TAFP Blog

Medicaid expansion: A tale of two states

Tue, 30 Apr 2013 21:29:00 GMT

It’s no secret that Texas Gov. Rick Perry openly opposes federal health care reform. He has used every opportunity to reiterate that he will veto any effort by the legislature to participate in Medicaid expansion in Texas – an option granted to the states by last summer’s Supreme Court ruling. One source counts 14 states that have fully rejected accepting federal funds to extend health care coverage to low-income adults, while 20 states are fully participating in the expansion and 16 are undecided.

A state certain to participate in the expansion is Colorado, my new home state. The bill to expand Medicaid to 330,000 Coloradans passed both chambers of the General Assembly last week. Once the Senate approves amendments to the House version of the bill, it will head to the desk of Gov. John Hickenlooper, who has pledged to sign it into law.

In many respects (to the delight of this Texas native), the two states are very similar. Colorado has its urban capital, several other mid-size cities, and vast expanses of rural space. Residents also have a fierce loyalty to the state. And, until the past decade when control of the House, Senate, and the governor’s mansion has flip-flopped between the parties, Colorado has historically been conservative. The current split in the House is 37 Democrats, 28 Republicans. In the Senate, it’s 20 Democrats, 15 Republicans. And, of course, the governor is a Democrat.

As Colorado considered expansion, opponents (Republican lawmakers) argued that it would drain state coffers and leave the state footing the bill when generous federal funds run out. Proponents pointed to an analysis that shows Colorado will spend $133.8 million less over 13 years and create more than 22,000 new jobs over the same period, boosting the economy by $4.4 billion.

The lone Colorado Senate Republican who voted in support of the expansion told Kaiser Health News that he has “no choice but to support this.” He represents a district that includes several of the state’s poorest counties and says that hospitals in his district are “strained to the breaking point caring for the uninsured.” The Colorado Hospital Association supports Medicaid expansion in Colorado, as does the Colorado Medical Society.

Perhaps it’s no surprise that the fiscal argument is gaining ground in Texas among Republican lawmakers and conservative organizations who acknowledge the economic implications for rejecting federal dollars. George B. Hernandez Jr., president and CEO of the University Health System, said refusing the expansion will impose a 20 percent surcharge on Bexar County hospital district property taxes.

But Texas Republicans must tread carefully around this “radioactive issue,” as demonstrated by a strange sequence of events in the House last week when representatives approved a budget amendment that would have allowed for negotiations should Texas decide to participate in the expansion only to reconsider the vote hours later and ultimately pull it down. The concept still lives through a related budget rider approved by the Senate, and it will be a part of conference committee discussions.

The most promising plan standing, and one supported by the Texas Association of Business, is the so-called “Texas Solution,” House Bill 3791 by Rep. John Zerwas, M.D., R-Simonton. It would create a kind of voucher program designed to extend health coverage to the state’s poorest adults through the private marketplace and create a taskforce to reform Texas Medicaid. The House Appropriations Committee approved this measure last week on a 15-9 vote and it now waits to be heard by the full House.

Yet the proposal might never get a chance on the House floor. House Republicans in Texas represent chambers of commerce, hospitals, and other powerful entities that want to participate in Medicaid expansion. But if those representatives voted for anything resembling expansion, they would be hammered by powerful factions like the Texas Public Policy Foundation and Michael Quinn Sullivan’s Empower Texans. Why would Speaker Joe Straus put his members through what would most certainly be a damaging debate only to have the bill vetoed by the governor?

The arguments and the issues surrounding Medicaid expansion in both Colorado and Texas are the same. But Colorado will benefit from $12.28 billion of Medicaid funding while Texas will refuse $100 billion over the next 10 years and continue to bear the costs of a large population of uninsured poor citizens. The difference between the two states lies only in the makeup of their state governments. Once again the old adage is proven true: politics drives policy.

– kalfano

So easy a child can do it

Mon, 29 Apr 2013 15:47:31 GMT

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?

Some of this skepticism is well founded. For the past four years I have used the same EMR software I helped implement in my own residency 14 years ago. I can do work but do not save time. It still cannot talk to the hospital system so I do not have to look up the results of lab tests drawn five miles away. Although the computer file format that allows EMRs to communicate with each other has existed for years, I recently read another editorial lamenting the lack of interoperability between competing software products. While I firmly believe that such technology can improve patient care, these benefits are far from inevitable. In the United States, we believe in the goodness of technology like an article of faith. If you don’t think that technology will make your life better, you must be old-fashioned, or tragically unhip. Too often, however, we fail to adequately question whether the benefits the vendor promised are as good as advertised.

In a recent discussion thread, colleagues compared the latest fitness apps for their smart phones and GPS-based devices. I have tried similar devices but have found an “old-fashioned” running watch to be far more reliable. While I enjoy my smart phone, tablet, and laptop, I think we must still channel our inner Luddite by asking: Is this technology really improving our lives as much as we think? Are there unintended consequences we will regret in years to come?

On the other hand, we shouldn’t simply disregard potential benefits based on such concerns. If my children can check in to their own appointments, why don’t we make this available for all our patients? If my 80-year-old patient can learn to use secure e-mail to communicate with me, why can’t you? If my 50-year-old patient on Coumadin can check his own INR at home, e-mail me the results, and adjust his medicine based on my e-mailed response, why don’t more patients adopt this technology?

My father learned engineering with a slide rule, was one of the first to use the “revolutionary” Hewlett Packard desktop calculator, taught himself DOS and Windows a decade later, and now is mastering the iPad. While he is not sure he likes how the screen orientation changes when he turns it, I doubt he would give up his iPad for a slide rule. Such technological changes are inevitable, but our responsibility is to ensure they benefit our patients. The genie is out of the bottle and it’s too late to put him back.

Shine your light in service to your specialty

Mon, 29 Apr 2013 15:44:00 GMT

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.

I believe family medicine will play an important role in the establishment of a sustainable health care model for the future because it provides affordable quality care to patients. Family medicine will not lead simply because we have a great lobby team at the state and national levels, nor because we bark the loudest. It will lead because we are the best product out there, and this fact should not be undervalued, hidden under the snobbery of academia, nor belittled by “gatekeeper” terminology. The message we convey and the service we provide should not be buried in the sand because we feel despondent, frustrated, or worried.

