2011 was a year of new ideas, initiatives, and projects, and your Academy approached all with the same goal: to unite the family physicians of Texas, equip them with the tools to navigate a changing practice environment, and proactively advance the specialty of family medicine.
By Kate Alfano
From the start of the legislative session in January to the 10th ABFM SAM Group Study Workshop in December (and all events in between), TAFP members and staff stayed engaged in their mission. Read on for a review of happenings over the past year.
Advocacy: Just two weeks after the start of the new year, the 82nd Texas Legislature convened, sending TAFP’s leaders, lobby team, and staff into high gear to advocate on behalf of family medicine’s top concerns: graduate medical education, scope of practice, and physician workforce. Compounding the session was a $4 billion deficit in the 2010-2011 biennium and a $23 billion shortfall for 2012-2013, which threatened all state-funded programs and any proposal containing a fiscal note.
Throughout the regular session and special session, the Academy kept members updated on the legislative twists and turns through weekly Capitol Update news articles and monthly Capitol Report news webcasts, and empowered members with various advocacy tools such as a series of issue briefs outlining scope of practice, graduate medical education, and licensure for international medical graduates, and a substantive policy brief on scope of practice.
TAFP’s advocacy effort was also boosted through the TAFP Political Action Committee and the contributions of its 77 monthly donors. Through TAFPPAC, members got involved at the grassroots level, built personal relationships with elected officials, and enabled political campaign participation and contributions to candidates who support family medicine.
Heralding the message that investing in family medicine will help contain spiraling health care costs while improving patient care, TAFP supported and lawmakers passed a comprehensive state health care reform bill. By encouraging better coordination of care between doctors, hospitals, and others, and aligning financial incentives to keep patients healthy and out of the most expensive care settings, the bill could save $468 million over the next biennium.
Despite some significant gains this session, many state programs were slashed under the 2012-2013 budget, including those under the Texas Higher Education Coordinating Board—primary care residency programs, the Texas Statewide Preceptorship Program, and the Faculty Development Center. The budget also underfunds Medicaid by at least $4.8 billion and underfunds public schools by $4 billion, setting the stage for another difficult budget session when the 83rd Legislature convenes in 2013.
TAFP has begun forming a strategy for the 2012 legislative interim and election cycle. The Academy is working to advance an omnibus package of state reforms—tentatively called the Primary Care Rescue Act—to repair, rebuild, and restore Texas’ primary care infrastructure to improve quality of care and bend the cost curve through workforce development, delivery system and care coordination improvements, administrative simplification, and investment in health information technology. The Academy has called for member input and there’s still time to provide yours. E-mail suggestions to TAFP Director of Communications Jonathan Nelson at email@example.com.
In recognition of TAFP’s advocacy effort to preserve physicians’ scope of practice against attacks by advanced practice registered nurses, AAFP again named TAFP a recipient of the AAFP Leadership in State Government Advocacy award, which Nelson accepted at AAFP’s State Legislative Conference Nov. 4-5, in Salt Lake City, Utah.
On the national advocacy front, AAFP and several other specialty organizations developed a unified strategy and grassroots campaign to urge members of the congressional Joint Select Committee on Deficit Reduction, or “supercommittee,” to avoid making damaging cuts to Medicare and graduate medical education, and to include a permanent fix to the broken sustainable growth rate formula that will enact a 27.4 percent cut in Medicare physician pay unless Congress acts. Unfortunately the supercommittee failed to reach a budget compromise by the November deadline and AAFP quickly responded with a statement from AAFP President Glen R. Stream, M.D., M.B.I., advocating for swift action to prevent the pending cut.
Another national issue that gained momentum this year was the call to replace the AMA/Specialty Society Relative Value Scale Update Committee. The RUC makes annual recommendations to the Centers for Medicare and Medicaid Services on Medicare physician fee reimbursement and how certain procedures should be valued. Detractors say that its recommendations have devalued primary care in favor of specialty societies.
AAFP sent a letter to the RUC in June with a list of demands: more primary care voting positions; new seats representing consumers, employers, health systems, and health plans; the elimination of three rotating subspecialty seats; and voting transparency. AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, addressed the RUC in September to clarify the Academy’s request. AAFP has asked for a response to its demands by March 1, 2012.
Practice transformation: With 2011 came ideas and strategies for reforming the practice of medicine and payment for care delivery. Recognizing the complex and changing practice environment, TAFP and AAFP provided resources and news reporting to keep members informed of the initiatives to discern their readiness or ability to participate.
