An excerpt from the 2013 incoming presidential address
By Clare Hawkins, M.D., M.Sc.
TAFP President, 2013-2014
Change is inevitable. We can change or die. As family physicians, we can lead the coming change in our health care delivery system.
Charles Darwin said, “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.”more
By Richard Young, M.D.
Ms. M was a 68-year-old Hispanic female who had not seen Dr. Smith (not his real name) in nearly a year. She had run out of her diabetes, high blood pressure, and cholesterol medications months before.
Ms. M had other concerns in addition to these three chronic diseases and the practical difficulties she faced filling her prescriptions. She asked Dr. Smith to help her with her foot pain and knee pain. She was told by another doctor at an ER that she had visited for a non-urgent problem a few months prior that her blood potassium level was low. She expected Dr. Smith to address her heartburn, recent weight gain, bad teeth, and an additional but distinctly different abdominal pain. She wanted a test for her kidney function, for which Dr. Smith had to spend a couple of minutes trying to figure out why she was concerned about her kidneys in the first place and the results of blood tests at other facilities such as her recent ER visit. Dr. Smith also spent several minutes explaining the need and importance of osteoporosis screening, which she ultimately declined.more
By Lamia Kadir, M.D.
Brushy Creek Family Physicians
As summer vacation draws to an end, lunches, school buses, and homework will soon replace swimsuits, road trips, and television. For those family physicians who see pediatric patients, sports physicals and well child checks are aplenty. It is our responsibility to remind our patients and their parents of the importance of routine immunizations. As we all know, prevention of disease is essential for both patient health and control of medical costs.
The national vaccine immunization program is one of the most successful examples of effective preventive care in the U.S. Want some powerful examples? How about the marked decrease in cases of invasive haemophilus influenzae type b infection since the introduction of HIB conjugate vaccines in December 1987? The number of cases in children younger than five years of age declined by more than 99 percent by 2000. Here’s another: In 1979, the global eradication of smallpox was announced, one of the greatest achievements of modern medicine, made possible by the advent of the smallpox vaccine.more
By Troy Fiesinger, M.D.
TAFP President, 2012-2013
Although I missed the blockbuster 2011 Brad Pitt movie Moneyball, I recently read the book by Michael Lewis. Oakland A’s general manager Billy Beane, a promising high school prospect out of California, was drafted by the New York Mets the same year as Darryl Strawberry and Lenny Dykstra. Despite looking like a top prospect to the scouts, Beane’s major league career ended early while Strawberry and Dykstra won the 1986 World Series with the Mets. As the general manager of the Athletics, Beane struggled to define more accurately what makes a baseball player good. This got me thinking: How do I know I’m a good doctor?
I can point to the diplomas on my wall and tell you I went to good schools, but the U.S. News and World Report rankings are little more than opinion surveys with minimal hard data to back up their lists. I can show you a copy of my Texas medical license, but that just means I haven’t broken any laws nor received any complaints to the Texas Medical Board. You could look at my American Board of Family Medicine diploma, know that I have passed a national exam and do annual online education modules, and consequently assume I know something. You do not know, however, if I am better than the doctors across the street.more
By Janet Realini, M.D., M.P.H.
Chair, Texas Women’s Healthcare Coalition
In a bipartisan effort, the 83rd Texas Legislature increased funding for preventive care for low-income women, making an important first step toward restored access for over 140,000 low-income women. Senate Bill 1, now signed into law by Gov. Rick Perry, invests in family planning in three key funding streams.
- It adds $32.1 million in state funding to the Department of State Health Services Family Planning Program, replacing federal dollars awarded to the private Women’s Health and Family Planning Association of Texas network through Title X;
- It adds $100 million for a DSHS Primary Health Care Expansion for women’s health care, 60 percent of which will provide contraceptive care; and
- It adds $71.3 million in state funding to maintain the Texas Women’s Health Program, which lost its federal funding due to the “Affiliate Ban Rule” that excluded Planned Parenthood from the program.
By Kathy McCarthy, TAFP COO
Looking back at the past few years, TAFP has much to be proud of. Family medicine had a successful legislative session this year – increases in graduate medical education funding, restoration of the loan repayment program, and passage of legislation that will reduce hassle by standardizing prior authorization forms. Some other areas to highlight include the tremendous leadership we have at TAFP and the ways that branches out. The election of Dr. Lloyd Van Winkle to the AAFP Board last year makes sure that the voice of the small practice physician is heard at the national level. There are currently three TAFP members serving on the TMA Board of Trustees – Dr. Art Klawitter, Dr. Lewis Foxhall, and Dr. Doug Curran. It’s so important to have those family docs at the table sharing their concerns and perspectives within the house of medicine.