The challenges in health care require us to tackle difficult and controversial topics. The cost of health care is the real enemy, and we must learn all we can about reducing redundancies in our health care delivery systems and eliminating excessive procedures and tests, as well as unnecessary ER visits and hospitalizations. We must be willing to cast off old treatment paradigms within our own practices that can no longer be defended by evidence.

There will also be an emphasis on patient accountability. We need to embrace elements such as motivational interviewing and patient self-management support tools to empower patients to live healthier lives and embrace healthier living practices. Yet we will also need to respect personal freedoms that sometimes lead to self-destructive patterns of behavior. While we should always treat patients with respect and dignity, there will need to be an acknowledgement that society can no longer bear the responsibility of expensive treatments for the conditions that ensue from some of these behaviors. How our government and our society tackle these difficult ethical issues will be the greatest challenge in this process. And to have our government and our society do so without the expertise of family physicians, who have been at the bedside of these patients, would be a great tragedy.

So again, I ask, how are you using your gifts and talents? What does your light look like? If you are looking for ways to make your voice heard, and want to be a part of these big issues that face our society, our nation, and our specialty, then please be a part of what we are doing here at TAFP. Do not bury your gifts and talents, and do not hide your light under a bowl. Do not succumb to doubt, dread, or fear. The future is bright for our specialty, and brighter still if the armies of our members rise up to the challenge with confidence and integrity. I look forward to having you join us along this journey.

TAFP member’s research basis for AAFP recommendation to CMS

Wed, 10 Apr 2013 18:28:00 GMT

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.

In the letter, Stream acknowledged that CMS might encounter some “operational issues” in creating new codes, namely defining primary care physicians. AAFP says that primary care physicians perform three functions – “first contact with the patient, continuity of care, and comprehensiveness of care.” The Academy also believes that physicians trained in primary care should be eligible for the new E/M codes.

In addition to the letter to CMS, AAFP also created a Primary Care Valuation Task Force in 2011, which officially released recommendations in 2012 that included primary care-specific codes such as these.

> Read the AAFP letter to CMS and see Katerndahl’s research
> Read the AAFP News Now story

– samantha

With rising abuse of prescription drugs, all must take action

Sun, 03 Mar 2013 15:12:32 GMT

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.

For family physicians on the frontline of prescribing, the solution will come from implementing changes in your practices, staying up to date on evidence-based pain management strategies and ways to identify potential abuse, and use of an online drug monitoring system like Texas’ Prescription Access in Texas (PAT).

Self-observation and assessment helped one Colorado primary care group practice take action to ensure proper prescribing. They identified a provider who had been prescribing large doses of narcotics without well-described indications and came together as a group to set a procedure. They now require a consultation with an appropriate specialist if one of their physicians uses long-term narcotics for treatments of conditions other than cancer pain or terminal illness. They also require patients to fill out a narcotic contract stating the intent of the medication, their responsibility, and potential risks. And they require physicians to use the Colorado version of PAT to make sure there is only one physician prescribing narcotics.

Ultimately, lawmakers may decide to increase monitoring and regulation of these medications, but physicians have the opportunity to educate yourselves and your patients on using these medications safely to ensure access for the patients who need them.

– kalfano

Reminders for C. Frank Webber & Interim Session

Thu, 21 Feb 2013 22:15:00 GMT

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.

On Thursday, registration for the SAM Group Study Workshop on Mental Health in the Community starts at 9 a.m. and the workshop begins at 10 a.m.

On Saturday, registration for the SAM Group Study Workshop on Heart Failure starts at 6:30 a.m. and the workshop begins at 7 a.m.

Online syllabus
This year, the C. Frank Webber Lectureship syllabus is available online for your convenience. Individual PDFs of the slides and handouts are available as hyperlinks following each lecture title on the CME schedule page of TAFP’s website at www.tafp.org/professional-development/cfw/cme. You may also download a complete PDF packet of all handouts here, or through the additional resources box on the right side of the CME schedule page. These documents are currently available until Monday, March 4. A print syllabus will still be provided on site.

Hotel information
Omni Austin Hotel at Southpark
4140 Governor’s Row
Austin, TX 78744
(512) 448-2222

Self-parking is free for anyone visiting the hotel. The parking lot is open and available to all. Valet parking is also available at the attendee’s own expense. For a map, click here.

DIRECTIONS FROM THE NORTH – VIA I-35 SOUTH
Traveling on I-35 South, follow past Austin center city and take Exit 231 - Woodward. Follow the frontage road to the third stoplight (Ben White Blvd). Turn left at the stoplight, follow for 0.1 mile, and turn right on Governor’s Row. The Omni Austin Hotel at Southpark’s entrance will be on the right.

DIRECTIONS FROM THE SOUTH – VIA I-35 NORTH
Traveling on I-35 North, take Exit 230 toward 290W / TX 71/ Johnson City/ Bastrop. Follow the parallel frontage road for 0.3 miles and turn right onto Director’s Blvd. Continue for 0.1 mile, then turn left onto Governor’s Row. The Omni Austin Hotel at Southpark’s entrance is located on the left.

DIRECTIONS FROM THE EAST – VIA HWY 71 WEST
Traveling west on Hwy 71, proceed past Austin-Bergstrom International Airport for approximately 5.3 miles. Follow to the Woodward Street intersection and turn left at the stoplight. Follow for 0.2 miles and turn right onto Freidrich Lane. Continue for 0.2 miles then turn right onto Director’s Blvd. Continue for 0.1 mile and turn right onto Governor’s Row. The Omni Austin Hotel at Southpark’s entrance will be on the left.

Conference attire
All CME and business meetings are business casual. Meeting rooms can often be cold and TAFP recommends that you bring a light jacket or sweater to ensure your comfort inside the general session.

Interim Session business meetings
Each year TAFP holds its Interim Session in conjunction with the C. Frank Webber Lectureship. All committees, commissions, and the Board of Directors meet to discuss current issues in family medicine and set recommendations for the Academy.

Even if not appointed to a certain committee, all TAFP members are invited and encouraged to attend any meeting as a non-voting guest. Section membership is not appointed and these meetings are open to all. Download a PDF of the Interim Session schedule here. To view the agendas and backup materials for each meeting, go to v1.tafp.org/membersonly. You will need to log in with your AAFP ID number as the username and your last name in lower case letters as the password. Most groups meet on Saturday, but the Commission on Legislative and Public Affairs and the Commission on Continuing Professional Development meet Friday, 7-10 p.m.

– samantha

Have you ever attended ALF or NCSC? Why not this year?

