Association serves as resource for Texas physicians and practices
With physicians and practice leaders constantly on the lookout for ways to improve their business skills, professional associations serve as valuable sources of new material. TAFP has partnered with the Medical Group Management Association to provide members with a discounted rate to access the organization’s benchmarking data.
MGMA is most widely known as a resource for data and benchmark information, and releases an annual survey report. Surveys focus on practice revenues and expenses, provider and management compensations and group performances.
Starting in August, TAFP members can access the 2008 Cost Survey Report, which is based on 2007 data, for a discounted rate of $185—a $165 savings. To take advantage of this discount, TAFP members can access the MGMA store through the organization’s Web site, www.mgma.com, and enter the code TAFP08, or call (877) 275-6462 to order. The “Cost Survey for Single-Specialty Practices: 2008 Report Based on 2007 Data” is item number 7047.
The report includes:
- Data on single-specialty practices, including primary care, non-surgical and surgical;
- Details on staffing and operating costs, broken out per physician, per provider, per patient, per square foot, as a percent of total medical revenue, per total Relative Value Unit and per work RVU; and
- Revenue performance data, including accounts-receivable, charges, payer mix and procedural volume.
According to MGMA, physicians and practice leaders can use the information to compare their practice or practice costs to others in their region or nationwide, answer financial management questions, develop models for strategic planning and analyze medical revenue to aide in staffing decisions. Survey results are compiled from members and non-members who then receive free access to reports.
Some members-only tools on the MGMA Web site include the Physician Compensation Calculator, and access to over 500 health and business related publications, e-mail forums, more than one million research articles, a member directory and a transcript service.
Members can also choose to join 22 specialty societies designed for group practice leaders. TAFP members might be especially interested in the Primary Care Assembly that serves as a forum for information exchange related to primary care.
Comprised of 21,500 members, MGMA is a national professional association that serves as a network and education tool for medical group practice professionals and the organizations they represent. For more information, go to the MGMA Web site, www.mgma.com, or contact Liz Johnson at press@mgma.com.
New HHS designation system threatens funding for underserved areas
AAFP, along with six other organizations, has appealed to the Department of Health and Human Services to withdraw a proposed regulation that could take Health Professional Shortage Area and Medically Underserved Area designations away from numerous urban and rural areas across the United States.
The proposed rule, issued by HHS earlier this year, would decrease the amount of care to which millions of patients currently have access by changing the measures used to determine if areas are underserved. The current criteria for HPSAs and MUAs would be combined into a new system called the Index of Primary Care Underservice.
According to a news release from Health Resources and Services Administration, the revision is designed to create a simpler system, incorporate better measures of health status and access, improve identification of designated areas and minimize unnecessary disruption.
Currently, HPSA and MUA designations are used to determine underserved areas that qualify for support such as federal funding of community health centers or National Health Service Corps physicians and clinicians. If the new regulations take effect, nearly 29 million people currently living in MUAs would no longer be considered medically underserved, according to a study from the George Washington University School of Public Health and Health Services. With the number of uninsured Americans on the rise, this regulation would diminish the amount of health services being provided across the nation, according to the study.
The new Index of Primary Care Underservice includes three levels of designation: geographic HPSA, population MUP and safety-net facility HPSA. Each of the first two categories is split into two tiers depending on each area’s need for additional resources. According to the study, areas that exceed the population-to-provider ratio threshold with all clinicians counted are placed in tier 1. Areas that exceed the threshold only when federally-sponsored clinicians are excluded qualify under tier 2. Safety-net facility HPSA is a new designation that is given to health centers if 40 percent of patients in metropolitan areas, 30 percent in rural areas and 20 percent in frontier areas are Medicaid-eligible and uninsured. Ten percent of the health center’s total patients must also be uninsured.
Estimations by HRSA, the Robert Graham Center, and the George Washington University study project that Texas will retain 96 percent of HPSA designations compared to a 74-percent retention rate nationwide. Texas would also retain 80 percent of its primary care physicians and 89 percent of its population under HPSAs compared to 36 percent and 59 percent nationwide.
“I think out of all the states, Texas is one of the best [in regard to retention rates],” says Stephen Petterson, Ph.D., senior health policy researcher and chief analyst of AAFP’s impact analysis.