Chief among the reforms was the push toward coordinated care, particularly through accountable care organizations. The ACO concept is not new, though it received fresh attention in the Patient Protection and Affordable Care Act through the Medicare Shared Savings Program set to roll out Jan. 1, 2012. The Centers for Medicare and Medicaid Services released the final ACO rule on Oct. 20, which included many of the revisions suggested by AAFP including the ability for primary care physicians to participate in multiple ACOs and reducing by half the number of individual quality measures for an ACO to qualify for shared savings.
CMS’ electronic health record incentive program began on Jan. 1, 2011, and by October had distributed $30 million in payments to Texas physicians. Also by that point, 11,000 Texas physicians had registered to participate in the program while 1,400 had completed stage 1 of the program, meeting 20 of 25 meaningful use criteria.
Texas family physicians also began preparing for the switch to HIPAA 5010 transaction standards, which will affect how they transmit and receive electronic transactions such as claims and eligibility verifications. The compliance date for use of the new standards is Jan. 1, 2012, but penalties won’t kick in until March 31, 2012.
And, though seemingly far off with a compliance deadline of Oct. 1, 2013, physicians began educating themselves and their staffs on the process to switch from ICD-9 diagnosis codes to ICD-10—an addition of nearly 55,000 codes.
Considering all of these deadlines, penalties, and new programs, TAFP organized the 2011 Payment Reform Summit on Oct. 1, “Lead or Be Led: How to Thrive in the Evolving Health Care Delivery System.” More than 50 physicians joined the expert speakers who reiterated how physicians must lead reform as the system moves from a volume-based model to a value-based model. Video recordings of most sessions will be available online in early 2012.
Communications: Through quarterly magazine Texas Family Physician, TAFP Communications presented features and news on legislative and regulatory topics, practice tips, member happenings, and more. Communications staff was particularly proud to present the fourth-quarter issue, which sported a new nameplate and cover design, a fresh set of fonts, and a commitment to packaging content in smaller, more easily digestible bites that we hope will make your reading experience even better.
In addition to regular news reporting through the QuickInfo e-newsletter, TAFP launched the new Products & Services e-newsletter in July to highlight products and services important to family physicians. This monthly e-mail contains the latest practice management tools and resources, educational opportunities, public health materials, and more from TAFP, AAFP, and Academy partners.
This year brought a tremendous expansion of TAFP’s social media effort through Facebook, Twitter, LinkedIn, and TAFP’s blog. These platforms provide an opportunity for members to connect with the Academy, share feedback, and connect with other colleagues.
TAFP Communications has several exciting developments in the works. Be sure to watch as we move forward with a new logo and website in early 2012.
Education: TAFP presented four annual symposia in 2011: the C. Frank Webber Lectureship and Interim Session in Austin, TAFP’s 2011 Annual Session and Scientific Assembly in Dallas, and Primary Care Summit in both Houston and Dallas. These programs reached more than 1,400 family physicians and other health professionals. Attendees of TAFP symposia had the opportunity to earn more than 84 CME credits at these conferences on more than 82 topics.
Expanding the reach of high-quality TAFP CME, the Academy released three online CME activities in the fall through which viewers can earn one CME credit each. Originally recorded during Annual Session, videos of lectures on maintenance of certification, accountable care organizations, and physician employment contracts are available for free on TAFP’s website.
To help ABFM diplomates meet certification and recertification requirements, TAFP offered 10 SAM Group Study Workshops in 2011. Six workshops were held in conjunction with TAFP symposia, and four standalone programs were held in Houston, Lubbock, McAllen, and San Antonio. TAFP will offer at least 10 more SAM workshops in 2012 to meet the growing needs of our members.
The National Procedures Institute also had a successful year, providing procedural training to primary care physicians across the country. A joint investment of AAFP, TAFP, and the Society of Teachers of Family Medicine, NPI provides members valuable practice enhancement techniques while also providing the Academy non-dues revenue. In 2011, NPI delivered 103 procedural workshops to more than 1,000 medical professionals around the country. View the 2012 event schedule and register for upcoming CME conferences on the NPI website at www.NPInstitute.com.
Members and Leaders: Both TAFP and AAFP reached membership milestones this year: TAFP exceeded 7,000 total members and AAFP exceeded 100,000 members. TAFP remains the largest subspecialty physician membership organization in the state; AAFP is the second largest subspecialty physician membership organization in the country after the American College of Physicians.
TAFP student and resident enrollment rose to more than 2,300, reflecting the continued effort of TAFP leaders and staff to reach out to these future family physicians through the Texas Conference of Family Medicine Residents and Students in March, through support for the medical schools’ family medicine interest groups, through visits to the medical schools and residency programs, and by presenting leadership training and developing tools to help supplement medical education and training.
