Archives / 2015
  • Represent Texas at AAFP’s NCCL and ACLF conferences

    Tags: delegate, aafp, aclf, nccl, leadership, scholarship, ncsc, alf, special constituents

    Funded delegate spots and scholarships available for NCCL and ACLF

    Each year, AAFP holds the National Conference of Constituency Leaders and Annual Chapter Leader Forum together in Kansas City, Missouri. NCCL representatives and ACLF attendees from across the nation gather to discuss various issues, suggest policies and programs to AAFP, and receive leadership training. This year’s conferences will be held May 5-7 and TAFP is looking for members to serve on the delegation or apply for scholarships to attend.

    TAFP opportunities for NCCL

  • Notes for Annual Session & Primary Care Summit attendees

    Tags: annual session, annual session and primary care summit, primary care summit, business meetings, cme, self assessment module

    posted 11.10.15

    Thank you for registering for TAFP’s 2015 Annual Session & Primary Care Summit. We look forward to seeing you later this week at The Woodlands Waterway Marriott. Below is some information about the conference. If you have any questions or concerns, please call (512) 329-8666 or email

    TAFP Registration Desk Location and Hours
    Wednesday, Nov. 11 | 12 - 6 p.m. | Waterway Ballroom Foyer
    Thursday, Nov. 12 | 7 a.m. - 2:30 p.m. | Waterway Ballroom Foyer | 3:30 p.m. - 7 p.m. | Town Center Foyer
    Friday, Nov. 13 | 6:30 a.m. - 6 p.m. | Town Center Foyer
    Saturday, Nov. 14 | 6:30 a.m. - 6 p.m. | Town Center Foyer
    Sunday, Nov. 15 | 6:30 a.m. - 12:30 p.m. | Town Center Foyer

  • Why I precept medical students

    Tags: billings, perspective, preceptorship, medical student, rural medicine, rural, rural physician

    By Adrian N. Billings, MD, PhD, FAAFP

    Why do I precept medical students? Luckily, I ask myself this question less and less frequently because I enjoy having these junior colleagues with me, especially at 2 a.m. while delivering babies. However, I recently explored this question with some reflection on my past seven years of precepting around 100 medical students and 20 resident physicians in my practice. 

    Unequivocally, the answer to the preceding question is that I precept medical students because my patients receive better care if I have a medical student working with me. It does not matter how fresh a medical student is into clinical training, two sets of eyes and two sets of brains examining and thinking about a patient’s problem are better than my own brain by itself. I have had preclinical students consider and make diagnoses that I have not been able to. Even if the students don’t make the correct diagnosis and they hear zebra hoofbeats instead of horse hoofbeats, this mental task causes me to consider a broader and more thorough differential diagnosis with their valuable input. I consider it an honor and privilege to be entrusted by medical schools with these young student physicians.

  • Time to step up to the plate

    Tags: ragle, president's letter

    By Dale Ragle, MD
    TAFP President, 2014-2015

    This will be my final letter to you as TAFP president. It has been an honor and privilege to serve you and our outstanding organization.

    This is an exciting and challenging time for family medicine. Health care reform and the sustainable growth rate repeal are expanding the rolls of the insured and will transition us from a volume-based payment system to a quality-based system over the next several years. Some analysts are concerned that increasing the number of insured may strain our health care system in the absence of increasing the physician workforce. While increasing the insurance rolls will generally increase access to care in the younger population, the resultant strain on our health care system could make it more difficult for certain vulnerable populations, such as elderly patients already on Medicare, to access the health system. This effect could be magnified in our state, which has about a 20 percent uninsured rate, unfortunately the highest in the nation.

  • Doctors report insurers are auditing billing procedures for services provided by NPs, PAs

    Tags: insurance, nurse practitioner, physician assistant, billing, coding, compliance, reiner

    Physicians should examine insurer contracts, provider policy and procedure manuals to ensure compliance

    If you employ nurse practitioners or physician assistants, you should make sure you’re complying with each payer’s protocols when billing for services provided by nonphysicians. TAFP has recently heard from members who thought they were billing properly but have found themselves under investigation by payers. If these practices are found to be out of compliance, they may owe payers substantial refunds.

