Texas Family Physician Volume 53 No.2 | Report on the Campaign to Take Back Medicine

Justin V. Bartos, MD, TAFP President

Report on the campaign to Take Back Medicine...

The campaign is moving forward at a rapid rate of speed, as is my year as president of the academy. Though my term is far from complete, I’ve already had an opportunity to see, first-hand, exciting changes at the academy and a new spirit of commitment from our members.

Attendance at the academy’s Interim Session and C. Frank Webber Lectureship was up more than 94 percent. I believe this was due in large part to the leadership of the Commission on Annual Session and CME to identify grant opportunities to deliver high quality CME at significantly reduced registration fees. As the 2001 Annual Session approaches, I’m excited that we will be able to offer CME for 70 percent less than the 2001 registration costs. I hope to see everyone in San Antonio July 11-14.

The student and resident attendance at C. Frank Webber was especially exciting with over 70 attendees who participated in the Annual Student and Resident Conference. The conference offered a number of interesting topics such as “Can I Afford to be a Family Physician” by Stephen Benold, M.D. The conference also featured a roundtable discussion with AAFP resident board member English González, M.D., AAFP student board member Jaime Hartung, TAFP resident member Andrew Mills, M.D. and TAFP student member Leanna Mosher. You can read excerpts from the panel discussion in this quarter’s Member News department. The majority of Texas residency programs were also on hand to showcase their programs at the second annual TAFP Residency Fair.

The meeting rooms for commission and committee meetings were overflowing with members helping the academy chart a course for the future. The scene of approximately 40 members packed into a room surrounding an oval table discussing legislative initiatives reminded me of a vintage World War II film. Heated debate rose over the best actions to take as we move forward on critical issues impacting our patients and our practices. Issues of note include addressing the growing medical liability crisis, prompt payment, taxation of physician services, scope of practice, Medicaid and many others.

In my opening address, I stated that I wanted to impress upon the membership three things during my tenure as president: be a role model, be politically active, and expand your capabilities in order to be successful in the future. I am proud to say the academy membership has heeded the call and is stepping up to help change the way health care is delivered to ensure that our patients get the highest quality of care available.

BE A ROLE MODEL

Robert Hogue, M.D., TAFP President-elect, was invited to testify before the Senate Finance Committee on the overall tax burden on the medical profession. The committee is studying the state’s tax structure, because even before the tragic events of Sept. 11, state budget experts were projecting a substantial budget shortfall. In an effort to avoid a tax on medical services or expanding the state franchise tax to physician practices, Hogue explained that health care services are profoundly different from most other services, since they are third-party financed, with fixed reimbursement based on allowables, and they cannot by law and public policy be passed on to the patient as a cost of doing business. Hogue added that this additional burden, coupled with increased practice expenses, such as increased malpractice premiums, could force many family physicians to either drop or limit lower reimbursed lines of business, thereby reducing access to care for many individuals, particularly those on Medicaid.

Stephen Benold, M.D., represented the academy on the Ad Hoc Committee on Collaborative Practice, which is designed to identify and negotiate scope of practice issues outside of the legislative arena. The committee is composed of five physicians, five nurse practitioners and five physician assistants. This committee has been incredibly successful in the past at working out challenging, contentious issues.

This session, the nurse practitioners and physician assistants are pursuing a number of legislative and regulatory changes to their scope of practice, including closing the Medicaid payment differential, adding physician-based or collaborative model as an alternative to the current site-based model for delegation of prescriptive authority, and expanding delegated prescriptive authority to include controlled substances.

The academy has long stood as the primary opponent to delegated prescriptive authority for narcotics for midlevel providers, since we are the physicians who typically deal with patients who abuse and misuse these medications. Allowing midlevel providers to prescribe narcotics will greatly expand the number of prescribers and increase the potential for abuse and misuse. However, physicians would have the authority to designate which drugs they would allow their midlevel providers to prescribe. Forty-five states currently allow midlevels to prescribe controlled substances. Academy staff is exploring the effects of midlevel prescribing in other states.

Joane Baumer, M.D., residency director at John Peter Smith, testified before the Senate Health and Human Services Committee on the adequacy and availability of mental health services for children. Baumer discussed the erosion of mental health services across the state and how reimbursement changes have eliminated available psychiatric services. She explained that unaddressed mental illness in childhood results in serious consequences to the individual and the state. Consequences to the individual include incapacitation, disability, homelessness, substance abuse, violence and even death by suicide or murder. Consequences to the state include increased pressure on the budget through increased dependence on social services and burdens placed on the juvenile justice system. Baumer outlined a number of keys to improved outcomes, including early intervention and prevention, requiring parity for mental health services, providing scientifically-proven prevention and treatment algorithms, and increasing access to specialized mental health care services at the community level.