TAFP’s membership is strong and continues to grow. At a time when membership organizations are struggling to retain members, TAFP has seen almost 6.5 percent growth in active membership in the last five years.more
On behalf of the Texas Academy of Family Physicians staff, thank you for registering for the 64th Annual Session & Scientific Assembly! We have an eventful conference planned for you and we look forward to seeing you in Fort Worth.
Please visit the TAFP registration desk to pick up your materials including your CME syllabus, registration packet, and official program, which includes schedules, maps, and other information about the conference.
New this year...Annual Session Mobile Appmore
It’s no secret that Texas Gov. Rick Perry openly opposes federal health care reform. He has used every opportunity to reiterate that he will veto any effort by the legislature to participate in Medicaid expansion in Texas – an option granted to the states by last summer’s Supreme Court ruling. One source counts 14 states that have fully rejected accepting federal funds to extend health care coverage to low-income adults, while 20 states are fully participating in the expansion and 16 are undecided.
A state certain to participate in the expansion is Colorado, my new home state. The bill to expand Medicaid to 330,000 Coloradans passed both chambers of the General Assembly last week. Once the Senate approves amendments to the House version of the bill, it will head to the desk of Gov. John Hickenlooper, who has pledged to sign it into law.
In many respects (to the delight of this Texas native), the two states are very similar. Colorado has its urban capital, several other mid-size cities, and vast expanses of rural space. Residents also have a fierce loyalty to the state. And, until the past decade when control of the House, Senate, and the governor’s mansion has flip-flopped between the parties, Colorado has historically been conservative. The current split in the House is 37 Democrats, 28 Republicans. In the Senate, it’s 20 Democrats, 15 Republicans. And, of course, the governor is a Democrat.more
By Troy Fiesinger, M.D.
TAFP President, 2012-2013
When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments. This was my first time to take them to the dentist, as my wife usually drives them. My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats. Freed from manually registering patients, the front-desk clerk monitored patient flow and welcomed everyone to the clinic with freshly-baked chocolate chip cookies.
Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waited in the lobby as patients have done for decades. His office has the same electronic medical record as mine, but his clipboard system has not changed in decades. My clinic has an electronic medical record with a web portal and secure patient e-mail, but our patients still queue at the front desk to give their information to a clerk. At the gas station, I swipe my credit card and fill my gas tank without talking to another human being. At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before. We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation. We complain about the inefficiencies of our EMRs but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices. Are we so focused on our frustrations that we forget our patients?more
By Janet Hurley, M.D.
Chair, TAFP Commission on Health Care Services and Managed Care
As I look with uncertainty to the future health care landscape and talk with fellow family physicians, I find many of us fearful of what the upcoming years will bring. I admit there are times when I get discouraged too, when it seems like things are too difficult to fix or that the problems are too big to solve. It’s in those moments that I realize we are living in a fallen world and the temptation is strong to just hide or give up. But God does not call us to hide our worries; he calls us to shine our light to the world around us. So I ask you, what does your light look like?
We are all called to be leaders to some degree, either in our families, our practice, or our government. Some will move on to state and national leadership realms, but it is okay if not all of us do that. How do you use your gifts and talents? Are you befuddled with frustration and worry? Have you hunkered down in seclusion? To squander our gifts and talents is like burying the best of ourselves in the sand. We’ll look back and wonder where the “good old days” have gone and realize that our health care system is no longer recognizable to us and that we have been left behind, frustrated and broken. Each of us has gifts and talents that should not be left unused.more
AAFP recently submitted a letter to the Centers for Medicare and Medicaid Services urging them to create a new set of evaluation and management codes for primary care physicians. The recommendation, sent to CMS Acting Principal Deputy Administrator Jonathan Blum, was accompanied by supporting documents based on the research of TAFP member David Katerndahl, M.D., M.A.
The Academy suggested that CMS create the codes and include them in the 2014 Medicare physician fee schedule. AAFP Board Chair Glen Stream, M.D., said in the letter that a new payment model is necessary for the country to reach better health care for people and populations, as well as lower health care costs. “That system should recognize the complexity of ambulatory care provided by primary care physicians and reward the quality of services provided in their practices,” said Stream.
New E/M codes that differentiate primary care physicians from specialists or subspecialists would show the true value of both types of care, rather than devalue them as the current coding system does. Katerndahl’s research shows that the complexity of a primary care physician’s patient visit including E/M is much different than those with other specialists.more
A January 2013 report revealed a disturbing statistic: Nationally, roughly 1 in 22, or 4.57 percent, of people aged 12 and older reported having used pain relievers non-medically in the past year. Texas fares slightly better with a rate of 4.33 percent, placing our state at 17th lowest in the country in our rate of abuse.
Still, this is a grave public health concern. The National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration shows that the highest rate of prescription drug abuse occurs in the young adult population. Nationally, 10.43 percent of this group reported misuse of the drugs in 2010-2011 compared to 9.21 percent of Texas’ young adults. In Texas’ 12-17 age group, the rate is 6.03 percent.