    Many payers pay reduced fees for services provided by NPs and PAs but the rules and billing procedures doctors should follow when filing claims differ from payer to payer. For instance, Blue Cross Blue Shield of Texas pays 15 percent less for services provided by NPs or PAs than they would for services provided by the supervising physician. The insurer requires that practices include a “Modifier SA” when filing claims to indicate that a service was performed by an NP or a PA.

  • TWHC wins funding for preventive health care in the 84th Texas Legislature

    Tags: texas women's healthcare coalition, preventive care, women's health, texas family planning, texas women's health program, expanded primary health care program, nelson, davis, howard, realini, 84th, legislature

    By Anna Chatillon
    Director of Policy and Advocacy for the Texas Women’s Healthcare Coalition

    In the midst of the chaos and inevitable drama of the 84th Texas Legislature, we risk overlooking one piece of news with the potential to change thousands of lives for the better. Funding for women’s preventive health care services, such as annual check-ups and contraceptive care, was increased by nearly $50 million in the state budget for the coming biennium.

    In 2011, draconian budget cuts to Texas’ Family Planning program devastated the women’s health care safety net. When the Texas Women’s Healthcare Coalition, a collaboration of 60 member organizations led by TAFP and others, was formed in 2012, its aim was to restore that funding. The Coalition’s successful advocacy restored the funding in 2013 through the Texas Women’s Health Program and the Expanded Primary Health Care program, in addition to the Family Planning program.

  • Public health efforts pay off with legislative wins in the 84th Texas Legislature

    Tags: texas public health coalition, 84th, legislature, tobacco, e-cigarettes, vaccination, immunization, cancer, hinojosa, ebola, sheffield, abbott, department of state health services, texas emergency medical task force, craddick, health and human services commission

    By Joey Berlin
    Texas Medicine

    The Texas Public Health Coalition and diligent physicians earned significant victories during the 84th Texas Legislature in their drive to reduce tobacco and electronic cigarette use.

    Lawmakers also provided the Texas Department of State Health Services with a likely bump in chronic disease prevention funding, and an effort to keep children’s immunization records in the state registry through their early adult years made its way into law.

  • First do no harm? A reflection on pain and intervention at the end of life

    Tags: perspective, mandola, end-of-life

    By Vincent J. Mandola, MD

    March 25, 2015 was a day I will never forget. It was the day I watched my mother take her last breath. She was 56 years old and had battled cancer for two years. It was a surreal time stepping into the unknown for my close family, but it’s not the moment of her passing I want to write about here. It is the days leading up to that moment, as this experience has given me a new outlook on end-of-life care.

    After surgery and nearly a year and a half of chemotherapy, mom was determined to have a couple of decent weeks before what she knew was inevitable. She had just been discharged from the hospital for uncontrolled pain and sent home under hospice care.

  • The brave new world of the SGR repeal

    Tags: ragle, president's letter, legislature, medicare, medicare access and CHIP reauthorization act, MACRA, sgr, affordable care act, direct primary care

    By Dale Ragle, MD
    TAFP President, 2014-2015

    On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015, which phases out Medicare’s flawed sustainable growth rate payment formula over the next 10 years. The so-called “doc fix” enjoyed bipartisan and bicameral support in Congress, a rare phenomenon these days, as well as support from most major medical organizations, including AAFP and the American Medical Association. In spite of broad support, the bill took more than a year of tweaking and survived innumerable negotiations between both political parties and the White House, a testament to the adage that “the devil is in the details.”

    The SGR formula tied Medicare expenditures to the gross domestic product. Since demand and utilization of health care services do not rise and fall directly with the ebbs and flows of the general economy, the SGR often threatened to cut physician fees year after year. Perennially, Congress passed special legislation to delay the fee cuts, often only finding they have to repeat the action in the following year.

