; higher rates of mental health problems, diabetes, high blood pressure, high cholesterol, and other chronic diseases; and poorer reported health, sleep, and health exam outcomes. Food insecure seniors are at risk for lower nutrient intakes, poorer reported health, higher rates of depression, and more limitations in an activity of daily living. These health impacts can be observed in the heightened health care utilization rates and costs experienced by food insecure individuals.
ACP says that the United States needs to strengthen its food insecurity response and empower physicians and other medical professionals to better address those social drivers of health occurring beyond the office doors. Specifically, ACP recommends that:
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org .
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2. Analysis shows that life expectancy varies widely by race/ethnicity group and by state
Life expectancy improved over time, but remains lowest for Black Americans in almost every state
Abstract: https://www.acpjournals.org/doi/10.7326/M21-3956
Editorial: https://www.acpjournals.org/doi/10.7326/M22-1777
A cross-sectional time-series analysis found that disparities in life expectancy compared to White Americans have increased for Black and Hispanic Americans. The authors report that life expectancy remains lowest for Black Americans in almost every state. The findings are published in Annals of Internal Medicine.
Researchers from the University of Washington studied death records and Census data to estimate life expectancy for selected race/ethnicity groups in states from 1990 to 2019. The researchers analyzed life expectancy data for the 3 largest race/ethnicity groups by state: Hispanic, non-Hispanic Black, and non-Hispanic White Americans. They found that although mean life expectancy in the United States increased from 1990 to 2010, it has remained flat since 2010. The data showed significant differences across race/ethnicity subgroups between and within states when life expectancy was examined by race/ethnicity groups rather than the average for an entire state. Although disparities across states as a whole decreased within each of the race/ethnicity groups studied, disparities across states increased over the past 3 decades. Over the same period, the racial/ethnic disparities in life expectancy decreased for most of the 23 states studied but increased for females in 7 states and males in 5 states. Life expectancy improved but remains lowest for non-Hispanic Black people for almost every state.
An accompanying editorial, authors from Washington University and the University of North Carolina at Chapel Hill suggests that the results of this study highlight how stark differences in social and physical environments can drive health, well-being, and risk for death. The authors add that the recommendations made by the White House Equitable Data Working Group and the policy statement on racism from the American College of Physicians are important steps towards increasing access to and availability of the data necessary for measuring equity and inequity across and within all demographic groups. The authors call for future research to unpack the complex web of factors driving health and well-being by enabling better understanding of the places where they see persistent health disadvantage and advantage and the state-based explanations for these increasingly important differences determining population risk and resilience.
Media contacts: For an embargoed PDF or author contact information, please contact Angela Collom at acollom@acponline.org .
3. Physicians lose tens of thousands of dollars in income annually by not coding and billing preventative services
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4770
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A modeling study found that primary care physicians (PCPs) lost additional revenue worth up to $40,187 annually for preventive services that were provided but not coded and billed. The study is published in Annals of Internal Medicine.
The physician fee schedule plays a dominant role in how primary care and other physicians are paid. However, core features of primary care—first-contact care that is continuous, comprehensive, and coordinated—are poorly matched with visit-based payments. The Centers for Medicare and Medicaid Services (CMS) have made efforts to address this issue by adding billing codes for these aspects of primary care including preventive services, such as providing counseling for smoking cessation or weight loss, and for coordination services, such as providing transitional or chronic care management. Many of these codes have been characterized by low rates of adoption, suggesting that the codes are not being adequately used to perform their function of financing primary care activities.
Researchers from Brigham and Women's Hospital and Harvard Medical School used national survey data to estimate the service eligibility rate and the rate at which PCPs provided each of the services to their older adult patients. The authors analyzed 34 distinct prevention and coordination codes, representing 13 distinct categories of services. They found that although services were provided to up to 60.6 percent of eligible patients, billing codes were only used at a median 2.3 percent. The authors estimate that a single PCP could add $124,435 in prevention services and $86,082 in coordination services to their practice's annual revenue. They also estimate each PCP provided preventive services worth up to $40,187 in additional revenue.
According to the authors, the results suggest that having to navigate the eligibility, documentation, time, and component requirements of numerous separate codes may be too high of a hurdle to warrant the effort from PCPs to use prevention and coordination codes. They also note that these codes involve decomposing the care of a patient into parts with multiple steps and checklists, which may be inconsistent with how PCPs practice and document care.
For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding author, Sumit D. Agarwal, MD, MPH, please contact Sarah Sentman at SarahA_Sentman@DFCI.HARVARD.EDU
Annals of Internal Medicine
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Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of Physicians
28-Jun-2022