Posts Tagged ‘family physicians’
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.
Save money. Live better. It’s Wal-Mart’s corporate motto, but put it in the context of health care and add a third line targeted at improving care for individuals and you’ve got something awfully close to Don Berwick’s triple aim for health care reform. If cost is the real cancer in the U.S. health care delivery system—and we think it is—why not look to America’s low-cost leader for the cure?
When reports started hitting the news this week about a request for information Wal-Mart sent out to its vendors in late October announcing the mega-retailer’s intent to “build a national, integrated, low-cost primary care health care platform that will provide preventative and chronic care services that are currently out of reach for millions of Americans,” alarms went off in health policy circles across the country.
The company has since backpedaled on the statement of intent. John Agwunobi, M.D., M.P.H., M.B.A., head of Wal-Mart’s health and wellness division, released a statement on Nov. 9, 2011, saying, “We are not building a national, integrated, low-cost primary care health care platform.”
Well, that’s a relief.
What struck me about the RFI wasn’t just the ambitious statement of intent, now characterized by the company as “overwritten and incorrect,” it was the list of services Wal-Mart plans to offer: chronic disease management of everything from diabetes, asthma, and hypertension to sleep apnea, osteoporosis, HIV, and clinical depression.
A few years back, Wal-Mart announced plans to open more than 400 retail health clinics in its stores from coast to coast. As of now, it operates about 140 clinics. The company exerted its massive purchasing power and brought us $4 generic pharmaceuticals. And now it wants to bring its cost-cutting strategies to the chronic disease management market.
The trouble is the price points of primary care services and chronic disease management services aren’t the cause of our health care cost crisis. The real problem is the effect on system-wide health expenditures when chronic diseases aren’t managed properly. So maybe Wal-Mart’s idea of enhanced retail clinics could improve access to those services thereby improving population health and lowering overall health care costs, but I doubt it.
I tend to agree with AAFP President Glen Stream, M.D., M.B.I., who told National Public Radio that Wal-Mart’s proposal takes health care in the wrong direction. “I would still be gravely concerned that this is going to fragment care at a time when we now clearly understand that people having a usual source of comprehensive and continuous care in a single location is one of the main features that drives high-quality care, good patient health outcomes, and drives down costs.”
Today, family physicians across the country are transforming their practices to make them more accessible to their patients, and to evolve our delivery system into one that coordinates patient care in an efficient manner to make sure patients receive the right care at the right time and in the right setting. The 2010 AAFP Practice Profile survey shows that significant percentages of our members offer many of the same conveniences that retail health clinics offer. More than 73 percent offer same-day or open-access scheduling. More than 48 percent have extended office hours, and more than 31 percent offer weekend appointments.
Wal-Mart’s interest in expanding its line of health care services is a big indication that primary care is on the rise. Here’s yet another indication. The Baltimore Sun reported this week that Maryland state officials plan “to increase the number of primary care health professionals by as much as 25 percent in the next decade through a wide range of goals that include increased educational opportunities, financial incentives, and tort reform.”
Competition for primary care services is about to get fierce, folks. Wal-Mart knows where the money is and where the demand is. Seems to me family medicine is in a great position for strong market growth.
Texas House Speaker Joe Straus, R-San Antonio, released the interim charges for the standing committees of the House of Representatives. As he said in the accompanying letter, these charges will set the stage for legislation considered during the 83rd Texas Legislature, which convenes in January 2013.
Of those that may affect family medicine, one assigned to the House Committee on Public Health stands out for its sheer immensity. It directs the committee to:
- Examine the adequacy of the primary care workforce in Texas, especially considering: the projected increase in need (from an aging population and expanded coverage through federal health care reform), and cuts to workforce-building programs such as graduate medical education and physician loan repayment programs.
- Study the potential impact of medical school innovations, new practice models, alternative reimbursement strategies, expanded roles for physician extenders, and greater utilization of telemedicine.
- Make recommendations to increase patient access to primary care and address geographic disparities.
That about says it all, right?
Fortunately, TAFP is in a good position to positively influence the state health care reform discussion thanks to our members’ grassroots involvement through the TAFP Political Action Committee and the wise direction of big-picture strategists.
Because we’ve cultivated relationships with lawmakers, their staffs, and other capitol playmakers, they know the many benefits of primary care, family physicians’ concerns with the current system, and I’m convinced they even recognize the fonts and imagery on TAFP’s issue briefs. That means that we can actively work through the interim and the 2012 election cycle to proactively advance family medicine, and when the opening bell rings in January 2013, we’ll have laid the foundation to make substantial gains.
I invite you to use the comment section to give us your thoughts on any of the objectives above to give us direction as we move forward.
To the educators, what changes would you make to medical school curriculum that would provide the greatest benefit to the next generation of physicians?
To the innovators, actively experimenting with new practice models, what have you seen as the biggest barriers to controlling costs and providing the best care for patients?
To the rural physicians, what incentives are needed to draw more doctors to your area?
Eleven years ago, when I came on board as managing editor of Texas Family Physician, I was fresh out of journalism school with a love for design and an eye for art, photography, and typography, but no real-world experience in producing magazines. I learned much in those first few issues about the nuts and bolts of magazine production, all the while trying to appear as though I knew something about an expanding range of increasingly complex editorial topics my new magazine was required to cover.
My first cover story tackled the problems with the financing of graduate medical education – talk about jumping in at the deep end.
During those first issues, I knew the magazine needed a new look, a form and function that could achieve the news and information focus we wanted to deliver, while keeping the warmth and conversational nature we wished to convey. In 2002, we launched the first redesign of TFP under my direction, and while we’ve worked in each issue since to refine that design, I believe the artistic concept has served the Academy well.