  • Texas family physicians and family planning

    By Bhavik Kumar, MD, MPH

    In 2011, the Texas legislature cut its family planning budget by more than $70 million, resulting in a patchwork system of access to family planning services. Although much of this budget was restored in 2013, multiple barriers to care still exist. For example, abortion-affiliated family planning clinics that have commonly provided a significant amount of family planning and other preventive care are now specifically excluded from state funding programs like the Texas Women’s Health Program. Instead, much of the restored budget is being directed to primary care providers rather than specialized family planning providers.1 While Texas family physicians are well distributed throughout the state and provide care to a large volume of patients, it is likely a new role for many primary care providers who previously relied on family planning clinics that are now either cut off from state funds or have closed due to funding restrictions.

    The recent changes have also had an impact on Texans trying to access health care services. The restructuring has resulted in confusion and complexity for patients accessing family planning care. Notably, the decreased funding has limited coverage for preventive care, such as cervical cancer screening, as well as long-acting reversible contraception like the intrauterine device and contraceptive implant. Unfortunately, the changes have been most harmful for low-income women who rely on state-funded programs for much of their health care needs.2, 3

  • Court upholds subsidies in ACA

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid, supreme court

    Health care organizations and millions of people across the country can breathe a sigh of relief. The Supreme Court has upheld the subsidies established by the Affordable Care Act that help about 6.4 million Americans purchase health insurance on the federal exchange. Had the court struck down those subsidies, more than one million Texans might have lost their coverage.

    President Obama addressed the nation from the White House shortly after the ruling was announced, saying there could be no doubt that the ACA is working and that the law is here to stay.

    “Today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law,” the president said.

  • Report from TACHC, TAFP says Supreme Court ruling could worsen growing consequences to Texas’ refusal to expand Medicaid coverage

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid

    More than 1 million Texans might lose their health insurance if the Supreme Court rules against the Obama administration this month in King v. Burwell. Such a ruling would deny premium subsidies to Texans and residents of 35 other states that refused to establish state exchanges under the Affordable Care Act.

    Texas’ decision not to expand Medicaid coverage under the Affordable Care Act already leaves more than a million low-income, uninsured Texans without access to Medicaid or to federal subsidies to help them purchase insurance. A new report, “How will Texas’ Affordable Care Act Implementation Decisions Affect the Population? A Closer Look,” written by health care law and policy experts at George Washington University and commissioned by the Texas Association of Community Health Centers and TAFP examines the effects of that decision and the compounded damage to the state’s economy and health care infrastructure that would accompany a Supreme Court ruling in favor of the plaintiff.

    “The combined effects of not expanding Medicaid and the potential impact of King v. Burwell will hit Texas’ health care system hard,” according to the report. “County‐level estimates show that prior to implementation of the ACA, 38 counties experienced hospital annual uncompensated care levels of $50 million or greater, and four counties showed losses greater than $200 million. Texas’ failure to adopt the Medicaid expansion, coupled with the loss of premium subsidies as a result of a decision against the government in King would reverse the progress that has been made in reducing the number of uninsured Texans. Furthermore, hospitals could find that the demand for charity care actually rises, as thousands of previously‐insured people with serious health conditions turn to their hospitals for help.”

  • Cutting out the middle man

    Tags: ragle, president's letter, legislature, 84th, direct primary care, bonnen, hancock

    By Dale Ragle, MD
    TAFP President, 2014-2015

    Greetings colleagues. Do you remember a time when you could take care of your patients without any of the hassle and expense associated with billing insurance companies? When you could spend as much time with your patient as needed? When you simply received payment from your patients instead of some third-party payer?

    Many physicians practicing today have only heard stories of those days, but a growing number are rediscovering them by stepping off the insurance treadmill and contracting directly with their patients. Direct primary care is an innovative model for delivering and purchasing health care services that gives physicians and their patients an alternative to the third party, fee-for-service system. For a flat monthly fee, patients have unlimited access to their doctor—in person and by phone or e-mail—for a full range of comprehensive primary care services including acute and urgent care, regular checkups, preventive care, chronic disease management, and care coordination.