The Academy is proud to recognize the outstanding work of the University of Texas Health Science Center at San Antonio FMIG, which received AAFP’s 2011 Program of Excellence Award, and two Texas family medicine residency programs that were certified as level-3 patient-centered medical homes by the National Committee for Quality Assurance: Christus Santa Rosa FMRP in San Antonio and Memorial FMRP in Sugar Land.
TAFP’s support of young family physicians does not stop at the completion of residency. TAFP and AAFP continue to reach out to new physician members—those who have been in practice for seven years or fewer—through practice support resources, board review courses, coding resources, and discount registration fees to Academy events.
To highlight active Texas family physicians and their unique approach to medicine, TAFP launched a new, online member feature in February called Member of the Month. Each article features a short biography of the physician followed by a question-and-answer section. Nominate one of your family physician colleagues by sending his or her name, phone number, and e-mail address to firstname.lastname@example.org.
TAFP’s new officers were installed at the 2011 Annual Session: President I. L. Balkcom IV, M.D.; President-elect Troy Fiesinger, M.D.; Vice President Dale Ragle, M.D.; Treasurer Clare Hawkins, M.D.; and Parliamentarian Ajay Gupta, M.D.
Also during Annual Session, the Academy recognized its award recipients. Thomas Mueller, M.D., was named Family Physician of the Year; the late Isaac Kleinman, M.D., was recognized as Physician Emeritus; HHSC Executive Commissioner Tom Suehs received the Patient Advocacy Award; Leah Raye Mabry, M.D., R.Ph., received the Presidential Award of Merit; Bruce Echols, M.D., received the TAFP Foundation Philanthropist of the Year Award; Philip Huang, M.D., M.P.H., won the Public Health Award; Tricia C. Elliott, M.D., F.A.A.F.P., was awarded the TAFPPAC Award; Jonathan MacClements, M.D., F.A.A.F.P., was awarded the Exemplary Teaching Award; and Kaparaboyna Ashok Kumar, M.D., F.R.C.S., received the Special Constituency Leadership Award.
Texas was well represented at AAFP’s 2011 conferences, including the National Conference of Special Constituencies and Annual Leadership Forum in Kansas City, Mo., the 2011 Family Medicine Congressional Conference in Washington, D.C., and AAFP’s 2011 Congress of Delegates and Scientific Assembly in Orlando, Fla.
Roland Goertz, M.D., M.B.A., completed his term as AAFP president and assumed his new post as AAFP board chair. Mabry completed her third term as speaker of the AAFP Congress of Delegates. Representing Texas during the Congress were Delegates Justin Bartos, M.D., and Erica Swegler, M.D.; and Alternate Delegates Linda Siy, M.D., and Douglas Curran, M.D.
Several TAFP leaders served on AAFP committees in 2011: Melissa Gerdes, M.D., Commission on Quality and Practice; Swegler and TAFP CEO/EVP Tom Banning, Commission on Governmental Advocacy; Hawkins, Commission on Continuing Professional Development; Joane Baumer, M.D., Commission on Education; Janet Hurley, M.D., Commission on Membership and Member Services; and Rebecca Gladu, M.D., Commission on Health of the Public and Science.
TAFP Foundation: The TAFP Foundation continues actively working to fulfill its goals: to raise and distribute funds for medical student scholarships for students planning to pursue a career in family medicine, family medicine office-based research, family medicine interest group activities at medical schools in Texas, and family medicine resident activities.
The Foundation could not meet these goals without the generosity of our donors, especially the 66 monthly donors. The philanthropic arm of the Academy and those who support us shined at Annual Session through the many activities held to benefit the Foundation. The signature event was a special reception to honor AAFP Board Chair Goertz, where colleagues and friends from around the state gathered to toast him for his years of service to family medicine on the state and national level.
Through sponsorship of the event, donations from individuals, and proceeds from a silent auction, the Foundation fully funded a new Roland A. Goertz, M.D. Scholarship that will be used to send student leaders to AAFP’s National Conference in Kansas City, Mo. The first award will be presented in 2012.
Back at the Office: The direction provided by the 2010-2011 Strategic Plan proved invaluable as TAFP members and staff worked to fulfill action initiatives in the areas of advocacy, practice viability, membership, and education. By the end of the year, many had been completed and progress had been made on all, evidenced by the many new projects detailed in this report.
TAFP looks forward to another banner year in 2012 serving the family physicians of Texas.