Mon, 28 Jan 2013 12:30:00 GMT

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.

All family physicians can benefit from the leadership training provided at ALF; it’s specifically targeted to TAFP officers, aspiring TAFP leaders, and chapter staff. This year’s topics will teach you how to engage your local payers, influence legislators, navigate the “bold new world” of health care reform, leverage the power of negotiation (particularly for women), interact with the media, engage your practice staff in the patient-centered medical home, and much more.

Kelly Gabler, M.D., residency faculty at the San Jacinto Methodist FMRP in Baytown, first attended ALF with the help of one of two of TAFP’s Future Leader Scholarships, which is open to first-time attendees of ALF. While there that first year she participated in NCSC sessions as well as ALF to get a flavor for both conferences. “ALF is a great opportunity to enhance personal leadership skills and to network with established leaders of the AAFP,” she says, “and NCSC provides an opportunity for consistent representation of the issues important to the members of the five special constituencies.”

“NCSC was an opportunity for me, as a new physician, to become involved at the national level. After I transitioned from resident to ‘active member’ I worried about how I could continue in a leadership role, and NCSC was the perfect place to start.”

Any member who is new to practice (up to seven years out of residency), a woman, an international medical graduate, a minority physician, or who identifies with the gay, lesbian, bisexual, or transgender communities can represent TAFP at NCSC in one of the five official delegate spots. You have to apply for these and you’re selected by a committee in February. There are also two scholarships available, one for a minority physician and one for a third-year resident. Outside of these spots, anyone who is a member of one of the five special constituencies can attend sessions to build their leadership skills.

Here’s what Bruce Echols, M.D., a family physician in Dallas and longtime NCSC attendee and delegate has to say.

“NCSC is a great opportunity to share with other physicians who are from a similar background as you and to give input on a national level to common areas of concern. I have made friends over the years who continue to provide encouragement and camaraderie throughout the year via the AAFP listserv(s) and social media.

“I have been given an opportunity to visit with and be listened to by national leaders—including individual members of the AAFP board and various state leaders. I have also been encouraged through this to become more active with TAFP as well and now serve on numerous committees, further increasing my input into the organization. While the annual NCSC meeting is busy, it is also fun and is a great getaway from the daily routine.”

Texas is always well represented and we greatly appreciate all members who take time out of their busy schedules to attend. To access information on how to apply for TAFP funding, go to www.tafp.org/news/stories/13.01.10/ncsc-alf. If you’d like to go ahead and register without applying for funding, go to www.aafp.org/leader. We’ll see you in Kansas City!

– kalfano

Denial ain’t just a river in Egypt

Sun, 27 Jan 2013 18:26:29 GMT

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.

When the CDC announced a new recommendation to screen all adults born between 1945 and 1965 for hepatitis C, I groaned. One more thing to do. My office visits have not gotten longer while my checklist for each visit has. When we are not having to meet new quality measures, we have to make sure our Medicare patients get their annual senior assessments and have all of their medical problems reviewed to make sure that our risk scores are correct.

Everywhere we turn, we seem to face pressure to do more while making each patient feel we spent enough time with them. With all this pressure pushing us in different directions, I am not surprised at my colleagues’ reactions to the report cards. I, too, often feel that I am back in school. I have been tempted to tell patients: “Hey, you’re killing me on my quality report card. Can you get your A1C checked for heaven’s sake?”

While I firmly believe that we must measure our performance to improve, I have been through this often enough to find our reactions humorously consistent. The late, great psychiatrist Elisabeth Kübler-Ross, M.D., could have used us as a case study.

Denial — “These patients aren’t mine. The attribution algorithm is wrong.”
Anger — “I referred him five times to get a colonoscopy. What do I have to do, drive him there myself?”
Bargaining — “If they could correctly identify my patients, then I would know where to start.”
Depression — “This is impossible. I’ve told them a thousand times to exercise. I give up.”
Acceptance — “OK, fine. Schedule those diabetics to see me and our dietitian so we can talk about healthy eating.”

Despite our frustrations, we do learn more about our practice by looking at this data. For example, our colorectal screening rate was at the national average, but only 10 percent of those tests were reported to the insurers with the correct CPT II code. That means we may not get the quality bonus we deserve. You can bet that motivated us all to click the little button for colorectal screening reporting.

We all think we’re good doctors when we sit in front of a patient. You have to have intestinal fortitude to look honestly at clinical data and admit that you are not as good as you think you are. So step by step, report card by report card, we pass through Stage 5 and get back to work.

Overwhelmingly, stakeholders support family medicine residencies

Sun, 27 Jan 2013 18:22:00 GMT

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.”

In early October, I attended a stimulating meeting of stakeholders presenting to the Texas Higher Education Coordinating Board’s Graduate Health Professions Subcommittee. I represented TAFP and the San Jacinto Methodist Family Medicine Residency. Also at the table were representatives from other large academic institutions—Texas A&M College of Medicine, the University of Texas Southwestern Medical School in Dallas and Austin, the University of Texas Health Science Center in Houston, Texas Tech University Health Sciences Center School of Medicine, the University of North Texas Health Science Center, and Baylor College of Medicine—plus the Texas Medical Association, the Texas Hospital Association, the Department of State Health Services, and, of course, THECB staff.

The coordinating board presented a report they released in April that assessed the adequacy of opportunities for graduates of Texas medical schools to enter residency training in the state. They also presented the ill-fated success story of the Physician Education Loan Repayment Program, which began to address health care access in the neediest areas in Texas before its funding was drastically slashed last session.

As TAFP reported in a recent issue of Texas Family Physician, “The Right Kind of Doctors for Texas,” THECB found in the report that while enrollment in Texas medical schools jumped 31 percent from fall 2002 to fall 2011, the number of first-year Texas residency positions remained flat. If no action is taken, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program in 2014 and 180 will not have this opportunity by 2016.

To expand the number of GME positions and restore part of the funding to the loan repayment program, the coordinating board has included two exceptional item requests in their budget to present to the Legislature. But because many funding streams pay for the cost of residency training—estimated to be around $150,000 per year per physician—physician members of the board asked if the state should focus on primary care.

There was resounding support for not just primary care, but for family medicine. Even internists were clear in their testimony that internal medicine does not have many residency graduates who stay in primary care and that family medicine provides the bulk of true primary care.

