One more chance to stop 5-percent Medicare cut

Congress is back in session for its one-week “lame-duck” term and time is running short to halt the scheduled 5-percent cut to Medicare physician payments. Lawmakers will wrap up business on Friday of this week, so now is the time to contact Texas’ two state senators and your representative.

When talking to your senators and representative, it is important that you:

1. Thank them for their public service and wish them luck as they carry out the people’s business.
2. Acknowledge that they understand and share physicians’ concerns about access to care for the elderly.
3. Respectfully remind them to make every effort to stop the scheduled Medicare cuts and to achieve a reasonable payment increase during the lame duck session by contacting their party leadership.
4. Give them an example of what the cuts will mean for elderly patients in your community as they try to access health care, and explain what effects these cuts will have on you and your colleagues who continue seeing Medicare patients.

Below is a list of the entire Texas congressional delegation and the phone numbers to their Washington offices.

Report: Texas health premiums climb, wages stagnate

Family health insurance premiums for Texas workers have risen 7.4 times faster than median earnings over the past six years, according to an October study by Families USA. Through the study, entitled, “Premiums versus Paychecks: A Growing Burden for Texas’s Workers,” the non-profit health care organization examines the impact that rising health care costs have to Texans: many employers have reduced or eliminated benefits or wages while many families have struggled with medical debt or bankruptcy.

Annual health insurance premiums for employer-provided coverage rose from $6,638 to $11,929 between 2000 and 2006 while median wages of Texas workers increased from $23,032 to $25,509 during the same period. This amounts to a 79.9 percent increase in coverage premiums while wages have increased 10.8 percent.

This imbalance results in more employers thinning or eliminating benefits, which shifts costs to families. As families pay a greater share of health care costs, they struggle to pay medical bills when health care is needed. The study reports that these families take drastic measures to avoid financial ruin — 35 percent of the underinsured have re-mortgaged a home or run up credit card debt to pay for medical bills – but even with their actions, more than half of bankruptcies are still caused in part by problems with medical costs. According to the study, “more than one-quarter of insured Americans report problems with medical bills or say that they are in the process of paying off medical debt.”

Families USA warns that Texas will face diminishing economic and health security unless national policymakers take steps to make health care more affordable and accessible.

To read the Families USA press release and to access the full study, go to the Families USA Web site.

United States health care system falls behind other countries

Cohesive, broad-based policy changes are needed in the United States to improve primary care and put the country’s health care system on par with others around the world, according to a study published in the November 2 edition of Health Affairs.

“On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries,” pools data from the Commonwealth Fund 2006 International Health Policy Survey of 6,000 primary care physicians in Australia, Canada, Germany, New Zealand, the Netherlands, the United Kingdom and the United States. The survey focuses on information technology and office systems, coordination of care, chronic illness management and use of teams, access to care and quality improvement initiatives.

Besides spending the most per capita for health care and having the largest portion of uninsured citizens, the United States differs from other countries by reporting that more patients have difficulty paying for care and fewer physicians receive incentives for quality improvement.

“In an era of advanced computer systems, it’s disturbing that the vast majority of primary care doctors in the U.S. don’t have the tools to electronically prescribe medications, access patients’ test results, or know when patients are overdue for essential care,” lead author of the article and Commonwealth Fund Senior Vice President Cathy Schoen said in a press release. “The data show that U.S. primary care doctors find it difficult or impossible to perform tasks that doctors in other countries find easy; they also practice without basic decision supports that could improve health outcomes and reduce costs.”

Only 28 percent of U.S. physicians polled currently use EMRs in their practices with 31 percent reporting that they plan to implement the systems in the next year. Only Canada reported worse EMR implementation with 23 percent of physicians currently using the systems and 18 percent planning on starting next year.