I would also like to recognize and thank the more than 35 members who have served as preceptors to clinical and pre-clinical medical students over the past three months. Please contact the TAFP if you are interested in serving as a preceptor.

BE POLITICALLY ACTIVE

With the recent primary elections, there has been an increase in grassroots political activity by academy members through the Texas Academy of Family Physicians Political Action Committee (TAFPPAC). The following members met with their local legislators and delivered TAFPPAC contributions: Cayetano Barrera, Roland Goertz, Mark Eidson, James Early, Mike McShan, Dale Moquist, Ken Davis, Stephen Benold, Arlynn Henry Hartfiel, Robert Matthews, Robert Shields, Lloyd Van Winkle, Miguel Vazquez and Donald Niño. To learn more about TAFPPAC and how you can become involved, check out the new Web site at www.tafppac.org.

Tamara Deuser, M.D., a resident at the Baytown program, helped organize a meeting between the medical staff at the Baytown residency program with TAFPPAC-endorsed Senate District 4 candidate Martin Basaldua, M.D. Deuser also helped put up campaign signs in the district.

John Redman, a second-year medical student at UTMB, helped organize a meeting between the UTMB FMIG association and TAFPPAC-endorsed Senate District 17 candidate Kyle Janek, M.D. Redman also helped coordinate a get-out-the-vote block walk for Dr. Janek in the Galveston area.

Tom Banning, the academy’s director of legislative affairs, spoke to the residents at UNTHSC and the medical students at A&M, as well as the FMIG association at UTMB, regarding the political process and the important role politics plays in family medicine.

In addition to meeting with local candidates, Russell Thomas, D.O., Erica Swegler, M.D., and myself, along with Tom Banning and Greg Herzog, met with the governor’s office to outline our legislative priorities. We met with Mike McKinney, M.D., chief of staff to Gov. Perry, and Chris Britton, deputy chief of staff to Gov. Perry. We focused on the looming medical liability crisis, prompt pay problems, and the effects a professional tax would have on our members.

We concluded our visit to the governor’s office with a request that more TAFP members be recommended or appointed to various boards any time a physician’s input may be appropriate. It is my hope that this will improve our exposure and understanding of other stakeholders in the legislative process. Some of you may be called.

The Texas Association of Business and Chambers of Commerce (TABCC) continues its attack on the medical profession, claiming physicians are engaged in a feeding frenzy of overcompensation, thereby driving up health care costs; covering up our colleagues’ medical errors, thereby driving up the cost of medical liability; and claiming physicians are more concerned about our pocketbooks than quality patient care. These comments do more than attack our professionalism and undermine our public image, they could damage our effectiveness in standing up for the interest of the patients and physicians of Texas.

The most effective way for physicians to counter the TABCC offensive is through a grassroots counter-attack. Once local chambers of commerce understand what TABCC is saying on their behalf about physicians and hospitals that are members of their associations, they will address the TABCC and explain the impact that local physicians have on their organizations and the local economy. The TAFP Executive Committee recently endorsed the Texas Medical Association’s “TABCC Action Kit.” We encourage academy members to obtain the action kit to use in your local community to address this misguided attack. You can get a copy of the action kit at www.texmed.org, or call Diane Arnett in the TMA Public Affairs Division, (800) 880-1300, ext. 1358.

EXPAND YOUR CAPABILITIES

The issue of colonoscopy training for family physicians came up at the Interim Session. The problem of screening large numbers of the population continues to worsen. Gastroenterologists are unable to service the population while also addressing individuals with acute illnesses. The consensus was that mini-fellowships could be developed to offer training in colonoscopy with polypectomy. Several residency programs are already offering this training.

Another capability that needs to be addressed is electronic communication. Family physicians should be on the cut-ting edge of communication through e-mail, secure messaging sites and Internet research. When we need to get a message out, we are utilizing the blast e-mail, which reaches 2,400 of our members. We need 100 percent participation. The U.S. mail is adequate for notification of an upcoming event, but not for current communication. Faxes are more current, but require multiple steps, all with their own inherent failure rates. In a campaign or a battle, up-to-the-minute communication is essential. Assist your fellow members in obtaining these capabilities if they do not have them. The QuickInfo blast e-mails will be a major form of communication in the future campaign to Take Back Medicine.