By Tom Banning
Dave Chase, a friend of mine who was a longtime contributor to Forbes among other magazines, spent the better part of the last three years traveling the country documenting the multitude of failures of our health care system (pricing, contracting, lack of transparency, conflicts of interest), but more importantly identifying simple and tested solutions employers and some local governments have utilized to decrease their total health care spend.
His efforts have culminated in a compelling, must-read book, “The CEO’s Guide to Restoring the American Dream.” We’ve partnered with Dave on several physician–employer community events and in return, he has thoughtfully offered members and friends of TAFP a complimentary digital copy of his book. Below, I’ve provided a link to his TED Talk, “How Health Care Stole the American Dream,” as well as a link you can use to download a copy of “The CEO’s Guide to Restoring the American Dream.”more
What kind of system do we want?
By Tricia Elliott, MD
In his seminal book “The Signal and the Noise,” renowned statistician, Nate Silver, examines the world of prediction, investigating how we can distinguish the truth — the signal— from the noise, which he describes as a universe of ever-increasing information, relatively little of which is useful.
Any candid observer of the now nearly decade-long effort to reform our health care system will readily admit that the health care debate we’ve been engaged in has generated a lot of noise and useless information for political gain. Our elected leaders, on both sides of the aisle, have been busy creating this noise and are now trapped in a political vise of their own making. They’ve sadly left the public with a binary choice of whose health care solution is better, that of the Republicans or the Democrats.more
A model whose time has come
J. Stefan Walker, MD
Luke Fildes’ portrait “the doctor” epitomizes the primary care physician that our younger selves aspired to become.That kind of doctor-owned practice is now slipping away as quickly as the business model supporting it. Where $300,000 per year is the new benchmark for employed primary care positions, the prospect of starting or joining a private practice only to tread water in a sea of acronyms (MACRA, HIPAA, HMO, ACO, etc.) for margins that barely cover overhead no longer makes sense to most family physicians. No wonder that in 2016, for the first time, less than half of American doctors partly or fully own their practices.
As the care of inpatients became a separate field, primary care was mostly sidelined into a 9 to 5 office job in a role now shared with mid-level practitioners, retail clinics, and telemedicine services. Unlike many other specialists still seeing patients during nights and weekends, primary care is now conspicuously absent in that important space, further putting pressure on family physicians to justify the level of reimbursement that can support independent practices. Now a rarity, small primary care practices — even those now thriving — risk succumbing to this tide of obsolescence, not unlike local department stores and indoor shopping malls.more
By Jean Klewitz
Do you have a specific interest in rural medicine? Want learn how to face challenges as a rural physician or a maternity care provider? This active section can help you work through those challenges. The integration of full-spectrum maternity care in rural family practices is their focus and they seek to create more opportunities for growth in these remote communities.
The section also works with AAFP’s Rural Health Member Interest Group and AAFP’s Reproductive Health Care Member Interest Group to provide opportunities for rural medicine and maternity care education, training, support, interest, and involvement for physicians, students, and residents.more
By Jonathan Nelson
Direct primary care practices are cropping up across the country as physicians grow more frustrated by administrative burdens inherent in a fee-for-service third-party insurance market. But some regulatory obstacles block many people from joining DPC practices. The Direct Primary Care Coalition — of which TAFP is a steering committee member — has called on physicians to ask their representatives in Washington D.C. to sign on to federal legislation that would remove those obstacles.
In DPC practices, physicians charge patients a monthly, quarterly, or annual fee — like a retainer or membership fee — that covers a broad set of primary care services and patients typically enjoy greatly enhanced access to their physician. IRS rules interpret these DPC payments to be like paying premiums for health insurance rather than just a different way to purchase a set of services. Even though Texas and 17 other states have passed laws defining DPC arrangements to be outside of state insurance regulation, the IRS interpretation bars individuals with health savings accounts paired with high-deductible health plans from using their HSA funds to pay DPC fees.more
By Perdita Henry
Congratulations go to the family medicine interest groups at the University of Texas Medical Branch at Galveston, Texas College of Osteopathic Medicine, and the Paul L. Foster School of Medicine for winning the first annual Texas FMIG Program of Excellence Award. Last year TAFP’s Commission on Academic Affairs voted to create the award to celebrate and support FMIGs for their work to inspire medical students to consider the specialty of family medicine.