  • A new way to train family physicians

    Tags: young, residency, perspective, rural medicine, rural, rural physician

    By Richard Young, MD

    What is the best way to train comprehensive full-service family physicians to learn how to thrive in underserved rural Texas? How have duty hour restrictions affected residents’ training with this goal in mind?  JPS might have some answers.

    The John Peter Smith Hospital Family Medicine Residency Program was chosen to be one of 14 programs to participate in the Preparing the Personal Physician Practice (P4) experiment, which was conducted from 2007 to 2012. The leading organizations that regulate family medicine residencies allowed JPS and 13 other programs across the U.S. to blow up their curricula and start all over. JPS innovated its curriculum in two primary ways. This is a report on some of our preliminary results.

  • Missed opportunities in the 84th Texas Legislature

    Tags: legislature, legislative update, 84th, medicaid, banning, medicare, graduate medical education, nelson, zerwas, residency, family medicine residency program, higher education, primary care coalition, texas medical association, preceptorship, bonnen, hancock, direct primary care, schwrtner, crownover, prescription, drug abuse, substance abuse, darby, yogi

    By Tom Banning

    Yogi Berra famously said I hate making predictions, especially about the future. It’s particularly painful when those predictions come true as was the case for many of the predictions TAFP made at the outset of the 84th Texas Legislature on how health care issues would fare this session.

    Playing to their primary voters, the House and Senate focused attention almost solely on tax cuts, border security, transportation, when and where you can carry a gun, and a host of other mostly inconsequential partisan ideas.

  • Notes for the Texas Family Medicine Symposium

    Tags: texas family medicine symposium, cme, self assessment module, san antonio

    posted 5.29.15

    For those of you who will be joining us for the Texas Family Medicine Symposium, thank you for registering! We are looking forward to seeing you at this inaugual event. If you wish to attend and have not yet registered, on-site registration will be available. See information below.

    Registration Schedule
    If you arrive on Thursday, June 4, you can check in at registration on from 5-7 p.m. in the foyer of the San Antonio Ballroom.

  • Which way from here?

    Tags: slocum, reform, health care reform

    Health care reform in the United States

    By Kim D. Slocum
    President, KDS Consulting, LLC

    Three years ago, I was interviewed for an article in Texas Family Physician entitled “Payment reform—The next step toward an efficient high-quality health care system.” At that time, I said that the United States would see one of three futures for health care: one based on rapidly escalating consumer cost shifting, one making significant use of price controls, or one focused on measuring and rewarding “value.” So, where do we stand in early 2015 and what can we expect next?

    At the moment, the concept of shifting costs to consumers is in high gear. The passage of the Medicare Modernization Act of 2003 created an opportunity for employers to move to high deductible health plans, which it was presumed would turn consumers into “happy economists” who would diligently study cost and quality ratings for various medical services, come to medical encounters fully prepared to argue the merits of each recommendation with their physicians, and only receive care that would optimize their clinical outcome.

  • You’re invited! Join your colleagues from every state at AAFP’s NCCL

    Tags: kelly, national conference of constituency leaders, special constituents, minority, new physician, women, international medical graduate, glbt

    April 30 – May 2, 2015 | Kansas City, Missouri

    By Christina Kelly, MD

    The American Academy of Family Physicians National Conference of Constituency Leaders will be held April 30 - May 2, 2015 (with a preconference on April 29) in Kansas City, Missouri. This is the AAFP’s premier leadership and policy development event for underrepresented constituencies, which includes new physicians (physicians in their first seven years of practice), women, international medical graduates, GLBT, and minority constituencies.

    At this leadership meeting, we gather every year for a purpose. We gather to: learn about how we can make a difference for our patients and our specialty, inspire each other to advocate, lead the way to action, and challenge our colleagues to join us in our efforts. A variety of issues are discussed at this meeting, such as patient barriers to quality health care that you want the AAFP to address, challenges within a variety of practice settings that you want fixed, or changes that need to occur to continually improve family medicine.

