• Notes for Annual Session & Primary Care Summit attendees

    Tags: annual session, annual session and primary care summit, primary care summit, business meetings, cme, self assessment module

    posted 11.10.15

    Thank you for registering for TAFP’s 2015 Annual Session & Primary Care Summit. We look forward to seeing you later this week at The Woodlands Waterway Marriott. Below is some information about the conference. If you have any questions or concerns, please call (512) 329-8666 or email tafp@tafp.org.

    TAFP Registration Desk Location and Hours
    Wednesday, Nov. 11 | 12 - 6 p.m. | Waterway Ballroom Foyer
    Thursday, Nov. 12 | 7 a.m. - 2:30 p.m. | Waterway Ballroom Foyer | 3:30 p.m. - 7 p.m. | Town Center Foyer
    Friday, Nov. 13 | 6:30 a.m. - 6 p.m. | Town Center Foyer
    Saturday, Nov. 14 | 6:30 a.m. - 6 p.m. | Town Center Foyer
    Sunday, Nov. 15 | 6:30 a.m. - 12:30 p.m. | Town Center Foyer

  • Why I precept medical students

    Tags: billings, perspective, preceptorship, medical student, rural medicine, rural, rural physician

    By Adrian N. Billings, MD, PhD, FAAFP

    Why do I precept medical students? Luckily, I ask myself this question less and less frequently because I enjoy having these junior colleagues with me, especially at 2 a.m. while delivering babies. However, I recently explored this question with some reflection on my past seven years of precepting around 100 medical students and 20 resident physicians in my practice. 

    Unequivocally, the answer to the preceding question is that I precept medical students because my patients receive better care if I have a medical student working with me. It does not matter how fresh a medical student is into clinical training, two sets of eyes and two sets of brains examining and thinking about a patient’s problem are better than my own brain by itself. I have had preclinical students consider and make diagnoses that I have not been able to. Even if the students don’t make the correct diagnosis and they hear zebra hoofbeats instead of horse hoofbeats, this mental task causes me to consider a broader and more thorough differential diagnosis with their valuable input. I consider it an honor and privilege to be entrusted by medical schools with these young student physicians.

  • Time to step up to the plate

    Tags: ragle, president's letter

    By Dale Ragle, MD
    TAFP President, 2014-2015

    This will be my final letter to you as TAFP president. It has been an honor and privilege to serve you and our outstanding organization.

    This is an exciting and challenging time for family medicine. Health care reform and the sustainable growth rate repeal are expanding the rolls of the insured and will transition us from a volume-based payment system to a quality-based system over the next several years. Some analysts are concerned that increasing the number of insured may strain our health care system in the absence of increasing the physician workforce. While increasing the insurance rolls will generally increase access to care in the younger population, the resultant strain on our health care system could make it more difficult for certain vulnerable populations, such as elderly patients already on Medicare, to access the health system. This effect could be magnified in our state, which has about a 20 percent uninsured rate, unfortunately the highest in the nation.

  • Doctors report insurers are auditing billing procedures for services provided by NPs, PAs

    Tags: insurance, nurse practitioner, physician assistant, billing, coding, compliance, reiner

    Physicians should examine insurer contracts, provider policy and procedure manuals to ensure compliance

    If you employ nurse practitioners or physician assistants, you should make sure you’re complying with each payer’s protocols when billing for services provided by nonphysicians. TAFP has recently heard from members who thought they were billing properly but have found themselves under investigation by payers. If these practices are found to be out of compliance, they may owe payers substantial refunds.

    Many payers pay reduced fees for services provided by NPs and PAs but the rules and billing procedures doctors should follow when filing claims differ from payer to payer. For instance, Blue Cross Blue Shield of Texas pays 15 percent less for services provided by NPs or PAs than they would for services provided by the supervising physician. The insurer requires that practices include a “Modifier SA” when filing claims to indicate that a service was performed by an NP or a PA.

  • TWHC wins funding for preventive health care in the 84th Texas Legislature

    Tags: texas women's healthcare coalition, preventive care, women's health, texas family planning, texas women's health program, expanded primary health care program, nelson, davis, howard, realini, 84th, legislature

    By Anna Chatillon
    Director of Policy and Advocacy for the Texas Women’s Healthcare Coalition

    In the midst of the chaos and inevitable drama of the 84th Texas Legislature, we risk overlooking one piece of news with the potential to change thousands of lives for the better. Funding for women’s preventive health care services, such as annual check-ups and contraceptive care, was increased by nearly $50 million in the state budget for the coming biennium.