Experts have raised many contributors fueling this epidemic. Patients may be more likely to misperceive the safety of these medications since they’re prescribed by doctors and take them under circumstances not recommended by their physician. Also, prescriptions for stimulants and opioids have increased dramatically and are more readily available. Some physicians have said they feel pressure to get high patient satisfaction scores and are more likely now than in previous decades to strive to eliminate pain in their patients rather than conservatively manage it. And, patients more frequently seek out these now well-known medications, whether because they feel they will better treat anxiety, pain, sleep problems, or enhance focus, or for deviant purposes.more
The 2013 C. Frank Webber Lectureship is upon us and we are looking forward to seeing you there! Below you will find important information to make sure everything during the event goes smoothly for you.
Thursday, Feb. 28 | 9:00 a.m. – 7 p.m.
Friday, March 1 | 6 a.m. – 7 p.m.
Saturday, March 2 | 6:30 a.m. – 4:30 p.m.
C. Frank Webber Lectureship registration and packet pickup on Thursday and Friday will be located on the main floor in the hotel lobby outside the Omni Ballroom. The CME breakfast lecture begins at 7 a.m. on Friday.more
Earlier this month, TAFP put out a call for TAFP members to apply for travel funding to attend two national conferences in April: AAFP’s Annual Leadership Forum and National Conference of Special Constituencies. If you’ve never attended one of these conferences yet, I highly encourage you to consider it this year. Nine funded delegate spots or scholarships are available from TAFP and anyone else interested can simply register to attend.
But why should you take time away from your practice and family to go to Kansas City, Mo.? These conferences bring together a diverse group of family physicians from around the country and provide leadership training specifically tailored to family physicians. In addition, NCSC delegates identify concerns related to them and propose policy to take to AAFP.
ALF and NCSC are relevant to members of all ages and all practice types and both provide the opportunity to network, brainstorm with others, and learn best practices. Most of all, you’ll come away feeling energized and fired up for family medicine.more
By Troy Fiesinger, M.D.
TAFP President, 2012-2013
We received our monthly physician quality report cards recently. Software mines our electronic health record and generates reports to tell us if we are meeting our goals. These quality measures are defined by Medicare, our clinically integrated physicians group, and commercial payers like Blue Cross Blue Shield. While some are based on solid medical evidence, others seem arbitrary and not relevant to the day-to-day reality of seeing family medicine patients.
I prefer creating and using our own data instead of relying on the often incomplete and inaccurate claims data from insurance. Despite our efforts to be good sports, often we feel bombarded by the endless number of things we should do to show we are good doctors.more
By Clare Hawkins, M.D.
With another legislative session underway, our Academy is poised to make great gains for family medicine and recoup budget losses from 2011. We’re building on a decade of work educating legislators and the public about the value of family medicine, but it’s evident that our work particularly since the last session has led to a deeper understanding of the current and coming crisis in the primary care workforce.
This summer TAFP held a legislative training seminar in Austin and attendees of that conference formed the core of a new Key Contacts program. These leaders actively share resources provided by the Academy with their state representative and senator, which include not only our own policy briefs and legislative magazine features, but editorials and news stories from the major daily newspapers. People are “getting it.”more
Join this public health effort and help decrease
youth tobacco use
By Rebecca Hart, M.D.
Happy anniversary, Tar Wars! Did you know that Tar Wars, AAFP’s tobacco-free education program, celebrated 25 years in 2012? To mark this milestone, the National Tar Wars Advisory Group wants to re-energize the program.
Remember Tar Wars? Most of you may have been involved in medical school or residency, giving talks to fifth-grade students at local schools. You went into the classroom with about 30 kids and had a fun interactive session talking about smoking, questioning them about what they knew, educating them, and inviting them to do their own creative thinking about how to stay smoke free. You then invited them to make a smoke-free poster and enter the national poster contest. Kids love the interactive presentation, and really enjoy the contest. It was fun for you and was a great community service.more
Once again waiting until the last minute, Congress passed a bill on New Year’s Day that averts the fiscal cliff, delays sequestration provisions for two months, and staves off the 26.5 percent cut in Medicare physician pay for another year.
The fiscal cliff agreement increases revenue largely by targeting married couples earning more than $450,000 a year and single people earning more than $400,000 a year by raising rates for wages and investment profits, but shields those earning less than $250,000 a year from income tax increases, the Washington Post reports.
As TAFP reported in the weeks leading up to this agreement, Congress had to find roughly $30 billion to pay for a one-year patch to the sustainable growth rate formula and considered reversing the Medicaid primary care bonus to offset the cost. Modern Healthcare reports (free registration required) that cuts will come from other Medicare programs, most of which affect hospitals, pharmacies, and dialysis clinics. The primary care bonus appears to be intact.more