In the spirit of the holidays, we’d like to take a moment to thank you for your continued membership.
Representing 7,000 family physician members, family medicine resident members, and medical student members across the state, TAFP stands strong with you in the mission to improve the health of your patients, families, and communities. You – our members – are our greatest asset and most precious resource, and what we can do together and learn from each other is the greatest member benefit we have to offer. We’re here to support you in your practice and we look forward to serving you in 2012.
From all of us at TAFP, happy holidays!more
As TAFP faculty and staff travel to San Antonio and Lubbock to present two SAM Group Study Workshops tomorrow, it brings to mind a few changes to the ABFM Maintenance of Certification process that all diplomates should know about.
First, ABFM has changed the requirements for the Performance In Practice Module, which satisfies Part IV of the MC-FP process. PPM involves a physician assessment of 10 patients using evidence-based quality indicators. The physician enters the data into the ABFM website and ABFM provides feedback on each indicator. The physician chooses an indicator and designs a quality improvement plan, submits the plan to ABFM, and puts the plan into action.
Here’s where the change comes in. Previously, the physician had to wait 90 days before assessing the care provided to 10 patients in the chosen health area; now this period is just one week. ABFM says shortening the time between implementation and assessment should make it easier for physicians to complete their improvement project.more
You’ve probably heard by now that the Joint Select Committee on Deficit Reduction, the “supercommittee,” failed in its efforts to reach a budget compromise. The 12 congressional lawmakers had until Thanksgiving to formulate a plan to trim at least $1.2 trillion in federal spending, and health care advocates hoped they’d also include a fix for the flawed Medicare payment formula, the SGR, in this plan.
This wasn’t wishful thinking; years of temporary fixes weigh heavily on the deficit. Plus, the committee had been granted special authorization to find and score savings wherever they could. Up until this point, insiders promised that committee members were seriously considering including an SGR fix, which would prevent a planned 27.4-percent cut in Medicare physician payment come Jan. 1. Not only is this cut still on the table, automatic reductions triggered by the supercommittee’s inaction will cut another 2 percent in Medicare payment in 2013.
A health care lobbyist told the Associated Press that “lawmakers of both parties wanted to deal with the cuts to doctors, but a fundamental partisan divide over tax increases blocked progress of any kind.”more
Save money. Live better. It’s Wal-Mart’s corporate motto, but put it in the context of health care and add a third line targeted at improving care for individuals and you’ve got something awfully close to Don Berwick’s triple aim for health care reform. If cost is the real cancer in the U.S. health care delivery system—and we think it is—why not look to America’s low-cost leader for the cure?
When reports started hitting the news this week about a request for information Wal-Mart sent out to its vendors in late October announcing the mega-retailer’s intent to “build a national, integrated, low-cost primary care health care platform that will provide preventative and chronic care services that are currently out of reach for millions of Americans,” alarms went off in health policy circles across the country.
The company has since backpedaled on the statement of intent. John Agwunobi, M.D., M.P.H., M.B.A., head of Wal-Mart’s health and wellness division, released a statement on Nov. 9, 2011, saying, “We are not building a national, integrated, low-cost primary care health care platform.”more
Texas House Speaker Joe Straus, R-San Antonio, released the interim charges for the standing committees of the House of Representatives. As he said in the accompanying letter, these charges will set the stage for legislation considered during the 83rd Texas Legislature, which convenes in January 2013.
Of those that may affect family medicine, one assigned to the House Committee on Public Health stands out for its sheer immensity. It directs the committee to:
- Examine the adequacy of the primary care workforce in Texas, especially considering: the projected increase in need (from an aging population and expanded coverage through federal health care reform), and cuts to workforce-building programs such as graduate medical education and physician loan repayment programs.
- Study the potential impact of medical school innovations, new practice models, alternative reimbursement strategies, expanded roles for physician extenders, and greater utilization of telemedicine.
- Make recommendations to increase patient access to primary care and address geographic disparities.
Eleven years ago, when I came on board as managing editor of Texas Family Physician, I was fresh out of journalism school with a love for design and an eye for art, photography, and typography, but no real-world experience in producing magazines. I learned much in those first few issues about the nuts and bolts of magazine production, all the while trying to appear as though I knew something about an expanding range of increasingly complex editorial topics my new magazine was required to cover.
My first cover story tackled the problems with the financing of graduate medical education – talk about jumping in at the deep end.
During those first issues, I knew the magazine needed a new look, a form and function that could achieve the news and information focus we wanted to deliver, while keeping the warmth and conversational nature we wished to convey. In 2002, we launched the first redesign of TFP under my direction, and while we’ve worked in each issue since to refine that design, I believe the artistic concept has served the Academy well.more
By Juleah Williams
Among this season’s new fall line-up comes a new drama from the CW – Hart of Dixie – featuring surgeon-turned-country doctor Zoe Hart. Full disclosure: As can be expected from most CW programming, this show is geared toward a teenage audience and includes enough love triangles and “frenemies” to keep their attention. However, exposing this young population to the benefits of primary care and emphasizing the importance of having a relationship with a personal family physician is crucial to increasing interest in the specialty down the road.
As the story goes, Zoe graduated at the top of her class from medical school and seeks to follow in the footsteps of her father, a cardiothoracic surgeon. After residency she fails to be accepted into a fellowship because her superiors deem her “too cold.” Desperate, she decides to accept the offer of a kind stranger—who turns out to be her real father—to join his family medicine practice as a general practitioner in Bluebell, Ala.more
By Richard Young, M.D.