While many U.S. physicians report offering some early morning hours (40 percent), evening hours (38 percent) and weekend hours (47 percent), almost a third of practices do not offer any hours for care outside of normal business hours. In contrast, more than 85 percent of physicians in Germany, the Netherlands and Australia offer before- or after-hours care.

In the United Kingdom, 92 percent of physicians receive financial incentives based on achieving certain clinical care targets, compared to 23 percent in the United States. Seventy-nine percent of U.K. physicians receive incentives for the effective management of patients with chronic diseases or complex needs, while only 8 percent of U.S. physicians receive similar incentives. The United Kingdom’s opportunity for rewards reflects the effect of the 2004 GP contract, which gauges performance on 146 indicators from clinical domains and preventive care to patient experience.

Part of the differences between the seven countries rests in their payment policies and treatment of primary care. The United Kingdom, Australia and New Zealand all use quality-related incentives to invest in the specialty. Both the Netherlands and Germany use guidelines for chronic care as well as some financial incentives for primary care physicians. The United States and Canada do not have national payment initiatives for physicians in primary care and rely on physician or private investment to fuel health information technology use.

“Expect big things” for family medicine after November elections

The billboards, yard signs and bumper stickers are fading away in the period after the November midterm elections, but the events of last Tuesday are still creating a buzz among advocacy circles and will continue to affect the actions of state and national legislators.

Nationally, the shift from a Republican majority to a Democrat majority in Congress will pose unique challenges for pending health care issues during the post-election “lame duck session,” which began Monday, Nov. 13 and will run until Friday, Nov. 17. Of critical importance is fixing the flawed Medicare payment formula, also known as the SGR, but this issue may be put on the back burner as legislators adjust to the party changes.

“Sadly, political dynamics have complicated the situation where it is unclear whether the House will have the political will to fix the SGR in the lame duck session,” says Tom Banning, TAFP’s director of legislative and public affairs.

Additional health care issues likely to be addressed at the beginning of 2007 include whether to change prescription bargaining within Medicare Part D, how to stem skyrocketing health care costs and make health insurance more widely available, and whether to create regulations to support health information technology and transparency.

In Texas, the changes to party representation in the Legislature aren’t as drastic: five new senators and 28 new House representatives will join the ranks at the Capitol in January. This means that the outlook for positive action for family medicine is good, according to Banning.

“TAFP members and TAFPPAC got its politics right during the election cycle and good things should be expected from medicine-friendly legislators in the upcoming legislative session,” he says. “We should expect big things.”

The big health care issues in Texas expected to be addressed include Medicaid and CHIP funding, the high numbers of uninsured Texans, health information technology, reimbursement to providers, managed care reform and strengthening graduate medical education.

Extra, extra! Read all about family medicine in state and national news

Over the past few months, articles and news segments about family medicine have been popping up across the state and country in newspapers, in magazines and on television. The increase in attention is due in no small part to the timely release of key reports from AAFP and TAFP, and the AAFP’s Vote for America’s Health Rally at the Capitol preceding November’s midterm elections. Several of our doctors attended the rally at the nation’s capitol and a couple were interviewed by a Cox News reporter for a syndicated story that ran in papers across the country.

After the publication of “Fractured: the State of Health Care in Texas,” a report released in October by TAFP and its partners in the Texas Primary Care Coalition, the Academy has been successful in scheduling editorial board meetings with the state’s major daily newspapers where a few eloquent local primary care physicians sit down with members of the papers’ editorial writers to discuss health policy and the real-world issues that affect patient access to care in their communities. Not only are those meetings resulting in editorials and news stories supportive of primary care, but the phones are ringing at TAFP as reporters call for interviews and information for other health stories they’re writing.

Media hubs in all of the major Texas metropolitan areas and others around the country have picked up on the news and published articles or opinion pieces echoing our concerns in the Houston Chronicle, the Dallas Morning News, the San Antonio Express-News, the Los Angeles Times, the Boston Globe and more. Recently, ABC’s World News Tonight featured our own Russell Thomas, D.O., and Steve Spann, M.D., along with AAFP President Rick Kellerman, M.D., in a story on the primary care physician workforce shortage.

