By Troy Fiesinger, M.D.
TAFP President, 2012-2013

When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments. This was my first time to take them to the dentist, as my wife usually drives them. My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats. Freed from manually registering patients, the front-desk clerk monitored patient flow and welcomed everyone to the clinic with freshly-baked chocolate chip cookies.

Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waited in the lobby as patients have done for decades. His office has the same electronic medical record as mine, but his clipboard system has not changed in decades. My clinic has an electronic medical record with a web portal and secure patient e-mail, but our patients still queue at the front desk to give their information to a clerk. At the gas station, I swipe my credit card and fill my gas tank without talking to another human being. At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before. We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation. We complain about the inefficiencies of our EMRs but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices. Are we so focused on our frustrations that we forget our patients?

By Janet Hurley, M.D.
Chair, TAFP Commission on Health Care Services and Managed Care

As 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.

AAFP recently submitted a letter to the Centers for Medicare and Medicaid Services urging them to create a new set of evaluation and management codes for primary care physicians. The recommendation, sent to CMS Acting Principal Deputy Administrator Jonathan Blum, was accompanied by supporting documents based on the research of TAFP member David Katerndahl, M.D., M.A.

The Academy suggested that CMS create the codes and include them in the 2014 Medicare physician fee schedule. AAFP Board Chair Glen Stream, M.D., said in the letter that a new payment model is necessary for the country to reach better health care for people and populations, as well as lower health care costs. “That system should recognize the complexity of ambulatory care provided by primary care physicians and reward the quality of services provided in their practices,” said Stream.

New E/M codes that differentiate primary care physicians from specialists or subspecialists would show the true value of both types of care, rather than devalue them as the current coding system does. Katerndahl’s research shows that the complexity of a primary care physician’s patient visit including E/M is much different than those with other specialists.

A January 2013 report revealed a disturbing statistic: Nationally, roughly 1 in 22, or 4.57 percent, of people aged 12 and older reported having used pain relievers non-medically in the past year. Texas fares slightly better with a rate of 4.33 percent, placing our state at 17th lowest in the country in our rate of abuse.

Still, this is a grave public health concern. The National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration shows that the highest rate of prescription drug abuse occurs in the young adult population. Nationally, 10.43 percent of this group reported misuse of the drugs in 2010-2011 compared to 9.21 percent of Texas’ young adults. In Texas’ 12-17 age group, the rate is 6.03 percent.

Experts have raised many contributors fueling this epidemic. Patients may be more likely to misperceive the safety of these medications since they’re prescribed by doctors and take them under circumstances not recommended by their physician. Also, prescriptions for stimulants and opioids have increased dramatically and are more readily available. Some physicians have said they feel pressure to get high patient satisfaction scores and are more likely now than in previous decades to strive to eliminate pain in their patients rather than conservatively manage it. And, patients more frequently seek out these now well-known medications, whether because they feel they will better treat anxiety, pain, sleep problems, or enhance focus, or for deviant purposes.

The 2013 C. Frank Webber Lectureship is upon us and we are looking forward to seeing you there! Below you will find important information to make sure everything during the event goes smoothly for you.

Registration hours
Thursday, Feb. 28 | 9:00 a.m. – 7 p.m.
Friday, March 1 | 6 a.m. – 7 p.m.
Saturday, March 2 | 6:30 a.m. – 4:30 p.m.

C. Frank Webber Lectureship registration and packet pickup on Thursday and Friday will be located on the main floor in the hotel lobby outside the Omni Ballroom. The CME breakfast lecture begins at 7 a.m. on Friday.

Earlier this month, TAFP put out a call for TAFP members to apply for travel funding to attend two national conferences in April: AAFP’s Annual Leadership Forum and National Conference of Special Constituencies. If you’ve never attended one of these conferences yet, I highly encourage you to consider it this year. Nine funded delegate spots or scholarships are available from TAFP and anyone else interested can simply register to attend.

But why should you take time away from your practice and family to go to Kansas City, Mo.? These conferences bring together a diverse group of family physicians from around the country and provide leadership training specifically tailored to family physicians. In addition, NCSC delegates identify concerns related to them and propose policy to take to AAFP.

ALF and NCSC are relevant to members of all ages and all practice types and both provide the opportunity to network, brainstorm with others, and learn best practices. Most of all, you’ll come away feeling energized and fired up for family medicine.

By Troy Fiesinger, M.D.
TAFP President, 2012-2013

We received our monthly physician quality report cards recently. Software mines our electronic health record and generates reports to tell us if we are meeting our goals. These quality measures are defined by Medicare, our clinically integrated physicians group, and commercial payers like Blue Cross Blue Shield. While some are based on solid medical evidence, others seem arbitrary and not relevant to the day-to-day reality of seeing family medicine patients.

I prefer creating and using our own data instead of relying on the often incomplete and inaccurate claims data from insurance. Despite our efforts to be good sports, often we feel bombarded by the endless number of things we should do to show we are good doctors.

By Clare Hawkins, M.D.
TAFP President-elect

With 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.”