A recent study in Annals of Internal Medicine looked at what happened when patients were cared for in the hospital by private physicians (presumably often their personal physicians) compared to hospitalists.
For a little background, hospitalists are doctors whose job is limited to taking care of patients in the hospital. They pick up new patients in shifts or cycles and almost always have no previous relationship with the patients. They rarely see patients in clinics and have no long-term outpatient relationships with patients.more
Following the most basic model for success in business means minimizing overhead and maximizing revenues, Dr. Mark Laitos pointed out at TAFP’s Payment Reform Summit last Saturday. For doctors in private practice and other health care providers, this means billing for as many relative value units, or RVUs, as possible at the best conversion rate, and maximizing ancillary revenue, when possible.
And while this strategy is simple enough, Laitos said it has reduced the “proud field” of medicine to “conveyor belt medicine.” Worse, as payers – including health insurers, employers, and patients to some extent – strive to minimize RVUs, the solution to the cost crisis in a fee-for-service system is to slash payment to physicians and deny care to patients.
Of course neither patients nor doctors (nor the organizations that advocate for them) would allow this to happen considering the scale needed to rein in escalating health care costs. The solution, then, as speaker after speaker suggested, is to trade the volume-based model for a value-based model. This is also the cover story of the latest Texas Family Physician magazine.more
As could be expected, Gov. Rick Perry’s decision to seek the Republican nomination for president has intensified state and national media scrutiny of Texas’ health care record, particularly regarding the uninsured, Medicaid, health care costs, and our medical liability climate.
TAFP has long been on record in our public positions—from “Fading Away” to “Fractured” to “The Primary Solution”—that starving down our primary care infrastructure and the continued fragmentation of care across the spectrum of settings transcends moral concerns and translates into very real economic consequences that threaten everyone from local taxpayers to employers and families. We have been equally ardent in our position that a vibrant primary care delivery system operating in a healthy liability climate is the solution to the crisis facing our health care delivery system.
Armed with these resources, TAFP’s physician leaders, lobby team, and advocacy staff have routinely briefed top Texas political and health care writers, as well as legislators and their staffs, particularly leading up to and during legislative sessions. Now TAFP has been called upon for similar briefings and interviews by a rapidly growing body of national writers from media outlets as diverse as CBS News, NBC News, NPR, the Wall Street Journal, the Los Angeles Times, the Washington Post, the New York Times, the Boston Globe, Kaiser Family Foundation and Politico, the Hill, and others.more
An excerpt from the inaugural speech of TAFP’s new president
By I. L. Balkcom IV, M.D.
TAFP President, 2011-2012
In 1987, as I was graduating from the Columbus medical center’s residency program, I thought I was hot potatoes. We were good. The 12 of us just thought that we were it. I felt like I could do a Caesarean section with a teaspoon. There was no body cavity I couldn’t align. We felt like we could just do it all.
So, armed with that knowledge, I set off in the world. I happened to be going to a meeting at the Capitol one day, and as I checked in at my hotel, I was puffed up pretty good. I signed in: “Dr. I. L. Balkcom, IV, M.D.”more
By Greg Sheff, M.D.
I am fortunate to be a part of a multi-year patient-centered medical home and shared savings pilot at Austin Regional Clinic. ARC is an approximately 300 physician multi-specialty group delivering care at 18 clinics and seven hospitals throughout the Austin area. Earlier this year, ARC joined a multi-year medical home pilot administered by Blue Cross and Blue Shield of Texas. The pilot was initiated in large part in response to Texas legislation requiring the Employees Retirement System, the self-funded insurer for state employees, to experiment with alternate payment and delivery models in an attempt to reduce the state’s ever-increasing health care costs. We are one of five physician groups in the state participating. Our program serves roughly 45,000 patients, including both the ERS (whose health care benefits are administered by BCBSTX) and BCBSTX fully-insured populations.
In addition to the traditional PCMH goal of comprehensive, coordinated, accessible, patient-centered care for all, ARC is also implementing processes to proactively identify high-risk patients and then deploy intensive, focused, physician-led care management interventions to these high-risk patients.more
By Janet Hurley, M.D.
Having been a patient not too long ago, I am convinced that doctors should be patients more often. As we continue to talk more in health care about “patient-centeredness” and the “patient experience,” I have a few thoughts on things I learned during my convalescence period after a tonsillectomy in 2009.
- My surgeon, my anesthesiologist, and the surgical center staff were GREAT. As providers, the things we do become routine to us, but to patients they are extraordinary. Taking the time to explain a procedure carefully and thoughtfully can make a big difference.
- Follow directions. Patient handouts have important information in them and the treatment team knows what they’re doing. I must remember to listen to their advice and review the patient materials when I have questions.
- Don’t be your own doctor! If you have questions about medications or symptoms, ASK SOMEONE ELSE. You may choose to be a highly educated patient, but not your own doctor.
- I am not too tough for pain medications. While I dislike the mental fogginess they create, I had to keep in mind steps I prescribe to my patients—maintain better hydration, better nutrition, and keep my throat moist—to make myself more comfortable.
- I will never even think about accessing my Electronic Medical Record from home until fully off narcotics. Impairment was obvious.
- When on narcotics, I communicate better with my fingers than my tongue. You can’t rush recovery, even when you know you have important work to do. E-mail communication with others kept me connected when my speech was slurred and my throat hurt.