For the past couple of years, we’ve been working on a fresh face for our magazine, a reinvention of the basic building blocks of the design, and with our Fall 2011 issue, we’re happy to unveil the new design. With a new nameplate and cover design, a fresh set of fonts, and a commitment to packaging content in smaller, more easily digestible bits, I believe this evolution of Texas Family Physician will keep our magazine at the top of its class.
Watch your mailbox and give it a read or view the virtual issue at issuu.com/txfamilydocs/docs/4mag2011. I hope you enjoy our new and improved Texas Family Physician.
By Juleah Williams
Among this season’s new fall line-up comes a new drama from the CW – Hart of Dixie – featuring surgeon-turned-country doctor Zoe Hart. Full disclosure: As can be expected from most CW programming, this show is geared toward a teenage audience and includes enough love triangles and “frenemies” to keep their attention. However, exposing this young population to the benefits of primary care and emphasizing the importance of having a relationship with a personal family physician is crucial to increasing interest in the specialty down the road.
As the story goes, Zoe graduated at the top of her class from medical school and seeks to follow in the footsteps of her father, a cardiothoracic surgeon. After residency she fails to be accepted into a fellowship because her superiors deem her “too cold.” Desperate, she decides to accept the offer of a kind stranger—who turns out to be her real father—to join his family medicine practice as a general practitioner in Bluebell, Ala.
Zoe moves from New York to Alabama to find that her real father has passed away and left her half of the family medicine practice. His former partner, Dr. Brick Breeland, resents the young hotshot doctor’s presence.
As a side note, while it’s technically correct that she can enter practice as a “general practitioner” without completing a residency, they refer to her later in the episode as a family doctor. Her patient population may include entire families, but she didn’t complete her three year residency in family medicine – and this is a little misleading for viewers.
Technicalities aside, the show’s characters find themselves in mostly-realistic, but dramatized medical emergencies that you might expect in a rural setting. And it’s in these moments that family medicine really shines. In the most recent episode, Zoe is nearby when a farmer’s arm is trapped under a piece of heavy equipment. Moving the machinery will cause him to bleed to death, so she must perform an arterial clamp in the field. However, she must call her indignant practice partner Brick for assistance because…wait for it…she was bitten by a snake earlier in the episode and only has one usable hand.
When he arrives, Brick doesn’t know how to perform the procedure and he refuses to let her talk him through it; he doesn’t want to be “her puppet.” Of course he relents for the good of the patient and together they save the farmer’s arm and life. As word spreads through the town, Brick receives all of the credit and Zoe (who has been trying her hardest to fit in) gets jealous.
This is the big moment: Zoe confronts Brick, saying that he couldn’t have performed the procedure without her. He replies with the fact that after the patient was out of danger, she left. He calmed the panicked patient, rode with him to the hospital in the ambulance, spoke to his wife and reassured her that their livelihood would be okay – all part of his comprehensive care after the initial encounter. This is the “ah-ha” moment of the show as Zoe recognizes that she has a lot to learn about being a primary care doctor.
So for now, the show portrays family physicians as the quintessential doctors – able to care for medical needs while adding an extra element of having a strong relationship with patients and a deep understanding of the community. That’s spot on. As the season continues, I’m intrigued about how the show will ultimately portray the small town family physician.
Juleah Williams is TAFP’s Student, Resident, New Physician, and Membership Coordinator.
By Richard Young, M.D.
A recent study in Annals of Internal Medicine looked at what happened when patients were cared for in the hospital by private physicians (presumably often their personal physicians) compared to hospitalists.
For a little background, hospitalists are doctors whose job is limited to taking care of patients in the hospital. They pick up new patients in shifts or cycles and almost always have no previous relationship with the patients. They rarely see patients in clinics and have no long-term outpatient relationships with patients.
This study found that hospitalist patients stayed in the hospital 0.64 days fewer than the private physician patients. This finding is consistent with previous studies. However, hospitalist patients were 18% less likely to be discharged home (more likely to a nursing facility), 18% more likely to make an ER visit in the 30 days after discharge, and 8% more likely to be readmitted to the hospital. This study was important because it measured real world performance across the U.S. after previous controlled studies showed the hospitalist approach had merit.
The hospitalist movement was born from many factors. One was the assumption that a doctor who is at the hospital can be more efficient because he can, for example, check on a patient later in the day and discharge the patient if a test performed in the middle of the day came back normal in the afternoon (while the private practice physician won’t come back to the hospital until the next morning). The private physician is paid nothing for any work past the first patient encounter each day. The hospitalist isn’t either, at least as a payable charge to Medicare or most insurance companies, but he’s at the hospital anyway so it’s not nearly as inconvenient for him to see the patient again.
To my knowledge, no study or private initiative has ever tried to preserve the personal physician-patient relationship in the hospital by paying the physician for the time it takes to do further work in one calendar day beyond the initial trip to the hospital–neither face-to-face work nor work performed electronically.
The best summary on the research of the impact of hospitalism to me is exactly what this study found — the length of stay decreases a little and is associated with a few problems down the road. Whether a patient spends three days or 10 days in the hospital has a lot more to do with how sick she is, not the kind of doctor providing the care. My biases about family medicine are transparent, but I can’t help wondering: if there is no significant improvement for a patient so sick she needs to be in the hospital to see a hospitalist, then why not create incentives and processes to encourage the pre-existing relationship with her family physician to continue in the hospital, especially when is she is the most ill, vulnerable, and scared?
The hospitalism movement is not a hindrance to improving our health care system, but it’s no solution either.
This post originally appeared on American Health Scare blog on Sept. 4, 2011. It has been reprinted with permission from Richard Young, M.D.
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.