For a more detailed account of recent media mentions of primary care and the Academy, visit the news page of TAFP’s Web site.

TAFP Foundation to coordinate diabetes study

Physicians’ Foundation for Health Systems Excellence awarded the TAFP Foundation a research grant to investigate the effectiveness of using health information technology in the screening and management of patients with diabetes. Through the study, “Improving Diabetes Care through Implementation of Health Information Technology in Solo and Small Family Physician Practice,” the Foundation in cooperation with TAFP will sponsor the implementation of HIT in rural family medicine practices.

“This grant gives us the resources to focus on a major chronic disease in Texas and work with the doctors on the front lines — small practice physicians in underserved communities,” says Kathy McCarthy, executive director of the TAFP Foundation. “We’re pleased to receive the grant and eager to get started on an exciting two-year project.”

This year, PFHSE awarded over $5.6 million in grants to 15 non-profit medical organizations and universities; the TAFP Foundation will receive more than $300,000 over two years. Other grantees will examine topics such as the disclosure of medical errors, patient safety and racial disparities in the treatment of type II diabetes.

PFHSE, a grant-making foundation, was founded in 2004 following the 2003 settlement of an antiracketeering class action lawsuit between physicians, 19 state medical societies and Aetna, Inc. For more information about the grant, read PFHSE’s press release or visit their Web site.

Be Physician of the Day at the Texas Capitol

TAFP invites all members to serve as the Physician of the Day during the upcoming 80th Legislative Session. Spots are still available from January through May. The program has provided a family physician for each convening of the Texas Legislature — including special sessions — since 1971.

The Physician of the Day staffs the Capitol Health Services Clinic, standing ready to treat legislators and their staffs as well as any person on the capitol grounds who needs care. All volunteer physicians are introduced in the House of Representatives and the Senate by their district’s legislators and their names become part of the official legislative record. Volunteers are encouraged to bring a prescription pad and basic doctor’s bag.

This program is coordinated and organized by TAFP and co-sponsored by the Travis County Medical Society, Texas Medical Association, Texas Osteopathic Medical Association and Texas Department of State Health Services.

Sign up by completing the online form on TAFP’s Physician of the Day Web site or by contacting Kate McCann at TAFP headquarters.

New Medicare Part D resource from TMF

The first anniversary of the Medicare Part D prescription drug program is quickly approaching, giving health care professionals, patients and lawmakers the chance to survey its progress. Throughout the year, TMF Health Quality Institute hosted four prescription drug plan collaboration conference calls to discuss the program. The archive of recorded calls is now available on the TMF Health Quality Institute Prescription Drug Plan Web page as well as more information on Medicare Part D.

Office-based research opportunity

At the 2007 AAFP Convocation of Practices and Networks, attendees will learn about office-based research and how it benefits primary care physicians. Recognizing how important office-based research is for the specialty and the Academy, the TAFP Commission on Public Health and Clinical Affairs created a $1,500 travel scholarship for which TAFP members can apply. The 2007 Convocation will be held March 1 - 4, 2007 in Virginia Beach, Va.

To apply for the scholarship, fill out the application and return the completed form and supporting materials to Paige Newman at TAFP headquarters by November 30. They will be reviewed by the Chair and Vice Chair of the Commission on Public Health and the Chair of the Section of SPARRC. The recipient will be notified in December. E-mail Paige Newman with any questions or visit the AAFP Web site for more information.

New search feature available at www.tafp.org

Now available on TAFP’s Web site: a keyword search feature. By typing a few words into the search box at the top-right corner of the page, users can easily find member tools, advocacy documents, information on certain topics and more. Keep checking the Web site for more tools that will further increase the efficiency of perusing the online resources of the Academy.

Copyright 2006, Texas Academy of Family Physicians