- I have great clinic coverage partners. I had no worries about who would check my messages, approve refill requests, and see my patients when I was out. We must remember that good patient care during such times requires that we receive help from our colleagues.
- Don’t undervalue the significance of family and friends. I am grateful to my husband who took care of our kids and took care of me, and the friends and neighbors who looked for ways to help out during my recovery. It’s okay to lean on those closest to you in times of need!
Now that the 12 members of the Joint Select Committee on Deficit Reduction have begun meeting to develop a plan to trim at least $1.2 trillion in federal spending, advocacy groups and politicos have ramped up their effort to influence what goes on to and what stays off of the chopping block.
Since our last blog post, AAFP has taken significant steps to encourage the supercommittee to avoid making damaging cuts to Medicare and graduate medical education. AAFP met with representatives from seven medical societies and seven professional organizations on Sept. 7 to develop a unified strategy for the house of medicine, with AAFP still holding strong to the position that the SGR should be repealed or, barring that, the committee should enact a five-year Medicare payment fix that includes a 3-percent higher payment rate for primary care physicians.
During this week’s Congress of Delegates meeting, AAFP launched a grassroots campaign that calls for AAFP Delegates and other members to send a letter to their Congressional representatives asking for immediate repeal of the SGR. AAFP already sent its own letter to the “super 12” on Aug. 10 outlining its asks, and the 12 AAFP state chapters in which a supercommittee member lives requested meetings with their super person during the Congressional recess that extended through Labor Day. Texas is, of course, home to committee co-chair U.S. Rep. Jeb Hensarling, and Doug Curran, M.D., TAFP past president, current TMA board member, and constituent from Athens, has a meeting scheduled with the representative in the next couple of weeks.more
Last month’s debate on the U.S. debt ceiling brought to light the ugly side of how we finance the nation’s operations, and as lawmakers move forward on a deal to reduce the deficit, they will inevitably turn their eyes to one of the country’s biggest expenses: Medicare. Federal spending for fiscal year 2010 totaled $3.5 trillion and Medicare comprised 15 percent of the total amount.
However, with crisis comes opportunity and a convergence of factors may make this the time to address a structural deficit in how the country pays physicians and other providers for the services they provide to Medicare beneficiaries.
Under the debt deal, a 12-member joint committee has until Thanksgiving to formulate a plan to cut at least $1.2 trillion in spending over the next 10 years. Then, recommendations made by the so-called “supercommittee” must go before Congress and pass by a simple majority in both chambers by Christmas. If the committee can’t agree on cuts or Congress fails to pass them, a series of across-the-board reductions would be triggered. One cuts pay to Medicare providers by up to 2 percent starting in 2013, which experts estimate would add up to around $12 billion.more
As a die-hard fan of the Texas Longhorns, I have no shame in telling you that after last year’s 5-7 record, I was glad the college football season was over. Even though I’m a self-admitted policy wonk and political news junkie, I was equally relieved—even somewhat jubilant—when the 82nd Texas Legislature finally closed up shop and went home. If you followed the frustrating struggle to balance the state budget without additional revenue, and witnessed the resulting cuts to higher education, public education, and health and human services, you might have been just as ready for it to end as I was. At least when they’re not in session, they can’t do any more damage, right?
Now is not the time to bury our heads in the sand. In fact, the legislative interim is perhaps our best opportunity to formulate and articulate our most effective arguments for renewed investment in Texas’ primary care infrastructure. We can document the ill effects of the drastic reduction in state support for graduate medical education, especially in family medicine residency training, and we can illustrate the broken promise of access to primary care physicians for underserved communities made manifest by the 76-percent cut to the state’s Physician Education Loan Repayment Program.
And now is the time to begin preparations for a major initiative in the next legislative session. In the late ’80s, rural medicine in Texas was in terrible need of state investment. Health care organizations and advocates rallied around a broad set of goals encompassed in what was called the Omnibus Rural Healthcare Rescue Act, which the Legislature passed in 1989. The law created the Center for Rural Health Initiatives and the Office of Rural Health Care, and it contained tort reforms, benefits for rural hospitals, several reforms to strengthen the state’s trauma care infrastructure, and new recruitment and training programs for primary care physicians. Family medicine won funding for third-year clerkships, among other valuable reforms.more
This Annual Session ushered in a new era of communication, and we asked members to interact with us, their fellow attendees, and their colleagues from around the state and country. Now that the dust has settled on a busy conference filled with CME, business meetings, and special events, we want to encourage you to continue the commentary.
So … what did you think? How were our posts/pictures/tweets? What can we do to improve our communication and interaction with you? And, in a very simple sense, what did you like or not like about our effort (so we can be better next time)?
As a recap, the total effort centered around the Annual Session Social Media Portal – http://tafp11.txfamilydocs.org/ – a page within our TXFamilyDocs.org blog. We had an ASSA Flickr stream updated nightly, as well as a daily news wrap. Staff tweeted more frequently than posting on Facebook, but that goes along with the urgency of the platforms.more
Maybe I’m biased, but Saturday is my favorite day of Annual Session! The morning started on the business side with the meeting of the TAFP Board of Directors and on the education side with the CME breakfast kicking off another full day of lectures.
The Business and Awards Lunch is where the Academy hands out top honors to outstanding family physicians and family medicine supporters. Dr. Tom Mueller of Columbus received the 2011 Family Physician of the Year Award. Glowing words from patients aside, his reflections on the important role of family physicians in caring for the community were amplified by his family’s commitment to the profession – at least five Muellers are also decorated family physicians.
