Celebrating the one-year anniversary of the Texas Family Docs blog (give or take a few days), gives us the opportunity to reflect on how we’re doing and give you, our members, a preview of what’s to come.
We launched on Jan. 10, 2011, with a goal to increase our connection with you and to encourage more interaction in the “post-health-reform era of rapid changes to the practice of medicine.” And we promised to share insights beyond our traditional news coverage on the issues you care about the most.
Through 36 posts, we explored the latest hot topics in policy: ACOs, the RUC, and the RACs; the often-maddening 82nd Texas Legislature; the even more maddening efforts to cut federal spending and address Medicare physician pay; and the importance of investing in primary care; and how the larger public views family medicine.
Of course now that we’re settled into a groove, we’re changing things up again! In just about a month, the Texas Family Docs blog will be rolled into the newly redesigned TAFP website. We hope it will further advance the mission of the blog and make it an indispensible resource for you. So watch for that announcement here in our original home and get ready for another great year in the blogosphere. Thanks for joining us!
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!
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.
Second, beginning in 2012, the ABFM MC-FP examination will be held in April instead of July. The dates for the April 2012 exam are April 6-7, 9-13, 16-19, and 21. The exam will also be offered in November for candidates who fail the spring exam, or for residents in good standing who are off-cycle and expected to complete training on or about Dec. 31, 2012. The dates for the November 2012 exam are November 7- 10.
And third, ABFM recently implemented “continuous MC-FP,” which completely removes the 7-year certification option. All family physicians who certified in 2011 or recertify in future years will enter the 10-year track. MC-FP rules now require the successful completion of each 3-year stage, which all have the same requirements.
- A minimum of 1 Part II module (SAM) – most worth 15 points
- A minimum of 1 Part IV module (PPM or approved alternative) – most worth 20 points
- One additional Part II module or Part IV module
- At least 50 MC-FP points (acquired by completion of modules) per three year stage
- 150 CME credits and a currently valid, full, unrestricted license to practice medicine in the United States or Canada
For more information, go to the ABFM website at https://www.theabfm.org/MOC/index.aspx. For additional resources for fulfilling the ABFM Maintenance of Certification requirements, go to TAFP’s website, http://www.tafp.org/.
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.”
In failing to act, they have “condemned millions of elderly and disabled Americans to continued health insecurity,” said AAFP President Glen R. Stream, M.D., M.B.I., in a statement. “This is no way to address the federal budget deficit. Nor is it the way to serve their constituents. Allowing the Medicare physician payment issue to fester worsens the health insecurity of millions of elderly patients and military families.” Read the full statement here.
With a little more than a month to go before the end of the year, there’s still time to pass another one- or two-year “doc fix,” and entering the 2012 campaign season, a short-term patch has wide support among Congressional lawmakers. But the question remains whether Congress as a whole can overcome the same gridlock that paralyzed the supercommittee.
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.
Dr. Laitos was the first to bring up the triple aim – three things a health system should strive to do: improve the health of the population, improve the patient experience of care, and reduce the per capita costs of care. This Health Affairs article goes into more depth, but it sounds a lot like the concept behind accountable care organizations – that care should be primary care-based, consider population health, empower patients, and integrate with other care providers on a macro level.
Dr. Eduardo Sanchez, a family physician and medical director of Blue Cross and Blue Shield of Texas agreed on two points, referencing a still-amorphous “virtual medical community” that aims to connect smaller practices currently organized as “onesies, twosies, and foursies” by providing them with a platform for information exchange and management.
He also brought up BCBSTX’s Bridges To Excellence program as a way for physicians to be recognized as high-performing. “Physicians will have to be able to capture data, analyze that data, and have ability to adjust what those data reveal. BTE and PQRS [Physician Quality Reporting System] are not the answer, but they are a way to get started and learn how to manage the system for quality improvement.”
Dr. Chris Crow of Plano, another speaker at the summit, asserted his strong belief in using data and analytics to measure quality and costs; he’s used it in his practice to provide better, more efficient, and more cost-effective care, and he can demonstrate this through real figures to any interested party. Dr. Crow said that once a physician has access to quality and cost measures, he or she can begin to implement changes to improve care services. Not knowing the metrics is like “driving a car without a dashboard.”
Dr. Laitos asserted that there will be winners and losers in health care reform. “The winners will be the doctors who know how to demonstrate value.”
To read more about the Payment Reform Summit, check out TAFP’s coverage published in last week’s QuickInfo e-newsletter. Also stay tuned for video recordings of the lectures to be published later this fall.
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.
TAFP anticipates that over the course of the next year and possibly beyond, the national attention paid to Texas will only escalate. This creates an opportunity to continue serving as a national leader to explain the socioeconomic and delivery system challenges plaguing our system, but more important to trumpet the role of family physicians as vital to the solution.
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.
Additionally, AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco said in an interview with Family Practice News digital network that the Academy will produce videos featuring “real family physicians who describe the real impact of these cuts for their practices,” in the hope that the videos go viral and incite larger action.
Most important, Goertz told AAFP members in the FPN video interview that physicians need to step up and take action. “Don’t go to sleep on this issue. We’ve been fighting this for 10 years. Don’t get fatigued about contacting those who represent you.”
“This is a big, big deal. A 29.5-percent cut in a payer source, particularly in Medicare, is going to put some practices out of business in some locations. So mobilize yourself, contact your elected officials, and if you feel comfortable with it, make sure you involve your patients because your patients are going to be the ones who unfortunately will suffer the outcomes.”