A committee member asked if the state should provide funds to academic institutions without stipulation and allow them to expand GME positions for any of the specialties experiencing shortages in Texas; he said of 40 specialties we’re only at the national average for three of them.

The answer: no. The stakeholders pointed out that fourth- and fifth-year GME positions have a return on investment for institutions and these positions would be more likely to be created than primary care positions. They explained that THECB should continue with their emphasis on first-year positions, with dominant sentiment that the funds should be disproportionately directed toward family medicine, general pediatrics, and psychiatry.

This meeting is just one example of the momentum driving lawmakers’ understanding that we need to invest in more family medicine residency positions for the benefit of Texans’ health and our economic stability. The coordinating board is on the right path and the Legislature will be well served with their expert direction. We in the Academy’s leadership encourage all TAFP members to continue talking about the value of family medicine to strengthen our message into the current session and beyond.

Tar Wars celebrates 25 years

Sun, 27 Jan 2013 18:18:00 GMT

Join this public health effort and help decrease
youth tobacco use

By Rebecca Hart, M.D.

Happy anniversary, Tar Wars! Did you know that Tar Wars, AAFP’s tobacco-free education program, celebrated 25 years in 2012? To mark this milestone, the National Tar Wars Advisory Group wants to re-energize the program.

Remember Tar Wars? Most of you may have been involved in medical school or residency, giving talks to fifth-grade students at local schools. You went into the classroom with about 30 kids and had a fun interactive session talking about smoking, questioning them about what they knew, educating them, and inviting them to do their own creative thinking about how to stay smoke free. You then invited them to make a smoke-free poster and enter the national poster contest. Kids love the interactive presentation, and really enjoy the contest. It was fun for you and was a great community service.

Tar Wars’ mission is to teach kids about being tobacco free, give them tools to make positive decisions about their health, and promote personal responsibility for their well-being. It accomplishes its goals with the help of family physicians, educators, and other health care professionals, like residents and medical students, who give presentations to students at school.

Tar Wars promotes advocacy for tobacco-free activities in communities, such as clean air ordinances and smoking bans in workplaces. The annual Tar Wars National Conference is part of this, as an opportunity to stress to legislators the importance of tobacco control. Student poster winners from the Tar Wars Poster Contest gather in Washington, D.C., to learn more about being tobacco free, meet their state congressmen and women, present them with their state winning poster, and talk about the project with them.

This last summer, I had the privilege of accompanying our national first place winner, Juan Elizondo of Houston, Texas, to meet Sen. John Cornyn at the Capitol Building in Washington. It was a great moment for him and 50 other kids from around the country. What an exciting prize for a fifth-grader to earn from being involved in a poster contest about staying smoke free! Juan’s poster said, “Say no to tobacco – Blow bubbles, not smoke.” It was a painting of a girl blowing bubbles with a little boy looking up at her. It is a great, positive message that he created. Every year there are hundreds of these messages generated by American kids who are prompted to think about the advantages of being smoke free for life.

In Texas, in the last year, Tar Wars has reached over 13,000 students at 137 schools across the state. Last year there were at least 240 presentations given with even more plans for this year. Residencies throughout the state sent residents into schools, medical school FMIG groups participated, and multiple private doctors gave presentations locally. But we can do even better with more participation!

In honor of its 25th anniversary year, I urge you to become more involved in Tar Wars locally. Here are a few ways can you get involved as a family physician in Texas.

Contact our state coordinator, Juleah Williams, by calling her at the TAFP office at (512) 329-8666, or e-mailing her at jwilliams@tafp.org.
Work with your local chapter to sponsor speakers for local schools. Some chapters sponsor a classroom, such as providing $25 for art supplies for the poster contest.
Log on to the Tar Wars Facebook site or the Tar Wars website and download the presentation.
Consider a donation to the national Tar Wars effort.

It’s easy to get involved, so do it as a great community service activity. Tar Wars is a positive, worthwhile program, sponsored by our own AAFP. Through Tar Wars, we teach kids about a tobacco-free life. We teach them to gain a greater understanding of the problem of tobacco abuse and addiction, to advocate for tobacco-free lives, and learn how they can make a difference in their community. Join me. Be a part of it!

Dr. Hart is a member of the AAFP Commission on Health of the Public and Science, and serves as the national chair of the Tar Wars Advisory Group.

Congress averts fiscal cliff, staves off Medicare physician pay cut

Wed, 02 Jan 2013 16:47:00 GMT

Once again waiting until the last minute, Congress passed a bill on New Year’s Day that averts the fiscal cliff, delays sequestration provisions for two months, and staves off the 26.5 percent cut in Medicare physician pay for another year.

The fiscal cliff agreement increases revenue largely by targeting married couples earning more than $450,000 a year and single people earning more than $400,000 a year by raising rates for wages and investment profits, but shields those earning less than $250,000 a year from income tax increases, the Washington Post reports.

As TAFP reported in the weeks leading up to this agreement, Congress had to find roughly $30 billion to pay for a one-year patch to the sustainable growth rate formula and considered reversing the Medicaid primary care bonus to offset the cost. Modern Healthcare reports (free registration required) that cuts will come from other Medicare programs, most of which affect hospitals, pharmacies, and dialysis clinics. The primary care bonus appears to be intact.

Modern Healthcare lists some of the cuts and savings: “For instance, a documentation-and-coding adjustment that seeks to recoup past overpayments to hospitals because of the shift to Medicare Severity Diagnosis Related Groups, or MS-DRGs, would save about $10.5 billion. A measure to re-price end-stage renal disease payments would save about $4.9 billion. That provision comes a few weeks after the Government Accountability Office released a report suggesting the federal government is overpaying for end-stage renal disease treatment. The bill also calls for re-basing Medicaid Disproportionate Share Hospital (DSH) payments, which is estimated to save about $4.2 billion.”

Hospital advocacy organizations have come out sharply against these cuts, saying they are “very disappointed” in the measure. “While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals’ ability to care for seniors and their communities,” said Rich Umbdenstock, president and CEO of the American Hospital Association, in a statement.

And physician organizations are undeniably frustrated that Congress has passed a one-year fix rather than a permanent solution to the Medicare physician payment problem.

AAFP Board Chair Glen Stream, M.D., M.B.I., said in a statement, “Congress has opened a path to assure the health security of elderly and disabled Americans by temporarily averting the more than 26 percent cut in Medicare payment for health services and delaying sequestration cuts.”