During the second part of the lunch, we inducted our 2011-2012 officers. Incoming President Dr. Balkcom talked about the need to stand up for family medicine and its central role in health care.more
Friday kicked off with the grand opening of the Exhibit Hall. More than 60 exhibitors from all facets of the health care industry staffed booths, ready to reach out to the family physicians of Texas. From Texas Medical Liability Trust to e-MDs to PedsPal, each vendor had a unique appeal to medical practice.
The big opening event coincided with the breakfast, featuring the TAFP Foundation board members greeted attendees and spoke about the group’s important philanthropic work. The Foundation is also offering 15-minute chair massages in the Hall; attendees have one more day to take advantage this perk, with proceeds benefiting the Foundation.
Also in the hall were the research poster displays, which brought medical students, family medicine residents, and family physicians from across the state to show off their latest findings. The grand winner was resident Richel Avery, M.D., of UTHSCSA, “Residents’ Knowledge, Attitudes and Behaviors in Colon Cancer Prevention: Findings from a Residency Training Project.”more
All hands were on deck for this busy Thursday. A note on how it all fits together, “Annual Session” refers to the business portion while the “Scientific Assembly” refers to the continuing medical education portion.
Both were in full swing today with Day 2 of the NPI workshop, the start of general session CME, and TAFP members meeting throughout the day in a dozen different policy-making groups.
One CME seminar to highlight is “Financial Realities for the Physician Manager,” with top Academy business minds Dr. Robert Youens of Weimar, Dr. Doug Curran of Athens, and Dr. Stephen Benold of Georgetown. Both Dr. Youens and Dr. Curran run very successful family medicine practices in rural areas, and Dr. Benold spends part of his time as a financial advisor. The idea for this seminar actually began with our August 2010 Strategic Planning meeting: TAFP members wanted more training as an increasing number of physicians are taking a larger role in the business side of medicine. Whether running a solo practice or joining a large hospital group, this seminar taught attendees the basics of business—addressing the difference between benchmarking and profit, the bottleneck concept, and the importance of efficiency.more
Day 1 is done! The last of the TAFP staff arrived at the host hotel, the Sheraton Dallas, joining in the effort to prepare for the week’s activities. The hotel is huge with three different towers of rooms and meeting space. Attendees will mostly use the center tower and the second floor for our meetings, special events, and education. (Please feel free to come by the TAFP registration desk to ask a question or just to say hi. We’re on the second floor by the skybridge.)
Today was the first of two days of the NPI workshop. We also held the SAM Workshop on Health Behavior that helps attendees meet one requirement of the American Board of Family Medicine Maintenance of Certification. The sold-out SAM was a great success; everyone passed the Knowledge Assessment portion of the SAM and now only has to complete an additional test to receive full credit. Dr. Clare Hawkins, the SAM moderator, did a great job as usual.
Tomorrow (Thursday) will be one of the busiest days of Annual Session with the second day of the NPI workshop, lots of Annual Session business meetings, and the start of the general session CME with afternoon concurrent seminars. Thanks for joining us on our virtual site, and don’t forget to check in and comment! Goodnight!more
TAFP is embarking on a new experience for the 2011 Annual Session and Scientific Assembly, July 27-31, in Dallas. We have developed the Annual Session Social Media Portal, a new blog page on TXFamilyDocs.org that presents an opportunity for all TAFP members to participate, provide input, and interact with our fully-integrated social media program during the entire gathering.
This page, http://tafp11.txfamilydocs.org/, will be your hub for a live-streamed lecture; TAFP’s social media feeds; and discussion topics before, during, and after Annual Session. We encourage all to participate, especially if you can’t physically attend Annual Session in Dallas.
On this page we’ll post the latest news, gather attendee feedback, and stream a lecture from the 2011 Annual Session, TMLT’s “Know Before You Sign! What to Look for in a Physician Employment Contract, Including Employment by Non-Profit Health Corporations” with Douglas Kennedy, J.D.more
Physician workforce – particularly in family medicine and primary care – has dominated TAFP’s focus during the past six months of the 82nd Texas Legislature and special session. Workforce issues emerge in all policy areas: health and human services, education, and their respective budgets – through medical school funding, graduate medical education, the Texas Statewide Preceptorship Program, and Texas Physician Education Loan Repayment program.
On June 11th, 2011, after the regular session ended and in the middle of the special session, I was very fortunate to be in the audience at the Stanford Medical School Commencement to see my sister receive her M.D./Ph.D., and to hear one of her classmates, David Austin Craig, M.D., give a thoughtful and humorous speech reflecting on his experience in med school and looking forward to the future.
Seeing the class of nearly 100 brand-new doctors “preparing to go from the frying pan of medical school to the Armageddon of residency,” as Craig said, reminded me why TAFP members spent so much time at the Capitol and in district offices meeting with legislators, testifying at hearings, developing and distributing issue briefs and policy papers, and reporting back to friends and colleagues in their communities. It’s all to support and protect the noble profession of medicine.more
By W. Mike McCrady, M.D., and Anne McCrady
While politicians debate health care reform in Washington, here in Texas change is already affecting the practice of family medicine. In hospital board rooms and medical staff meetings, local doctors are hearing about the transformation of primary care, payments based on quality and value, and the expectation of providers to capture a larger and larger market share. There is a confounding list of issues behind these pressures: some legislative, some economic, and others technological. In response, around the state, not just doctors, but administrators, legislators, and consultants are weighing in on the critical role of primary care to manage cost, ensure continuity, and meet patients’ needs.
