Archives / 2011 / January
  • Is it time to declare independence from the RUC?

    Tags: health care reform, medicare, ruc, payment

    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.

  • Bookmark another great member blog – Practice Transformation with Dr. Gerdes

    Tags: practice management, practice transformation, transformed, family physician

    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.

  • Blog rec: “Health Scare” online

    Tags: health care reform, family physician

    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

    – kalfano

  • Bleak House: Family medicine and the great budget debate, day one

    Tags: budget, legislature

    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.

  • It’s a budget session

    Tags: budget, legislature

    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.

  • The rise of the ACO and lessons learned from the Medicare Physician Group Practice demonstration

    Tags: health care reform, new england journal of medicine, accountable care organization

    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.)

  • Welcome to the Texas Family Docs blog

    Tags: blog, membership

    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.