“The AAFP calls on the 113th Congress to pass legislation that ensures Americans’ future access to high quality health care through a permanent solution to Medicare physician payment and through restoration of adequate funding for programs that produce the primary care physicians Americans need.”

Jeremy Lazarus, M.D., psychiatrist and president of the American Medical Association, said in a statement, “This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients. This instability stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination. Physicians want to work with Congress to move past this ongoing crisis and toward a Medicare program that ensures access to care and the best health outcomes for patients and a stable, rewarding practice environment for physicians.”

With the SGR time bomb reset to Dec. 31, 2013, AAFP will undoubtedly continue to advocate for a permanent fix to Medicare physician payment. We sincerely thank all members who joined your Academy in contacting your congressional representatives and advocating on behalf of the specialty and your patients. We’re hopeful for thoughtful and informed lawmaking in 2013.

– kalfano

TAFP’s top 10 news stories of 2012

Thu, 27 Dec 2012 15:01:00 GMT

As another year draws to an end and we’re once again waiting to see what Congress will do to about the SGR and the fiscal cliff-tastrophy, your TAFP Communications staff put together a list of the top 10 news stories from Texas Family Physician and TAFP News Now based on unique page views recorded through our analytics system.

Not surprisingly, it shows that family physicians are concerned about the practice environment and the future. These stories outline new regulations, administrative burden, experimental practice and payment models, and the future of the specialty.

1. TMB rules you may not know but should

This piece from TMLT outlines seven Texas Medical Board rules physicians may unknowingly break, from advertising yourself and products to administering office-based anesthesia.

2. Supreme Court upholds Affordable Care Act

The biggest story of the summer was the Supreme Court’s decision to uphold federal health care reform. The controversial individual mandate is valid but states don’t have to expand Medicaid coverage. Both TAFP and AAFP say “much work lies ahead.”

3. Physicians must obtain prior authorization for power mobility devices starting Sept. 1

Prescription of power mobility devices is a big issue for family physicians and payers as it is prone to fraud and errors. A demonstration kicked off in the fall in Texas requiring physicians to obtain prior authorization in addition to the extensive documentation requirements.

4. Accountable care organizations take shape in Texas

Supported under the Affordable Care Act, accountable care organizations are the latest iteration in payment and system reform that strive to increase quality and reduce costs. The first ACOs in Texas have been approved by Medicare and are taking their own approaches to meet these goals.

5. Clinical Integration: The key to improving quality and reducing cost in health care

It’s the future. Health systems are combining health information technology, physician leadership, administrative governance, and quality measurement to establish protocols, achieve best practices, measure results, and reduce process variation, all for the goal of increased quality and reduced cost.

6. CMS names first ACOs approved for the Medicare Shared Savings Program

A smaller story to the magazine feature above, this News Now article announced the step that made ACOs real: 27 were approved by CMS including two in Texas.

7. Recovery Audit Contractors: The age of audits and remediation

RACs are the latest oversight bodies that will scrutinize claims submitted to Medicare with incentives to identify overpayments. Our practice management consultant says the question isn’t “if a RAC knocks on your door…?” it’s “when?”

8. DPS launches online prescription drug monitoring program to curb abuse

The PAT program connects dispensing practices to physicians, licensing board investigators, and law enforcement officials. DPS hopes this will help physicians identify possible drug abusers and traffickers, and help law enforcement officials to investigate those individuals or organizations.

9. Condition critical: The case for rescuing primary care in Texas

Heading into another legislative session, TAFP has mapped out a strategy to regain some of the drastic budget cuts suffered in 2011 and rethink how we fund medical education and residency training to ensure we can meet the needs of the future.

10. New loan repayment program to draw physicians, dentists to central Texas

Medical education debt is on the mind of young physicians and influences specialty choice. This program from St. David’s recruits physicians and other health care providers to central Texas.

Many of these issues are ongoing and will see further discussion in 2013 on the state and national level. As always, your Academy will be here to analyze them and give you the family medicine perspective.

– kalfano

Social media changing the face of health care as we know it

Fri, 14 Dec 2012 21:58:00 GMT

While visiting Dr. Justin Bartos, this year’s TAFP Physician of the Year, we convinced the North Richland Hills doc to join the family medicine revolution (#FMRevolution) and create a Twitter handle (@jbartos3). We are proud to say that our very own TAFP President, Troy Fiesinger, M.D., maintains his own blog (http://texasfamilydoc.wordpress.com) and is very active on Twitter (@TroyTxFamilyDoc). The Academy, of course, is also lively across multiple social media platforms including Twitter (@TXFamilyDocs), Facebook, and LinkedIn.

While it may seem as though I’m speaking in code, it’s actually just the language of the technologically advanced 21st century. Get used to these hashtags, handles, links, and profiles, because they are here for the long haul. But what can social media do for health care and doctors like yourself, you ask? Simply put, it makes things that you already do easier, digitally. In fact, Medscape reports that one in four physicians already uses social media on a daily basis.

Websites like the aforementioned ones allow you to network with other physicians, connect with patients, follow medical organizations, and stay up to date on just about any kind of news. The Medscape study also found that primary care physicians are usually motivated to use social media as a way to connect with peers and be influenced by them. The Academy uses social media to spread news to our members, keep in contact with similar organizations and people relevant to health care and the state of Texas, and network with like-minded people.

Choosing a site to join is more personal preference than anything. Twitter updates, called “tweets,” are limited to 140 characters, so must be quick and to the point, and are usually something like an article, video, or blog we think our “followers” will find interesting. Facebook posts allow for more text, so this is where we go into more detail on topics. Companies use Facebook to put a face to their brand, which is similar to how we use it as the Academy. LinkedIn is a more professional site, allowing users to join groups like ours to network with people in similar fields.

We would like to encourage our members to embrace new forms of communication, including these social media outlets. Just as technology has always changed the way we approach health care, so will social media. If you are already signed up with these sites and don't already, follow TAFP on Twitter here, Facebook here, and LinkedIn here. If you have questions about social media, want help setting up your own accounts, or would like to submit things for us to post on social media, email me at swhite@tafp.org and I’d be happy to help!

– samantha

Meet the new TAFP Communications Specialist, Samantha White

Fri, 30 Nov 2012 19:51:00 GMT

On the eve of a recent photo shoot, I walked through my usual pre-shoot routine. Charge the battery. Empty the memory cards. Clean the lens. Load up the camera bag. A series of steps I’ve done so many times I could now complete successfully in my sleep. This shoot would be different, however. The following morning I would be shooting my first set of images for TAFP’s Texas Family Physician, a magazine I’m sure you are all aware of.