With so much at stake, Texas family physicians face a daunting future. How should we respond to these changes? As with so many things, the answer seems to be to work together. For a rapidly growing proportion of us, that means joining forces with other providers, often as part of a hospital system. A report from the Texas Department of State Health Services shows a drop in the percentage of physicians who identified themselves as being in partnerships from 50 percent to 30.2 percent in the past 10 years. This decreasing number of small medical groups is also documented in national statistics. In fact, a recent New England Journal of Medicine article predicts that by 2012, 40 percent of active primary care physicians will be employed by hospital systems.more
By Melissa Gerdes, M.D.
TAFP President, 2010-2011
Adequate payment for primary care health services has long been an issue for family medicine. The absence of adequate payment has affected our specialty in numerous ways, including forcing physicians to see too many patients too fast, causing student interest in family medicine to decline, and leading practicing physicians into non-clinical careers. This migration of physicians away from family medicine has a negative effect on the public and our patients. According to the Commonwealth Fund, countries that have a lower proportion of primary care physicians to patients have populations with higher morbidities and poorer health outcomes.
Our current payment system is volume-driven, where physicians are paid more for doing things to patients than for doing things for patients. Research shows that doing more things to a patient does not automatically result in improved health outcomes. In fact, such practice very often results in worsened health outcomes. How do we migrate away from the volume basis?more
Last Friday, the medical community was shocked and saddened by the sudden death of pediatrician and primary care advocate Barbara Starfield, M.D., M.P.H. During her decades spent at Johns Hopkins, she authored and co-authored numerous studies on the value of primary care that provided proof that many of us believed in our hearts but couldn’t quantify—that patients are healthier and costs are lower in a system based on primary care.
However, her work provided more than just facts; it provided the footing for a movement to redesign the fragmented system to one that is better for patients. She inspired us to really take a look at family medicine’s contribution and advocate for its importance. The process has been slow, but her momentum kept it going.
Because of her tremendous contributions to health care research and patient care, several organizations have released poignant and appropriate statements in tribute that must be shared. The first is the full statement from Roland Goertz, M.D., M.B.A., president of AAFP, and the second is an excerpt from Richard Roberts, M.D., J.D., president of the World Organization of Family Doctors.more
An important piece of legislation designed to improve quality and lower costs in our fractured and inefficient health care system has received a second chance in the Special Session after dying in the House when time ran out on the 82nd Texas Legislature. However, because of other actions taken by our legislators that defund primary care residency training and other programs to bolster the physician workforce now and in the future, Senate Bill 8’s laudable goals are left without the means to achieve them.
The overarching goal of S.B. 8 is to reverse the negative trend in our health care system, to bend the cost curve by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes. It achieves this through two key mechanisms: the creation of health care collaboratives and the creation of the Texas Institute of Health Care Quality and Efficiency.
As envisioned in the bill, health care collaboratives clinically integrate physicians, hospitals, diagnostic labs, imaging centers, and other health care providers, aligning financial incentives to keep patients healthy and out of the hospital and emergency room. They are designed to move the delivery system away from a fee-for-service based system—where physicians and hospitals are paid for quantity of services over quality—to one in which doctors, hospitals, and other providers are accountable for the overall care of the patient and the total cost of the care provided.more
Okay, if you haven’t started getting serious about educating yourself about the Recovery Audit Contractor program, it’s about time you should.
RACs are third parties hired by the Centers for Medicare and Medicaid Services to ensure that physicians are being paid correctly for Medicare Part A and B services. They identify all “improper payments,” whether the physician received too much or too little, and in return receive a share of the booty—I mean, spoils—I mean, identified payments. [Don’t mind me, it’s Friday.]
CMS released an update in late April that showed that in its first 18 months, the permanent RAC program had identified a total of $365.8 million in total improper payments—$312.2 million in overpayments and $52.6 million in underpayments. The agency attributed the four big reasons for improper payments to incorrect coding and billing for bundled services.more
As time winds down on the 82nd Texas Legislature, lawmakers are working extra-long hours trying to push their bills through the legislative process before a series of deadlines—intended to stretch out a few extremely stressful days to a few fairly stressful weeks—prevents the bills from becoming law. When a bill doesn’t make it to its next stage, it is considered dead, and the past two days marked two very important deadlines in the House. If your bill didn’t make it to second reading on Thursday, May 12, or to second and third reading on Friday, May 13, your bill has been killed and there is very little you can do about it.
Backing up a bit, the whole process seems designed to kill more bills than pass them. Depending on your generation, you either learned the step-by-step legislative process from your high school government class or the School House Rocks tune “I’m Just a Bill.” Away from the textbooks and animation, the real-life convolution of political forces, interest groups, and desire for re-election (of both the candidates and their supporters) means that things often run a bit differently in the Texas Legislature, and understanding how it actually works takes years of observation under the Capitol dome or a little insider’s knowledge.
Here’s the process how it stands on paper:more
By Melissa Gerdes, M.D.
TAFP President, 2010-2011
I devote this column to our Academy members and friends. The Texas Academy of Family Physicians is, after all, only as good as our membership.