FMIGs are student-run organizations with faculty and departmental support. They provide a forum in medical schools for students interested in family medicine. FMIG programs across Texas applied for the new award and a subcommittee of the Commission on Academic Affairs reviewed the applications and selected the winning programs. Award winners receive cash prizes to help cover student travel costs to AAFP’s National Conference of Family Medicine Residents and Students.more
By Jonathan Nelson
Amid the daily deluge of news about efforts to repeal Obamacare and the possible passage of the next iteration of health reform winding its way through Congress, it’s easy to forget the looming deadlines associated with Medicare’s Quality Payment Program. But don’t do it! We’re halfway through the year, which means you have only 6 months left to report at least one quality measure or activity in 2017 to avoid being penalized in 2019.
Your Academy has put together a wealth of resources to help you avoid that penalty and prepare for what’s to come. Bookmark this link in your browser and visit it frequently, as modules are being updated and developed as regulations are modified: http://www.aafp.org/practice-management/payment/macraready.html.more
By David Sabgir, MD
It was 11 years invested into medical training wasted. After doing my best for 11 years after college, I found myself totally ineffective at changing my patients’ behavior.
We’d had wonderful heart-to-heart talks. These conversations were real, full of great intention, and essentially worthless. As my patients came back for their six- and 12-month follow-ups, I realized I had not done my job. Their heart disease, which I knew to be 82 percent preventable, was not interrupted. It was a runaway locomotive. They were still sedentary and they hadn’t lost a pound. As a matter of fact, they were up 3 pounds. The weather had been too hot. The weather had been too cold. They knew they had to “get out.” This frustration didn’t repeat itself with one patient or a dozen patients, this was hundreds becoming thousands of patients. I was ineffective despite long, emotional conversations. One day, that was it. I refused to play this charade for what I hope to be a 30-plus-year career of trying to help others.more
By Perdita Henry
In a 2016 study published in the journal Obstetrics & Gynecology, researchers found that from 2011 to 2015, 537 Texas women died while pregnant or within 42 days of delivery, compared to 296 from 2007 to 2010. This doubling of maternal deaths made Texas the most dangerous place to give birth in the developed world. Maternal mortality was on the agenda for the 85th Legislature but many of the bills that would help us understand and identify the dangers facing new and expectant mothers were left to languish. Now with the Texas Legislature set to return on July 18 for a 30-day special session, they have a chance to do the right thing for Texas mothers.
The issue of maternal mortality is a concern all over the country but Texas unfortunately has the distinction of being the worst. In fact, Janet Realini, MD, MPH, president of Healthy Futures of Texas and chair of Texas Women’s Healthcare Coalition, spoke about her concerns during her Member of the Month interview. “Texas women have the highest maternal mortality rate of any state — higher than many third-world countries,” she said. “Preventive care and contraception are incredibly important in addressing this issue in two ways: preventing unplanned pregnancies that can stress women with health issues and serving as an entry to health care for women with health risks.”more
By Lane J. Aiena, MD
As physicians we are tasked with the monumental privilege of helping people as our craft. We train for four years in our undergraduate education, four years in medical school, and an additional three years minimum in residency to be given this trust by our patients. From this education, we gain the ability to help the patient in front of us, but all too often we lose sight of our ability to help the community as a whole. As physicians we have the ability to treat not just the patient in front of us but the thousands of patients beyond our door that are affected every day by policy.
Recently I was able to do a rotation with TAFP in Austin. This rotation was set up after several advocacy trips to Washington D.C. piqued my interest in policy. I was fortunate to match to a residency, Conroe Family Medicine Residency, that is very active both in its community and at the national level. The main takeaway from my first trip was this: everyone in politics has an ask, but stories are what stick. Simply talking about what we do on a daily basis can be a huge vehicle for change. I wanted a way to learn how to more effectively “get my story out there,” and this rotation was the perfect way to do just that.more