Rural locations are more likely to retain their designations, but they are also smaller, he said. Therefore, even if a large percentage of areas keep their designation, more people than expected will be affected.
According to the HRSA release, 2 percent of the nation’s 6,000 CHCs would lose federal funding, but as many as one-third could lose their MUA designation, Dan Hawkins, National Association of Community Health Centers senior vice president for policy and programs, said in a story from AAFP.
Number of underinsured balloons 60 percent, according to a study
A new study from the Commonwealth Fund found that the number of underinsured adults in the United States has increased 60 percent since 2003. The study, published in Health Affairs, analyzed data from a 2007 survey of adults ages 19 and older.
The study defines underinsured adults as “people who have health coverage that does not adequately protect them from high medical expenses.” Survey participants who spent 10 percent or more of their income, 5 percent for low-income participants, on out-of-pocket medical expenses were tagged as underinsured. Participants were also considered underinsured if they had deductibles that totaled 5 percent or more of their income.
Low-income participants were susceptible to being classified as underinsured but middle-income families saw the most impact. The number of underinsured adults who made about $40,000 annually, above 200 percent of the federal poverty level, tripled since 2003. Twenty-five percent of the underinsured adults had per-person annual deductibles of $1,000 or more.
The study also found that 42 percent of the under-65 population, an increase of 35 percent since 2003, had either no insurance or inadequate insurance in 2007.
The study’s authors found correlations between people who are uninsured or underinsured and tendencies to forgo necessary health care. Over half of the underinsured and 68 percent of uninsured went without needed health care such as visiting the doctor when sick or failing to follow up on recommended tests or treatment, compared to 31 percent of insured adults.
The authors of the study suggest that the United States needs to extend “affordable, well-designed” coverage to all.
They concluded: “As health costs continue to grow faster than income and evidence accumulates regarding variable quality and inefficient resource use, there is growing recognition of the need for coherent strategies that combine coverage with payment and other policies to change directions and move toward a more inclusive and higher performing, high-value health system.”
AAFP’s two-year practice redesign demonstration project concludes
Texas practice among “elite” of TransforMED
After two years of tests and evaluation, the TransforMED National Demonstration Project has come to a close. During the NDP, 36 family medicine practices—including the sole Texas practice, Trinity Clinic in Whitehouse—applied practice redesign initiatives to move toward the New Model of Family Medicine, as delineated in the 2004 Future of Family Medicine report.
The New Model recommends implementing advanced information systems like electronic medical records, providing open access to patients, using a team approach to care, focusing on quality and safety, and redesigning offices to be more functional. Practices were split into two categories, facilitated and self-directed. Trinity Clinic and other facilitated practices regularly participated in daily or monthly meetings, site visits, e-mails, and phone calls with TransforMED staff and other facilitated practices. The self-directed practices used the plan as a compass, but applied their own ideas to the system to find what would work best for their practice.
From the beginning, Trinity Clinic and its physicians, TAFP members Melissa Gerdes, M.D., Janet Hurley, M.D., and Amy Mullins, M.D., emerged as leaders in the project. “Trinity Whitehouse Clinic was one of the elite practices compared to the other facilitated NDP practices,” said David Garrett, M.H.A., TransforMED practice enhancement facilitator. “Like all of the other practices, Whitehouse had periods of change fatigue, frustration and circumstances outside of its control. This group was nimble and aggressive enough to be proactive and roll with challenges as they presented.”
In this project, willingness to change was key, which was one reason for the Trinity Clinic’s success. The physicians were already putting roughly half of the New Model recommendations into place when they applied, Gerdes said in a profile article published in the winter 2007 edition of TEXAS FAMILY PHYSICIAN. Trinity Clinic also had solid leadership in place and a strong communication base among the clinic staff in addition to an electronic medical record and same-day access slots for patients.
Gerdes says that the practice gained more confidence that they were headed in the right direction. “We also learned, as did many other practices, that people, staffing and communication are essential foundation components to enable change. If a practice does not have these elements in place, they will be the Achilles’ heel in halting change.”
The electronic medical record and same-day scheduling have become permanent components of the practice, Gerdes says, as well as open access and population-based chronic disease management. “However, the key is to have a solid values system, support people, and flexibility to change and implement new concepts as needed.”