I took over Kate’s reins as your communications specialist early in October (no worries though, she’s still around!) and have been nothing but excited about working for TAFP. She spent a few weeks teaching me much of what she knows and I feel fortunate to have her as a mentor in the position.

Born and raised in the panhandle (mostly Lubbock), I ventured south to get my photojournalism degree from UT Austin. I’ve been here in Austin for over six years now, and am a true Texan at heart. I’ve worked as a freelance photographer for about that long as well, shooting everything from babies and families to editorial images.

In addition to shooting photos for the magazine, I will also join Jonathan and Kate in writing content for our quarterly publication. I’ll be maintaining tafp.org and our multiple social media presences (@TXFamilyDocs on Twitter and our TAFP Facebook page), as well as some other web-related things. Feel free to e-mail me with any web concerns or questions, as well as anything you’d like to see broadcasted on our blog, in the magazine, or on social media. I’d love to hear from you!

I’m excited to be another creative mind at the TAFP table and to represent all of our family docs across the state. I have already had the opportunity to meet a few of you and cannot wait to meet more!

– samantha

Standardization can relieve administrative burden, if we can get there

Fri, 16 Nov 2012 19:39:58 GMT

The amount of time and money physicians and their staffs spend on the administrative tasks of medicine is astounding. A recent perspective article in the New England Journal of Medicine quantifies it this way: “The average physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures,” and physician practices hire coding and billing staff “who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements.”

That translates to an annual cost of $361 billion spent on health care administration, and half of these expenditures are unnecessary.

The authors argue that standardization is key to reducing administrative costs, and much of this can be achieved through health information technology and electronic health records. Though they say the only entity with the “clout” to push through standards in medical transactions is the federal government, measures in the Affordable Care Act and the Health Information Technology for Economic and Clinical Health Act (HITECH)—like instituting regulations on payers and providing incentives to physicians and facilities—may start us on the right path when previous efforts have failed.

It also helps that other physician groups are championing the cause. At the interim meeting of the American Medical Association held last week in Hawaii, the Colorado Medical Society presented and passed a resolution that directs AMA to advocate for more automation, standardization, and simplification of administrative tasks between payers and providers including claims transactions, prior authorization, and verification of benefits at the time of service. The resolution also directs AMA to expand their Heal the Claims Process campaign, which aims to reduce the cost of managing the claims cycle to 1 percent of revenue.

The challenge is that any reforms take time—for physicians to implement the systems that will potentially reduce administrative burden—and money—through paid staff and lobbying to legislate changes to a complex system. Both of which are in short supply.

– kalfano

Travis County's Proposition 1

Mon, 05 Nov 2012 14:55:00 GMT

The recent chatter of new medical schools in Austin and South Texas is back in the news, as Proposition 1 is on this year’s ballot in Travis County. If approved, the proposition would increase property taxes in order to fund healthcare services that will later be provided by a new medical school in Austin. Both schools will be a part of the University of Texas system.

As university systems expand and new medical schools open up, we must ask what they intend to do about the lack of primary care physicians not only in the state, but all across the country. Programs are being put into place to encourage students to pursue primary care, but are not widespread among schools.

AAFP Executive Vice President, Dr. Douglas Henley, M.D., addressed the shortage when speaking to the AAFP Congress of Delegates in Philadelphia last week. Henley describes a new type of medical education – “one which is more clinically oriented; one where all students are first educated and trained as ‘comprehensivists’ before seeking specialty training as residents; and one where students are taught to be leaders of efficient teams of health care professionals focused on delivering patient centered care to meet the triple aim of better care, better health, and lower cost.”

Henley goes on to say that today’s curriculum in medical schools is “broken” and focuses too much on the one person who ends up in the hospital as opposed to the thousands that “interact with our health care system in more common and very different ways.”

University of Texas System Chancellor Francisco Cigarroa says that the South Texas school will graduate its first class in 2018. Chronically underserved, the region would benefit from a medical school should the new school’s medical graduates stay in the area for residency or future practice.

In a recent letter to the editor of the Austin American Statesman, Ken Sherman, M.D., shares his concerns about the new Texas medical schools and whether or not they will address the primary care physician shortage. Sherman thinks that the new Austin medical school will be modeled after the current UT Southwestern Medical Center in Dallas, which he says does not produce enough family physicians. He is against the proposed tax increase until the UT System proves that the new school is “wholly committed to primary care with the primary care residency slots to match the community need.”

The fate of the proposition will be decided once and for all this week as Election Day is finally here. For more information on voting in Texas visit www.votetexas.gov.

UPDATE

Travis County voters approved Proposition 1 Tuesday 54.7 percent to 45.3 percent. Democratic state Sen. Kirk Watson of Austin, a major proponent of the tax increase, delivered a speech on election night saying that he “always felt strongly the people of Travis County would listen, see the benefit” and would vote in support of the tax increase as part of an initiative to establish a new medical school in central Texas. University of Texas at Austin President Bill Powers also spoke on the vote, saying that now “the hard work of building a medical school begins.”

– samantha

Reminders for Primary Care Summit

Tue, 30 Oct 2012 15:09:00 GMT

The 2012 Primary Care Summit in Dallas is upon us and we are looking forward to seeing you there! Below you will find important information to make sure everything this weekend goes smoothly for you.

Registration Schedule

Important – This year’s Primary Care Summit will be held in the Dallas Ballroom on the 3rd floor. To make registration easier, TAFP staff will open registration Thursday evening, Nov. 1. Registered attendees may pick up their materials on Thursday from 5:30 - 6:30 p.m. at the TAFP Registration Desk on the 3rd floor of the Westin Galleria. Please note that you will still need to stop by the registration desk on Friday to sign in.

Registration opens as scheduled on Friday, Nov. 2, at 6:15 a.m., in the 3rd floor foyer. The conference begins with our CME Breakfast Lecture on Friday morning at 7 a.m.

Please note that the SAM Workshops on Friday and Saturday are sold out. Only those attendees pre-registered for the SAM will be able to attend. All other attendees will attend the Friday and Saturday general session as part of the Primary Care Summit general CME.