As you will recall, TAFP held a strategic planning retreat in August 2010. We began with the anticipation that we would design a three-year plan, but it soon became a one-year plan. The group identified so many items needing urgent attention that the timeframe necessarily shortened. A physician champion paired with a TAFP staff person to design and implement each action item. Now, seven months later at Interim Session, we are well on our way to accomplishing our goals. The entire strategic plan can be viewed on www.tafp.org.more
By Roland Goertz, M.D., M.B.A.
AAFP President, 2010-2011
Passage of the Patient Protection and Affordable Care Act—commonly known as the Affordable Care Act, or simply PPACA—was an important step toward establishing primary care as the foundation of America’s health care system. The law will have a far-reaching impact on family medicine as the nation begins to rebalance our health care system with more appropriate emphasis on primary care. Once fully implemented, it will focus more on health care and place a greater emphasis on prevention, primary care, and improved health outcomes instead of a predominately sickness care model which has focused on paying for procedures and volume.
The final vote and the signing of the PPACA was a first step. Now the task is implementation. And this is where the real work—and the real debate—begin Since its passage, the AAFP has focused on filling in the holes in the Affordable Care Act, preserving its primary care-friendly provisions, and ensuring support for primary care education that will help increase the number of future family physicians.more
Several miles into a long run last week, I started to feel a pang of pain with which I had grown familiar. I knew I would need to stop to “shake it out,” then slow my pace substantially until I could regain my stride and run through it. Because I’d had the same pang around the same mile for the past two weeks, I started thinking that I should talk to my family doctor about it. My first thought wasn’t to call her office – it was early on a Saturday morning, after all – it was to tweet it.
In addition to my personal Twitter account, I am one of the administrators for TAFP’s account and I know several of our family physician members who follow our feed. My tweet (from my personal account) would have gone like this: “Need advice: Sharp pain in the outside of my left knee near my kneecap around mile 7. Is this serious? Should I wear a brace?” With the remaining 15 characters, I would have tagged a few physician friends, none of whom is my personal family doctor.
As I kept plodding through the miles, I decided it would be unprofessional for me to use TAFP members — even those I consider to be friends — to give me a free diagnosis. However, I wondered if it would even be possible or ethical for a physician to give a diagnosis in 140 characters.more
By Monica Kortsha
As a pre-medical student and journalism/biology double major at UT, I was extremely excited when I saw TAFP’s internship posting. I thought it would be a great opportunity to learn more about what issues concern family physicians—a career I’m interested in—while applying and improving my journalistic skills. During my time at TAFP I’ve learned a lot about the issues family physicians face and that there is plenty a physician must care about outside of the exam room.
Last week I wrote a short article summarizing the results of the 2011 Main Residency Match and how family medicine fared. I was glad to see that family medicine is on the increase, but seeing that only about half the residency spots were filled by U.S. graduates while other specialties were almost exclusively filled with these students put into perspective that family medicine isn’t an alluring future for many U.S. medical students.more
Should medical schools that receive state support for residency training be expected to produce the kinds of physicians Texas needs to ensure a cost-effective, high-quality, well-coordinated, more equitable health care delivery system? That’s the policy question posed by a Texas Tribune news article from March 10, 2011, “Budget Rider Would Emphasize Primary Care.”
The budget rider in question would concentrate state support for graduate medical education by paying for only the first three years of residency training, rather than supporting training in years four through seven, some part of which are required for subspecialties. The idea is controversial, and of course opposed by many academic health centers and by the Texas Medical Association, but it’s exactly the kind of reform to medical education that’s gathering momentum across the country.
The recently published 20th report of the Council on Graduate Medical Education proposes that a major culprit behind the declining interest in primary care among medical students is the “hidden curriculum” found in academic health centers that favors specialty care provided in the hospital setting over primary care. How did this “hidden curriculum” come to be? Because GME programs at large teaching hospitals have evolved to meet the needs of the academic health center rather than the general population.more
In testimony before the House Public Health Committee on March 2, Dallas physician John Carlo, M.D., put forth his support for a statewide smoking ban that would prohibit smoking in public places and workplaces. Advocates tried to pass similar legislation last session and failed, for various reasons. Now as it comes up again as House Bill 670 by Rep. Myra Crownover, R-Lake Dallas, and Senate Bill 355 by Sen. Rodney Ellis, D-Houston, public health groups are gearing up for another push.
Dr. Carlo said that physicians and the public at large have known conclusively since 1986 that secondhand smoke is dangerous to children and adults, and that there is no risk-free level of exposure to secondhand smoke. As medical professionals, you understand the biological explanation why secondhand smoke exposure causes damage to blood vessels and the heart. Study after epidemiological study demonstrates an increase in cardiac disease and mortality with increasing exposure to secondhand smoke.
While 33 Texas municipalities have passed some type of smoking ban in public places, including the largest cities in the state, many rural communities haven’t. Some say a smoking ban is an infringement on an individual’s right to smoke; others say it will hurt local businesses like bars and restaurants (which, by the way, isn’t true according to a January 2011 survey by Baselice and Associates, Inc.).more
By Greg Sheff, M.D.
I was fortunate to be one in a group of primary care physicians who met with Lt. Gov. David Dewhurst this February to discuss possibilities of payment reform in Medicaid, the Children’s Health Insurance Program, and the private insurance market. This meeting comes on the heels of the introduction of two major pieces of legislation, Senate bills 7 and 8. These bills would implement a host of pilot projects to test bundled payments, payments based on episodes of care, and quality incentives. It continues the positive momentum the state needs to move us away from a fractured health care system into one that provides the right care for Texans.