Garrett said the TransforMED staff gained knowledge on “practice readiness to change, change process, barriers to change, quality measures and operational efficiencies.” You can find an outline of the practices’ process on the TransforMED Web site, www.transformed.com. Using the NDP practices’ experiences as a starting point should be helpful to other family physicians because, as Gerdes says, she learned that family physicians “are all in this together.”
“Even with such diversity, we are more alike than we think,” she says. “We have the same struggles with things like payers and staffing. [Family medicine’s] strength is the diversity of solutions to these struggles and we need to share these solutions more as a group.”
As an LLC owned by AAFP, the next step for TransforMED will be to engage primary care practices on a contractual basis. Garrett recommends practices make use of the TransforMED Web site to gain insight on how family physicians can change their practices to meet patients’ needs. A formal report on the NDP will be available in fall 2009.
Texas scores poorly compared to other states in new child health care report
Texas was tagged as one of the worst in providing children with quality health care, ranking 46th among the 50 states and the District of Columbia, according to a recent report.
The “State Scorecard,” released in May by the Commonwealth Fund, assesses variations among states’ child health care systems using 13 indicators grouped into five dimensions of performance: access, quality, costs, equity and potential to lead long healthy lives.
In Texas, 20 percent of children are uninsured, putting the state at No. 50 in this dimension, compared to only 4.9 percent in highest-ranked state Michigan.
Because no individual state scored highest in every category and each states’ scores fluctuated vastly across the board, even high-scoring states have the potential to improve, said co-author and Commonwealth Fund Vice President Edward Schor, M.D.
“In looking at the country as a whole, we found that while there are pockets of excellence, there is no one state or region that is doing as well as it could be,” he said in a statement released by the Fund. “This scorecard points to the need to make more information available about children’s health care and to improve the health care system for children.”
Authors of the study—Katherine Shea, M.P.H., Karen Davis, Ph.D., and Schor—scored state performance relative to what is achievable, “based on benchmarks drawn from the range of state health system performance.”
One reason states rank low is because of their failure to establish “medical homes” where each child frequently sees a family doctor, said Gary Floyd, M.D. Floyd is a past president of the Texas Pediatric Society and an active member of the Primary Care Coalition.
The two states faring best in most categories, Iowa and Vermont, recently improved their states’ Children’s Health Insurance Programs and implemented quality-reporting measures.
Although Texas received low rankings in many areas, the state scored high in the potential to lead healthy lives category, specifically on measures of infant mortality and risk of developmental delays in young children.
According to the Commonwealth Fund’s calculations, if all states achieved top levels on each dimension of performance, 4.7 million more children would be insured and 10.8 million more would have a medical home.
“The health of our children is paramount to our country’s long-term success. This scorecard serves notice that children’s health and well-being are at risk,” said Davis in the statement released by the Fund. Davis is the Commonwealth Fund president in addition to co-author. “We must invest in children’s health and health care to ensure that they have the opportunity to become healthy and productive adults. The time to begin is now.”
TAR WARS: We have a winner!
Angelica Morris, 10, a 4th grader at Shanklin Elementary in Luling won the Texas Tar Wars poster contest this spring with her poster, “Take a Stand.” She and her parents, Rebecca and Mark Morris, will travel to Washington, D.C., July 21 and 22 to represent Texas in the national poster contest.
Hone your leadership skills at TAFP Leadership and Legislative Conference
August conference includes mock hearing, media skills training
Family medicine and the entire health care system stands at a precipice as the public is increasingly concerned with rising health care costs, congressional and state leaders have the opportunity to respond with historic changes to our delivery system. To be prepared and engaged for the challenges ahead, attend the 2008 TAFP Leadership and Legislative Conference.
The conference will begin Friday, Aug. 15 with a dinner at Carmelo’s restaurant in downtown Austin and an overview of health care policy and projections for the future. Saturday the group will delve into the specifics in the Bluebonnet room at the Doubletree Guest Suites hotel to build attendees’ skills in promoting the medical agenda, working with the media and developing relationships with legislators. We’ll conclude with a mock hearing at the Capitol Saturday afternoon. The registration fee for AAFP and TAFP members is $50.
For more information about the conference and to register, go to the TAFP Web site, www.tafp.org/advocacy, or call Kate McCann at (512) 329-8666 ext. 16.