  • The Power of the Preceptorship

    Tags: bias, preceptorship, medical student, perspective

    By Travis Bias, DO, DTM&H

    In middle school, I aspired to become a DJ. Because this required me to take the least amount of math. Despite this original goal, I started my time at Southwestern University as a pre-med student and headed to UNTHSC Texas College of Osteopathic Medicine to begin my medical education. A career as a physician stood perfectly at the intersection between intellectual challenge and service to others.

    I was drawn into medicine to make a difference. The calling of a medical career can be heard as young as 18. It requires determination, a selfless heart, and compassion no matter the situation. Between the ages of 22 and 26, however, a young physician-in-training must decide which specialty he or she would like to be practicing from age 30 until retirement. This decision shapes career options and powerfully influences the future lifestyle, and thus capacity for relationships, growing a family, and personal balance and well-being. This choice in path, like in other careers, also affects potential lifetime income. Thus, specialty choice is not to be taken lightly, especially given the growing burden of educational debt that young medical graduates face.

  • All hands on deck

    Tags: ragle, president's letter, 84th, legislature, medicare, meaningful use, icd-10, graduate medical education, direct primary care, public health, medicaid, physician of the day, tafppac, key contacts

    By Dale Ragle, MD
    TAFP President, 2014-2015

    Welcome colleagues to a new year, a new Congress, and a new Texas Legislature. On all fronts, health care is evolving. These changes present family physicians tremendous opportunities to shape our future health care system. It’s up to all of us as family physicians to advocate for our specialty in the halls where decisions are made that affect our patients and our practices.

    In Washington, D.C., the 114th Congress is well under way and is busy on a number of health care issues. AAFP’s advocacy work is focused on fixing Medicare’s broken payment model, changing Meaningful Use requirements, delaying ICD-10, and reforming graduate medical education funding. Another area in which AAFP is concentrating efforts is in making payment for direct primary care services a qualified health benefit under IRS rules. This would enable patients to pay for direct primary care with pre-tax HSA and FLEX account dollars, a move that would aid the expansion of this emerging and promising model of practice.

  • Notes for CFW and Interim Session attendees

    Tags: cfw, c. frank webber lectureship, interim session, business meetings, austin, cme, self assessment module

    posted 3.2.15

    Thank you for registering for TAFP’s 2015 C. Frank Webber Lectureship. We look forward to seeing you later this week at the Omni Austin Hotel at Southpark. Below is some information about the conference. If you have any questions or concerns, please call (512) 329-8666 or e-mail

    Registration hours
    Thursday, March 5 | 12:30 - 7 p.m.
    Friday, March 6 | 6 a.m. - 7 p.m.
    Saturday, March 7 | 6:30 a.m. - 4:30 p.m.

  • Increase support for residency training and invest in Texas' health

    Tags: legislature, legislative budget board, 84th, graduate medical education, residency

    By Blair Cushing
    Fourth-year TCOM student

    As a fourth-year medical student, I have spent the past four years highly concerned about what fate would await my classmates and me on Match Day, which is now only a few weeks away. With each passing year, the number of graduating medical students has climbed while the number of available first-year residency positions has remained stagnant. It is anticipated that in 2016, Texas medical schools will graduate 100 more doctors than available residency positions in the state. With three new medical schools expected to matriculate their first classes that fall, this number could easily rise to over 350 by the year 2020 in the absence of any new investment in graduate medical education.

    Despite Texas being one of the few states that currently uses state tax dollars to support GME, the dollars have not kept up with the need and more importantly, a flawed funding formula has prevented this money from being used in ways that align with the health care needs of our population. Fortunately, the 84th Texas Legislature affords us a unique opportunity to reform the way GME dollars are allocated in Texas.