Hotel Information

All Primary Care Summit events are held at the Westin Galleria. The Westin Galleria is located at 13340 Dallas Parkway in Dallas. Directions to the hotel can be found here. Remember, self-parking at the Westin Galleria is free and valet parking starts at $17 for the day rate and $26 for overnight parking and includes in and out privileges.

Online Syllabus

This year, the Primary Care Summit syllabus is available online for your convenience. Individual PDFs of the slides and handouts are available as hyperlinks following each lecture title on the CME schedule page of TAFP’s website, www.tafp.org/professional-development/pcs-dallas-fort-worth/cme. You may also download a complete PDF packet of all slides here and all handouts here, or through the additional resources box on the right side of the page. These documents will be available from Monday, Oct. 29, to Monday, Nov. 5. A print and CD syllabus will still be provided on-site.

Attire

Attire for Primary Care Summit is business casual. TAFP encourages you to bring a jacket or sweater as temperatures in the meeting rooms can fluctuate.

If you have any questions, please feel free to contact TAFP at (512) 329-8666 or on-site at the registration desk.

– samantha

TAFP members can make a difference this legislative session

Thu, 25 Oct 2012 17:38:00 GMT

Use TAFP resources to educate lawmakers on issues important to family medicine

TAFP serves as your voice in the Texas Legislature and we have a team of advocates with strong relationships throughout the Capitol community and in state agencies working on your behalf. We continue to make strides for the specialty, but we can’t do it without your help. TAFP members can make a difference and we invite you to get involved in the fight for family medicine.

The 83rd Texas Legislature convenes on Tuesday, Jan. 8, and getting involved is possible no matter how much time you’re able to commit. Whether taking five minutes to read one of TAFP’s Advocacy Action Item e-mails and send a message to your representative, or a few minutes to donate to TAFPPAC online, or dedicating a day to see patients at the Capitol, your involvement matters. Here are a few opportunities to consider.

Sign up to be a Key Contact – State and federal lawmakers are making decisions that directly affect your patients and your practice. As legislative battles heat up, legislators need to hear from family physicians about how medicine should be practiced. Physicians who sign up for TAFP’s Key Contact program serve as resources to their legislators, educating them on health care issues that affect the practice of medicine and patient care. As a Key Contact, TAFP will reach out to you leading up to and during the 83rd Legislative Session with resources and guidance for connecting with your senator or representative. It can be as easy as sending an e-mail, but each member interaction adds to the total effort.

Serve as a Physician of the Day – As a service to the Texas Legislature, TAFP coordinates the Physician of the Day program. TAFP-member family physicians volunteer to staff the Capitol Health Services Clinic for a day during each legislative session or special session, demonstrating first-hand the value and necessity of family physicians in Texas. The Physician of the Day is introduced in both the Senate and the House of Representatives and his or her name becomes a permanent part of the official legislative record. Sign up on the Physician of the Day page of TAFP’s website.

Join TAFPPAC – The TAFP Political Action Committee (TAFPPAC) speaks on behalf of TAFP members through grassroots involvement, personal relationships with elected officials, and political campaign participation and contributions. TAFPPAC is a non-partisan political action committee that supports candidates who demonstrate support for issues important to family physicians and our patients. TAFP members can give a one-time donation or sign up to be a monthly donor on the TAFPPAC page of TAFP’s website. Also, view TAFPPAC’s list of candidate endorsements as you head to the polls for the general election on Nov. 6.

Leading up to and during the 83rd Legislature, TAFP Communications will provide advocacy resources detailing the Academy’s stance on workforce, scope of practice, medical education and graduate medical education, and other important issues. To start, check out a set of white papers on changing medical education and GME to produce the physician workforce Texas needs now and in the future to care for a growing population.

Read “Primary Care in Texas: Condition Critical” for an analysis of the funding of graduate medical education and how this funding has contributed to the decline of family medicine residency slots.
Read “The Right Kind of Doctors for Texas: Revisiting barriers to building the primary care workforce, 20 years later” for a look back at challenges the Academy and other stakeholders identified in the early ’90s and what we must do now to reverse the damage of inaction.

For more information on any of these opportunities or resources go to www.tafp.org/advocacy or contact TAFP at tafp@tafp.org or (512) 329-8666.

Time to swing for the fences

Tue, 16 Oct 2012 18:06:00 GMT

An excerpt from the 2012 incoming presidential address

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

Whether we practice in Houston or Henderson, Wichita Falls or Weimar, El Paso or Del Rio, Alpine or Austin; we are all Texas family physicians. We bring different perspectives to the Academy based on where we live and where we’re from. I know what it’s like to work in a large integrated health care system, run a community health center, and teach our future family physicians, but I don’t know how to run your practice. I want to hear from each of you about how we can strengthen family medicine and take care of our patients.

Our health care system is in the midst of a painful rebirth. The insurers, the government, and the hospitals are pulling us in different directions. We stand with our patients at the middle of this storm of abbreviations and acronyms: ACA, ACO, PCMH, EHR, and the Medicaid 1115 waiver.

Now, we can ride off into the sunset like the cowboy in an old Western, resigned to obsolescence as the specialists, large hospital systems, and insurers take over health care. Or we can choose to pull up our britches and get to work. “If you don’t like change, you’re going to like irrelevance even less.” President Lyndon B. Johnson said there are two kinds of people in the world: “can-do people” and “can’t-do people.” I think family doctors are can-do people.

When Bobby Youens and Jorge Duchicela of Weimar grew frustrated at the lack of family physicians in rural Texas, they got together with Tricia Elliott of UTMB to organize a rural residency track. Instead of resigning himself to complaining about changes in health care, Lloyd Van Winkle of Castroville organized primary care docs into an IPA—and is running for the board of the American Academy of Family Physicians. When Melissa Gerdes and Mike McCrady grew concerned about how family docs would fit into large health care systems, they became physician leaders who could advocate for their patients from the inside. Instead of getting mad, Roland Goertz got even and headed off to Washington, D.C., as our AAFP president to bend the ear of every congressperson and senator he could find about the value of family physicians. While other specialties complain about “the government doing this” or “insurers doing that,” family doctors come up with a plan and get to work.

It is easy to get frustrated by the changes hitting us daily, but I urge you to channel your anger into action. We understand better than most the reality on the ground—and what our patients need. When patients ask me if I think all the frustrations are worth it, I think of a 1991 CNN interview with an old redneck from the Boots and Coots well control company. Boots and Coots is who they send in when the world is going to hell and someone needs to put the fire out. Behind him, the burning Kuwaiti oil wells spewed smoke and flames into the sky. When the reporter asked him why someone would do something so dangerous, he answered in his best Texas drawl: “Hell, there’s nothin’ I’d rather be doin’ than fightin’ oil fires.” I don’t push each day to get my patients the health care they deserve to quit now. They deserve my best. And there’s “nothin’ I’d rather be doin’.”