    In 2011, draconian budget cuts to Texas’ Family Planning program devastated the women’s health care safety net. When the Texas Women’s Healthcare Coalition, a collaboration of 60 member organizations led by TAFP and others, was formed in 2012, its aim was to restore that funding. The Coalition’s successful advocacy restored the funding in 2013 through the Texas Women’s Health Program and the Expanded Primary Health Care program, in addition to the Family Planning program.

  • Public health efforts pay off with legislative wins in the 84th Texas Legislature

    Tags: texas public health coalition, 84th, legislature, tobacco, e-cigarettes, vaccination, immunization, cancer, hinojosa, ebola, sheffield, abbott, department of state health services, texas emergency medical task force, craddick, health and human services commission

    By Joey Berlin
    Texas Medicine

    The Texas Public Health Coalition and diligent physicians earned significant victories during the 84th Texas Legislature in their drive to reduce tobacco and electronic cigarette use.

    Lawmakers also provided the Texas Department of State Health Services with a likely bump in chronic disease prevention funding, and an effort to keep children’s immunization records in the state registry through their early adult years made its way into law.

  • First do no harm? A reflection on pain and intervention at the end of life

    Tags: perspective, mandola, end-of-life

    By Vincent J. Mandola, MD

    March 25, 2015 was a day I will never forget. It was the day I watched my mother take her last breath. She was 56 years old and had battled cancer for two years. It was a surreal time stepping into the unknown for my close family, but it’s not the moment of her passing I want to write about here. It is the days leading up to that moment, as this experience has given me a new outlook on end-of-life care.

    After surgery and nearly a year and a half of chemotherapy, mom was determined to have a couple of decent weeks before what she knew was inevitable. She had just been discharged from the hospital for uncontrolled pain and sent home under hospice care.

  • The brave new world of the SGR repeal

    Tags: ragle, president's letter, legislature, medicare, medicare access and CHIP reauthorization act, MACRA, sgr, affordable care act, direct primary care

    By Dale Ragle, MD
    TAFP President, 2014-2015

    On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015, which phases out Medicare’s flawed sustainable growth rate payment formula over the next 10 years. The so-called “doc fix” enjoyed bipartisan and bicameral support in Congress, a rare phenomenon these days, as well as support from most major medical organizations, including AAFP and the American Medical Association. In spite of broad support, the bill took more than a year of tweaking and survived innumerable negotiations between both political parties and the White House, a testament to the adage that “the devil is in the details.”

    The SGR formula tied Medicare expenditures to the gross domestic product. Since demand and utilization of health care services do not rise and fall directly with the ebbs and flows of the general economy, the SGR often threatened to cut physician fees year after year. Perennially, Congress passed special legislation to delay the fee cuts, often only finding they have to repeat the action in the following year.

  • Texas family physicians and family planning

    By Bhavik Kumar, MD, MPH

    In 2011, the Texas legislature cut its family planning budget by more than $70 million, resulting in a patchwork system of access to family planning services. Although much of this budget was restored in 2013, multiple barriers to care still exist. For example, abortion-affiliated family planning clinics that have commonly provided a significant amount of family planning and other preventive care are now specifically excluded from state funding programs like the Texas Women’s Health Program. Instead, much of the restored budget is being directed to primary care providers rather than specialized family planning providers.1 While Texas family physicians are well distributed throughout the state and provide care to a large volume of patients, it is likely a new role for many primary care providers who previously relied on family planning clinics that are now either cut off from state funds or have closed due to funding restrictions.

    The recent changes have also had an impact on Texans trying to access health care services. The restructuring has resulted in confusion and complexity for patients accessing family planning care. Notably, the decreased funding has limited coverage for preventive care, such as cervical cancer screening, as well as long-acting reversible contraception like the intrauterine device and contraceptive implant. Unfortunately, the changes have been most harmful for low-income women who rely on state-funded programs for much of their health care needs.2, 3

  • Court upholds subsidies in ACA

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid, supreme court

    Health care organizations and millions of people across the country can breathe a sigh of relief. The Supreme Court has upheld the subsidies established by the Affordable Care Act that help about 6.4 million Americans purchase health insurance on the federal exchange. Had the court struck down those subsidies, more than one million Texans might have lost their coverage.

    President Obama addressed the nation from the White House shortly after the ruling was announced, saying there could be no doubt that the ACA is working and that the law is here to stay.

    “Today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law,” the president said.