  • The Family Medicine Preceptorship Program is open for business

    Tags: preceptorship, medical student, bias

    Hey Texas medical school students, have you been eagerly awaiting the open enrollment period of the Texas Statewide Family Medicine Preceptorship Program? Well wait no more. We are currently accepting applications, so tell your friends and sign up today.

    Our preceptorship program offers medical students the chance to break out of the academic setting and see what medicine is really like when it’s practiced in the community. By spending two to four weeks with a practicing family doctor, they can experience the joy and fulfillment of a career caring for patients who are friends and neighbors. They find out that family medicine isn’t just about running on the hamster wheel and treating runny noses and sore throats all day.

    Sure we have survey results that show when medical students complete rotations in the Family Medicine Preceptorship Program, they are more likely to choose a career in family medicine, but the family doctors who cherish the memory of their rotations tell the story better.

  • Texas Women’s Healthcare Coalition

    Tags: texas women's healthcare coalition, women's health, legislature, chatillon

    Working to improve Texans’ access to health care in the 84th Texas Legislature

    By Anna Chatillon
    Policy coordinator for the Texas Women’s Healthcare Coalition

    The Texas women’s Healthcare Coalition, of which TAFP is an active steering committee member, is a coalition of 47 health care, faith, and community-based member organizations. We are dedicated to improving the health and well-being of Texas women, babies, and families by assuring access to preventive health care for all Texas women. Access to preventive and preconception care—including health screenings and contraception—means healthy, planned pregnancies, and early detection of cancers and other treatable conditions. The TWHC was formed in response to the devastating legislative budget cuts to women’s health care in 2011.

    Now that the prior level of funding has been restored, it is clear the restoration was only the first step toward ensuring that all women in Texas have access to the preventive care they need. Even now, only three in 10 women who need publicly funded health care have access to it. Texas desperately needs to appropriate more funding for women’s health care in the next legislative session. The consequences of failing to provide women access are too high, both in human costs and in financial implications, for Texans to accept.

  • Asset protection: An ounce of prevention

    Tags: wiewel, finance

    By Brad Wiewel
    The Wiewel Law Firm

    Asset protection is something that many physicians, including family physicians, don’t focus on until they have been threatened with a malpractice lawsuit. I know, because I have had more than my share of telephone calls from frightened physician clients wanting to know if it is too late to do the planning I recommended when we met at my office to discuss their estate plans.

    Unfortunately, the answer is, “It’s almost always too late.” You must plan to protect your assets from being taken before a claim against you is pending, expected, or threatened.

  • More than meets the eye: Value of small practices shouldn’t be ignored

    Tags: perspective, van winkle

    By Lloyd Van Winkle, MD

    For years, we’ve been hearing about the decline — even death — of the small primary care practice, but I’m here to say that obituary is premature, if not flat-out wrong. When a recent study published in Health Affairs touted the value of small practices, I didn’t need convincing. I’m a small practice owner and have been for nearly 30 years.

    The study found that primary care practices with one or two physicians had one-third as many preventable hospital admissions compared to practices with 10 to 19 physicians. The study also reported that smaller practices achieved their impressive results despite caring for a higher percentage of patients with chronic conditions than larger practices.

  • Keep doing what you do best; change what needs to be changed

    Tags: president, ragle, president's letter, health care reform

    An adaptation of the 2014-2015 incoming president’s address

    By Dale Ragle, MD
    TAFP President, 2014-2015

    It is an honor and a privilege to serve my fellow family docs as TAFP President. There is no other group of people that I would rather serve and give my time to than you. I represent all of you, whether you are a solo, rural doc in west Texas where you may be the only doctor within 70 miles, a doctor in a big multi-specialty group, a resident in training, or a medical student aspiring for a career in family medicine. You all deserve my service and attention and you all shall get it.

    The last three members to serve as president of our organization have initiated their terms with inaugural speeches about change and reform of our health care system. I too will tell you that our health care system is indeed changing and we are going to have to adapt in some way. The forces driving this change are bigger than TAFP, they are bigger than AAFP, and they are bigger than the AMA.