Let’s be honest, though. We took some lumps in the 2011 legislative session: the primary care preceptorship was eliminated, state GME funding for residencies like mine was cut to within an inch of its life, and the loan repayment program which placed family docs in needy communities was slashed so badly it’s on life support. Medicaid rates weren’t cut, but in typical legislative fashion, Medicaid will run out of money on Dec. 31. Your physician leaders and Academy staff have drafted a policy manifesto for the 2013 legislative session: the Primary Care Rescue Act. This plan shows our legislators how they can improve the health of their constituents—our patients—by investing in training new family doctors and getting those doctors to where our patients need them. To improve health care in Texas, we need to:

Train more primary care doctors by restoring funding to our residency programs,
Push our taxpayer-funded medical schools to train more residents and make sure the medical students they educate go where the taxpayers need them,
Encourage medical students to pursue primary care by funding the primary care preceptorship program,
Consolidate Texas’ two loan repayment programs and restore their funding,
Encourage doctors to adopt health information technology by offering loan programs and business tax credits, and
Reward quality improvement by requiring health plans that receive state general funds to increase the fees paid to physicians who achieve national quality certifications from the NCQA and others.

These areas will be the focus of our legislative efforts for the next session. Now we could trot off to Austin in January with this list in hand to ask for more money—just like the school teachers, the universities, and everyone else whose programs were cut last time around. Too often, doctors approach politics like a disease to be cured. We come up with a sound policy, then we wait for our leaders to respond to the rightness of our cause. But being right doesn’t get us votes.

Politicians follow a different logic. Our most important issue may not be theirs. We must get to know them, learn what motivates them, and understand what issues matter to their constituents. Next year, the legislature will make decisions that will have a major impact on health care in this state. Now is the time to lay the groundwork for 2013.

Every TAFP member can contribute. You each have a state representative and a senator. Call them. Remind them you are a constituent—and so are your patients. “My patients have trouble getting the health care they need, they live in your district, and they vote.”

I am honored and humbled to be chosen as your president. It is time to swing for the fences. As I look forward to the next 12 months, I think of the motto: “Lead, follow, or get out of the way.” I am proud to be president of an Academy which chooses to lead.

Nurse practitioners are no substitute for physician-led team

Tue, 16 Oct 2012 18:03:16 GMT

By Roland Goertz, M.D., M.B.A.; Chair, AAFP Board of Directors

By the year 2020, our nation is expected to face a shortage of 45,000 primary care physicians. To address this shortfall, as well as rising health care costs, the nation is seeing a movement to grant independent practice to nurse practitioners.

But, this flawed, stop-gap approach overlooks some obvious obstacles to replacing physicians with non-physicians. For example:

The nursing field faces its own deficit with a shortage of 260,000 nurses projected for 2025. You can’t fill a gap with something else you lack.
Though some have supported the idea of independent nurse practitioners because of the lower costs involved with training and employing nurses, the approach fails to consider that those savings may be offset by decreased productivity and less efficient use of staff resources.
Granting independent practice to nurse practitioners would create two classes of care: one run by a physician-led team and one run by less-qualified health care professionals. Physicians are required to complete roughly 16,000 more hours of training than nurse practitioners.

The Academy addressed all these issues when it released a report—with support from the American Academy of Pediatrics, the AMA, and the American Osteopathic Association—that explains in detail the differences in training and clinical expertise between physicians and nurses, why a team-based approach is preferable, and why substituting non-physicians for physicians just won’t work.

Our report is intended, in part, to educate the public about those differences in training. Consumers are not discerning purchasers of health care when they don’t know the facts. Many patients, however, already express a preference for physicians. According to a recent AMA patient survey, 86 percent of respondents said that they benefit when a physician leads a primary care team, and 75 percent said they prefer to be treated by a physician—even if it takes longer to get an appointment.

At a time when AAFP is advocating a team-based approach to health care to improve outcomes and lower costs, some nurse practitioners are eager to go it alone. Our report makes a strong statement that the patient-centered medical home model is designed to be run with a physician leading a team of health care professionals. A recent report by the Patient-Centered Primary Care Collaborative offers more than 30 examples of public and private payers finding that better care, better outcomes, and lower costs are possible in the PCMH model. Specifically, team-based care has been proven to reduce emergency room visits, hospital admissions, and total inpatient stays.

The PCMH gives patients access to physicians, nurse practitioners, physician assistants, and other health care professionals. Together, these health care professionals can complement each other with their experience and expertise.

Finally, the report stresses that national workforce policies are needed to ensure adequate supplies of family physicians and other health care professionals to improve access to quality care and avert the anticipated shortages of primary care physicians and nurses. Wholesale substitution of non-physicians for physicians is not, and should not be, an option.

This post was originally published on the AAFP Leader Voices blog. Republished with permission.

TAFP Blog

Medicaid expansion: A tale of two states

So easy a child can do it

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

Shine your light in service to your specialty

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

TAFP member’s research basis for AAFP recommendation to CMS

With rising abuse of prescription drugs, all must take action

Reminders for C. Frank Webber & Interim Session

Have you ever attended ALF or NCSC? Why not this year?

Denial ain’t just a river in Egypt

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

Overwhelmingly, stakeholders support family medicine residencies

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

Tar Wars celebrates 25 years

Join this public health effort and help decrease youth tobacco use

By Rebecca Hart, M.D.

Congress averts fiscal cliff, staves off Medicare physician pay cut

TAFP’s top 10 news stories of 2012

Social media changing the face of health care as we know it

Meet the new TAFP Communications Specialist, Samantha White

Standardization can relieve administrative burden, if we can get there

Travis County's Proposition 1

Reminders for Primary Care Summit

TAFP members can make a difference this legislative session

Use TAFP resources to educate lawmakers on issues important to family medicine

Time to swing for the fences

An excerpt from the 2012 incoming presidential address

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

Nurse practitioners are no substitute for physician-led team

By Roland Goertz, M.D., M.B.A.; Chair, AAFP Board of Directors

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

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

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

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

Join this public health effort and help decrease
youth tobacco use

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