AAFP and other experts have acknowledged that the supercommittee may not address the SGR in their budget plan – because once again it may be too big an issue to tackle along with all of the other considerations. Hence, AAFP’s request for a five-year fix and 3-percent pay bump for primary care.
Another SGR-replacement idea released recently by the Medicare Payment Advisory Commission would implement a 10-year fix at a cost of around $200 billion. Though MedPAC’s plan would just replace one form of automatic payment cuts with different automatic payment cuts, it does include protections for primary care.
Kaiser Health News reports on their blog: “Reimbursements for primary care physicians would be frozen for 10 years, and specialists would see a reduction in payments for three years, at which time their rates would also be frozen.”
As Goertz said in an interview with AAFP News Now, “This is a game in evolution, and there are going to be some twists and turns.”
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.
While a reduction of any amount hurts, there is a bigger problem on the horizon: the Medicare physician payment formula, known as the Sustainable Growth Rate or SGR. Under the SGR, a across-the-board 29.5-percent cut would take effect on Jan. 1, 2012.
Every congressional budget cycle since 1997 has included a reduction in Medicare payments that has eventually been modified. Since 2002, Congress has stepped in 12 times to stop the cut, including four times last year. And each year that Congress provides a temporary patch, the price tag gets steeper. According to the AMA, if Congress were to wait until 2016 to eliminate the SGR, the combined price of providing temporary patches and fixing the structural problem would approach $600 billion.
Now it boils down to deficit reduction; if Congress doesn’t address the broken SGR in some way, it will continue adding to the deficit. This gives the argument to repeal the SGR strength it hasn’t had in previous years.
The real value of the supercommittee is that there are no restrictions on what they can recommend to cut or how it scores savings; its jurisdiction gives the 12 members the ability to find offsets for other spending in all areas of government. By virtue of normal committee jurisdiction, fixing the SGR—a Medicare Part B issue—would usually mean finding offsets only within Medicare Part B, and that hasn’t been possible without hurting the program. Similarly, the supercommittee could recommend federal medical liability reform and score those savings toward deficit reduction.
Late last month, the American Medical Association and 10 specialty societies (including AAFP) sent a video to Congress on the need for full repeal of Medicare’s flawed Sustainable Growth Rate formula. At just over two minutes long, a combination of text and eerie techno-classical music sets the scene: “By acting now, Congress can preserve access to care for people on Medicare and reduce Medicare spending by hundreds of billions of dollars. Or it can put off a solution…again.” Weaving through charts and graphs, they make the golden deficit-reduction argument, ending with the final statement: “Stop digging the hole. Pay the bill. Repeal the SGR.”
[Can’t see the embedded video above? View here: http://youtu.be/jNmuyZWi3qc]
The AMA proposes a three-pronged approach: repeal the SGR; provide five years of stable payments with positive annual updates; and transition to a broad array of payment and delivery innovations.
AAFP outlined similar asks in a letter sent to supercommittee members last week. First, stabilize Medicare payments to physicians by repealing the SGR, and specify a payment rate for the next 3 to 5 years with a 3-percent higher rate for primary care physicians delivering primary care services. Second, avoid making reductions in Graduate Medical Education, especially GME payments for primary care education and training, to protect the physician workforce.
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.
The highlight of the conference was our live stream of the lecture “Know Before You Sign! What to Look for in a Physician Employment Contract, Including Employment by Non-Profit Health Corporations.” Though it occurred from 5:15 – 6:15 p.m. on a Saturday afternoon, we had about a dozen viewers join us live, and we continue to have hits on the archived video on our Ustream channel: http://www.ustream.tv/channel/texas-academy-of-family-physicians. We even received a shout-out from Dr. Sevilla on his Family Medicine Rocks blog for this effort.
As fleeting as it seems, there is a certain longevity to social media tweets and posts, and I encourage you to revisit them. There is still time to upload pictures to our Flickr account (become a member and join our group: http://www.flickr.com/groups/txfamilydocs/), and it only takes a minute to scroll through our tweets and Facebook posts.
And, as mentioned above, this conference provided the building blocks for what we hope will be a larger effort to draw in our members and connect them beyond the walls of a host hotel. Watch as we work to further integrate all of our social media platforms at future conferences, and also please continue sending your suggestions. That’s the beauty of social media – it’s not about the person with the account password, it’s an fluid stream of interaction constructed for and by its contributors.
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.
If you tweet during the conference, don’t forget to follow TAFP on Twitter and include the hashtag #TAFP in your tweets so it’s logged in our conference feed. Also make sure to check in on TAFP’s Facebook page. Post your thoughts on speakers, special events, and exhibitors. Shooting photos? Sign up through Flickr and upload them to our group, www.flickr.com/groups/txfamilydocs, so they’ll be displayed through the social media portal. Be sure to tag them to our set “TAFP Annual Session 2011.”
Not only will you be able to keep up with your colleagues in Dallas, but you’ll also be able to enrich your experience by connecting with your colleagues around the state, our top-rated speakers, vendors, and staff, and participating in discussions of your choosing— all right here through TAFP’s blog, TXFamilyDocs.org. For more information about Annual Session, go to www.tafp.org/education/programs/2011as.
Need some more convincing? Check out this great post from The National Association of County and City Health Officials on the top 10 reasons to use social media at a professional conference. The short version is that you get to connect to people you might not otherwise, extend your professional network, stay on top of meeting logistics, and provide information to those who aren’t able to attend. I found it useful to follow TAFP’s Twitter feed during AAFP’s NCSC and ALF conferences so I could get the scoop on concurrent sessions!