The unrelenting march of increasing health care costs is unsustainable, both for Texas and for the nation. Payment reform that aligns physician and hospital incentives with our society’s goals—affordable, coordinated, evidence-based, quality-measured care—is critical to rein in health care costs. The patient-centered medical home, driven by a strong primary care workforce, is a proven cost-effective method for delivering this coordinated and integrated care.more
While I’m at home trying desperately to figure out how to set adequate parental protections on out Internet browsers and restrict my kids’ access to any and all Showtime original series on streaming Netflix, researchers at Baylor College of Medicine are posing some challenging ethical questions physicians are ever more likely to face. What if you tested a patient’s genes and found that he or she was likely the child of an incestuous relationship? What would your ethical responsibility be?
The BCM researchers write in the Feb. 12 issue of The Lancet that they have witnessed several of these cases while performing genomic tests on children. The topic is broad, with various implications regarding the age of the parents at the time of conception, their relational status, the possibility of criminal behavior or abuse, not to mention the emotional stigma and distress involved for the patient.
With all the promise genetic testing holds for understanding, identifying, and treating various conditions and disease states, the ethical ramifications are staggering, and this is just one particularly interesting and puzzling question to explore. Check out the article: http://tinyurl.com/47k7unt. We’d be interested to know your thoughts, so use the comment feature. What are your thoughts on the ethics of finding evidence of incestuous parentage through genetic testing, or just the ethics of genetic testing in general?more
The Senate Finance Committee has held hearings for the past two weeks on every section of the budget, and because so many primary care programs suffered cuts (as did most other programs), many interesting exchanges have come to light. In all the discussions, though, both lawmakers and those testifying agree that primary care is of the utmost importance to ensuring Texans’ access to care.
Because residency programs play such a large role in producing the primary care physician workforce, here enters Paul Klotman, M.D., president and CEO of Baylor College of Medicine. He testified during the Feb. 8 hearing of the Senate Finance Committee, and Sen. Bob Deuell of Greenville questioned him on the closing of the Baylor College of Medicine Kelsey-Seybold Family Medicine Residency Program. Here’s their exchange.
Sen. Deuell: A family medicine program closed. What’s your take on that?more
By Melissa Gerdes, M.D.
TAFP President, 2010-2011
Our Academy’s vision statement begins: “The Texas Academy of Family Physicians is dedicated to the promotion of a health care environment that values the vital role of family physicians.” I spoke of the importance of recognizing and promoting the value of Texas family physicians in my installation speech. It will take all of us doing what family physicians do every day: taking care of ALL Texans, knowing them, and tailoring care to individuals and communities.
How do we create value? How do family physicians feel valued? If we equate value to payment, I am afraid we will always be disappointed. Perhaps if our current triangular third-party payer system evolves, payment may provide a sense of being valued. For now, I would suggest we focus on the true ways in which family physicians are already valued. In my short four months as president, I have seen ample evidence that family physicians do play a vital role in our health care system and that people value us.more
By John K. Frederick, M.D.
I’ve been at this right at 20 years now. Some things are the still the same and will never change: the importance of a smile, a touch, a listening ear to a worried or discouraged patient, or wise counsel to a parent facing the health crisis of a child. That’s the clinical stuff, and it’s still “all good.” On the business side of my medical practice, things aren’t still the same. For all sorts of reasons the business has steadily gotten worse—lower payments, longer hours, and ever more forms to complete. Yet the same national politics which have caused an erosion of private practice over the years seems now to have turned, and may now offer us a golden opportunity. The crafters of the new federal health care law put us right back in the middle of things, requiring new vertically integrated health care ACOs to be built on a foundation of primary care! As a result this is the best, most timely opportunity for family medicine doctors since the advent of our specialty! What we do in the next 24 months may well either cement our validity with the public and general medical community, or relegate us to lapdog status.
Until now we have been putting out fires, providing episodic care driven by patient demand. There are a number of lesser-trained medical folks quite capable of working at this level. Our response has been to increase visit volume, and perhaps become more accurate in our coding. But in the near future our broader skill set, our breadth of training, and our ability to see the big picture will set us apart. Chronic medical care drives most of the health care costs in our country, and we are in a perfect position to put a significant dent in those costs with the help from one of the good EHRs now on the market. The really good news is that voluminous data now exists that health systems designed and led by primary care provides for lower costs and improved patient outcomes. And the politicians now know it.more
By Melissa Ayala
Launching into a new decade, TAFP experienced a year full of advancements in every category, from technology to politics. 2010 was marked with hard-hitting and award-winning advocacy and communications work, high-quality CME programs, and an ever-expanding network of member resources.
When Tom Suehs, executive commissioner of Texas Health and Human Services, addressed the Senate Finance Committee in a hearing on Feb. 1, he told the 15 senators in no uncertain language that going through with cuts to primary care proposed in the Senate’s draft budget will damage access to care.
Suehs (pronounced “seas”) is pushing for exceptional items that would reduce the cut in payment for primary care physicians treating kids enrolled in Medicaid and CHIP from 10 percent to 2 percent. This would cost the state around $125 million in general revenue next biennium, according to a Feb. 1 article in Quorum Report.
