Strength in numbers

Tags: gupta, president's letter, medicare, accountable care organization

An adaptation of the 2015-2016 incoming president’s address

By Ajay Gupta, MD
TAFP President, 2015-2016

Greetings colleagues. I am humbled and honored to serve as president of this extraordinary Academy and I want to thank all of those leaders and physicians who have mentored me and guided me along the way as well as my wonderful family for their steadfast support.

I became involved in the Texas Academy in my second year of practice because it equipped me with the tools to make my practice better. As you know, TAFP provides some of the best CME available and is produced for family physicians by family physicians. The Academy has helped me maintain board certification, which as you all are aware is an important process and not easy to do. The Academy also provides a range of practice support services to help my practice be more efficient. At our statewide meetings I get the chance to network with other family physicians to hear about the latest trends in health care delivery and payment—what’s working and what’s not working.

But perhaps most importantly, the Academy gives us the opportunity to do things collectively that we can’t do individually—whether it is to support a medical student interested in becoming a family physician or to influence public policy decisions. The Academy gives us a voice.

So, what do we want to say and how should we go about saying it? It’s through our involvement that our message is shaped, that our ideas are generated, and our Academy is strengthened. By joining committees and commissions, attending section meetings, coming to CME conferences and meeting your colleagues, we both get what we need from our association and we enable our association to provide ever greater support for our specialty.

That’s what membership is all about, and so I encourage you to get involved and to stay involved. If you’re already involved—thank you, keep it up, we need you. If you are sitting on the sidelines and waiting for the right moment, now is the time to suit up.

Let me give you a recent personal example of why it is so important to be involved and how TAFP helped me.

Over the last year I’ve spent a good deal of time learning about alternative payment models—accountable care organizations or ACOs, in particular. After much thought and consideration, our practice decided to join two ACOs in our city—a hospital-directed ACO and a physician-led ACO.

I was asked to serve on the board of the hospital ACO, while my partner joined a committee on the other one. 

Now let me give you a little background on our hospital ACO. Their board is comprised of five physicians, two of whom are primary care doctors and I’m the only family physician.

So I probably don’t need to tell you how the conversation went when we began discussing how money should be distributed when it came to things like shared savings. I think the last four decades of payment in the health care industry provide a pretty good guide.

But quite to my surprise, after getting some advice from TAFP staff and coaching from a couple of past TAFP leaders, I was able to make a compelling argument to the board and my specialist colleagues that primary care needed to be fairly and appropriately compensated in any shared savings.

As you can imagine things got a little tense. I was even asked at one point what would happen if specialists did not join the ACO. I retorted that primary care was doing the majority of the work to earn any shared savings, so what would happen if there were no primary care physicians to create the savings for everyone to share?

In the final accounting, my voice was heard and the outcome was much more favorable then it would have been had I not been involved in our Academy and had I not had the resources and counsel TAFP provided me.

Our collective voice was also heard when the U.S. Congress finally repealed the Medicare SGR. Our work, however, is not done. Starting in 2019, Medicare will institute two bonus payment tracks for physicians: a Merit-Based Incentive Payment System that consolidates existing Medicare fee-for-service physician incentive programs and a separate pathway to reward physicians for participating in alternative payment models, including ACOs and the patient-centered medical home.

Our members need to be preparing now to choose a pathway or face penalties. Your Academy will be launching an aggressive education campaign, developing CME, webinars, and other resources to help its members make the best decision for their practice.

Now is not the time to rest on our laurels. We need to continue to remind everyone that family medicine is the best hope to mend our broken health care system. We provide the best value out there, the most comprehensive care. The essence of our specialty is the key to fixing the system. We are compassionate. We treat the whole patient. It is who we are. 

Get involved in the Academy. Continue to make a difference with your patients, your community, and the health care system. Don’t let others decide what is best for family medicine and our patients.

I appreciate the opportunity to serve as president of the Texas Academy of Family Physicians. I will provide all my effort to serve our state and national health care system. It will take all of us working together to improve health care in America. I’m excited to lead the path into a new chapter.

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