Contents tagged with perspective
Shine your light in service to your specialty
By Janet Hurley, M.D.
Chair, TAFP Commission on Health Care Services and Managed CareAs I look with uncertainty to the future health care landscape and talk with fellow family physicians, I find many of us fearful of what the upcoming years will bring. I admit there are times when I get discouraged too, when it seems like things are too difficult to fix or that the problems are too big to solve. It’s in those moments that I realize we are living in a fallen world and the temptation is strong to just hide or give up. But God does not call us to hide our worries; he calls us to shine our light to the world around us. So I ask you, what does your light look like?
We are all called to be leaders to some degree, either in our families, our practice, or our government. Some will move on to state and national leadership realms, but it is okay if not all of us do that. How do you use your gifts and talents? Are you befuddled with frustration and worry? Have you hunkered down in seclusion? To squander our gifts and talents is like burying the best of ourselves in the sand. We’ll look back and wonder where the “good old days” have gone and realize that our health care system is no longer recognizable to us and that we have been left behind, frustrated and broken. Each of us has gifts and talents that should not be left unused.
moreTexas Family Physician - Vol. 63 No. 4, Fall 2012
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A workforce imperative: Change medical educationTwenty years ago, TAFP … more
Overwhelmingly, stakeholders support family medicine residencies
By Clare Hawkins, M.D.
TAFP President-electWith another legislative session underway, our Academy is poised to make great gains for family medicine and recoup budget losses from 2011. We’re building on a decade of work educating legislators and the public about the value of family medicine, but it’s evident that our work particularly since the last session has led to a deeper understanding of the current and coming crisis in the primary care workforce.
This summer TAFP held a legislative training seminar in Austin and attendees of that conference formed the core of a new Key Contacts program. These leaders actively share resources provided by the Academy with their state representative and senator, which include not only our own policy briefs and legislative magazine features, but editorials and news stories from the major daily newspapers. People are “getting it.”
moreTexas Family Physician - Vol. 63 No. 3, Summer 2012
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Primary care in Texas: Condition criticalFor the sake of Texas’ … more
By choosing wisely, physicians can help address the unsustainable trajectory of health care costs
By Richard Young, M.D.
“Every admitted patient should have a chest X-ray and a VDRL,” said one of my Type A personality internal medicine attending physicians during residency. The year was 1990 and this attitude was shared by a few other knowledgeable physicians at the time, though others questioned the practice and were more flexible in their medical decision-making. I would venture to guess that few family physicians or internists practice this way in 2012, but the practice is not completely dead.
A lot has changed since 1990. The total cost of U.S. health care was $724 billion and consumed 12.5 percent of the gross domestic product.1 In 2012, the total cost of U.S. health care is estimated to be $2.8 trillion and will consume 17.6 percent of GDP.2 This health care inflationary trend has continued unabated for the last 50 years.
moreTexas Family Physician - Vol. 63 No. 2, Spring 2012
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Prepare to defend your codingFamily physicians face increased scrutiny in … more
Texas Family Physician - Vol. 63 No. 1, Winter 2012
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2011 Year in Review
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Preserving a family traditionWith three decades of … more
Patient-centered medical home: Are we or aren’t we?
By David W. Bauer, M.D.
When is a patient-centered medical home not a patient-centered medical home? In my practice, the answer is “every day.” In 2009 we received NCQA’s designation as a Level 3 PCMH. To achieve this, our physicians had to document ways in which our patients had enhanced access to our practice, provide examples of how we use evidence-based guidelines to provide quality care, demonstrate the means by which we coordinated care across time and space, and a number of other measures. We do, in fact, do those things every day. What we don’t do, is do all of them for every single patient, every single day.
Consider the analogy of a patient with diabetes whose hemoglobin A1c is 6.9. We would say that the patient’s diabetes is well controlled and congratulate the patient. But there are many ways that a patient could achieve this value. One would be to have very little fluctuation of her glucose from hour to hour. Another would be for the patient to drop into the 40s overnight, and climb to 200 immediately after meals. The hemoglobin A1c is an average, and doesn’t factor in variation. For years, decreasing variation has been the mantra of those working to improve quality, increase efficiency, and decrease medical errors in the hospital setting. As we migrate toward a new model of health care in this country—the PCMH—it would be valuable to embrace this concept in our offices as well.
moreTexas Family Physician - Vol. 64 No. 2, Spring 2013
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Damage control: Mending Texas’ women’s health care safety net The health care … more
Texas can improve care and cut costs with medical home, shared savings initiatives
By Greg Sheff, M.D.
I am fortunate to be a part of a multi-year patient-centered medical home and shared savings pilot at Austin Regional Clinic. ARC is an approximately 300 physician multi-specialty group delivering care at 18 clinics and seven hospitals throughout the Austin area. Earlier this year, ARC joined a multi-year medical home pilot administered by Blue Cross and Blue Shield of Texas. The pilot was initiated in large part in response to Texas legislation requiring the Employees Retirement System, the self-funded insurer for state employees, to experiment with alternate payment and delivery models in an attempt to reduce the state’s ever-increasing health care costs. We are one of five physician groups in the state participating. Our program serves roughly 45,000 patients, including both the ERS (whose health care benefits are administered by BCBSTX) and BCBSTX fully-insured populations.
In addition to the traditional PCMH goal of comprehensive, coordinated, accessible, patient-centered care for all, ARC is also implementing processes to proactively identify high-risk patients and then deploy intensive, focused, physician-led care management interventions to these high-risk patients.
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