“I’m really concerned about having to cut primary care rates for physicians treating children,” Suehs told the committee. “We’ve already cut 2 percent this biennium from when y’all wrote the [2010-2011] budget. I believe that’s about as far as I can tolerate to maintain the access to primary care so I’m asking to put back not all 10 percent, but 8 percent. Exceptional item 1A is for Medicaid children, exceptional item 1B is for CHIP.”more
In a recent opinion column published in Kaiser Health news, two prominent voices in health care policy gave primary care physicians a piece of revolutionary advice: Quit the RUC.
If you don’t know what the RUC is, you aren’t alone.
RUC stands for the Relative Value Scale Update Committee, a group of 29 physicians from various medical specialties that meets three times a year to advise the Centers for Medicare and Medicaid Services on Medicare physician fee reimbursement and how certain procedures should be valued. Created by the American Medical Association in 1991, the committee has no official government standing, yet it yields great power.more
“Real Life Practice Transformation,” a blog by TAFP President Melissa Gerdes, M.D., for AAFP’s Family Practice Management journal, gives physicians advice on implementing aspects of the medical home. Gerdes’ practice emerged as a star of the initial TransforMED National Demonstration Project, making her the perfect physician to share her experiences—good and bad—with the larger AAFP community.
The TransforMED model builds on the physician-patient relationship already cultivated in primary care, while adding new technology and approaches to help practices better serve the needs of patients and practices. The basics of the model focus on increasing patients’ access to care and information, becoming more efficient in practice management, enhancing practice-based services, expanding the use of health information technology, providing better care management, improving quality and safety, coordinating care in a more effective way, and supporting practice-based team care.
If it sounds like a lot, it is, and the NDP proved that practices need support from the entire staff and their patients to start implementing some of the recommendations. Reading Gerdes’ posts is a good first step to evaluating what the TransforMED recommendations can do for your practice.more
Part of the mission of the TXFamilyDocs blog is to highlight the work of our members. I’d like to direct you to an insightful blog by TAFP member Richard Young, M.D., titled, “American Health Scare: How you are scared into buying health care you, your employer, and your country can’t afford.” On the blog and website, Young gives a family physician’s non-partisan perspective on the health care reform law and other big issues facing the specialty, challenging readers to consider the “appropriate role” of health care in our society and asserting that “the primary solution to expensive health care is that the relationship between doctors and patients must change.”
Check it out at www.healthscareonline.com.
Texas lawmakers got their first chance to comment on the first draft of the House budget for 2012-2013 today, when Appropriations Chair Jim Pitts took questions on the floor. The draft budget is $31.1 billion slimmer than the state’s current budget, coming in at $156.5 billion in all funds. That means general revenue plus federal matching funds.
The capitol press corps was in fine form, tweeting and texting a constant stream of budget-related news, and filing stories at a fevered pace. Check out the Texas Tribune’s coverage for a healthy dose.
Several lawmakers were upset over the proposed closure of four community colleges, and massive cuts to public education got a lot of play as well. Lost amid the critiques and complaints was the proposed fate of a set of programs designed to strengthen primary care.more
The biggest and toughest challenge legislators will face in the 82nd Texas Legislature will be balancing the budget. Comptroller Susan Combs announced that general revenue for the 2012-2013 biennium will likely be $72.2 billion, $14.8 billion less than the general revenue budget for the current biennium, and the shortfall in the current biennium would be $4.3 billion. She did not quantify the size shortfall expected in the next biennium, but the state would be about $27 billion short if lawmakers decided to continue current service levels in all programs.
Understanding the budget means looking at the two largest spending areas, articles II and III, otherwise known as education and health and human services, respectively. In his acceptance speech as president pro tempore of the Texas Senate, Sen. Steve Ogden, R-Bryan, told those in attendance to that it is “impossible to balance the budget” without making cuts to Medicaid and education.
At more than 1,000 words, the excerpt of the speech is lengthy, but it’s a must-read if you want to understand the next 140 days of the session.more
As envisioned in the health reform law, the latest evolution of health delivery system reform involves consolidating the fragmented system of health care providers into efficient groups that take responsibility for a population of patients. Called accountable care organizations, this model boils down to three concepts: providing coordinated care by using all members of the health care team, measuring performance against evidence-based benchmarks, and reforming a payment system that currently rewards quantity over quality and reactive medicine over preventive medicine. The hope is that coordination, performance measurement, and payment reform will allow physicians to improve the quality of care for patients and reduce the cost.
Coordinating care to reduce cost isn’t a new concept. Some liken it to health maintenance organizations of the ’80s and ’90s, others to the patient-centered medical home. There is plenty of literature on both, and we won’t delve into them here.
If you’re looking for guidance on ACOs, one of the most useful sources is the five-year CMS pilot project that began in April 2005 and concluded in March 2010. (When lawmakers were crafting the health reform law, they had access to years 1 and 2. Now we also have 3 and 4, and are waiting for 5.)more
Welcome to the next experiment in TAFP member interaction, the Texas Family Docs blog. In a post-health-reform era of rapid changes to the practice of medicine, your Academy hopes to use this space to delve into the topics most important to the family physicians of Texas.
This means explaining measures of health reform as they are implemented and tweaked, but also providing an insider’s look into Texas health policy, sharing practice management tips for all settings, highlighting tools and resources to improve your practice experience, sharing media links from the most influential medical journals, and more.
This is where you come in. The entire project began because you asked us to bridge these tough topics in a highly active forum. We want this to be a space where members contribute to the discussion. Comment on our posts or ask us how to submit your own. Share the most pressing issues facing your practice, a story from your medical training, or a “best practice” pearl that has helped you along the way. The possibilities are endless.more