August 2000 • Volume 6 • Number 8
Resource-based practice expenses
'Halt 2000' proposal would derail RBPEBY JANE STOEVER
Forty-some surgical groups are trying to take the steam out of resource-based practice expenses. The Academy and seven allies have come to RBPE's defense, wanting it to keep chugging toward its 2002 destination.
The surgical groups' proposal, "Halt 2000," would stop at midpoint the 1998-2002 transition toward using 100 percent RBPE for calculating Medicare payments.
Why the halt? To keep surgical specialists' share of the Medicare pot from shrinking.
The AMA House of Delegates adopted the Halt 2000 resolution June 14, despite strong opposition from the Academy and its partners in the Practice Expense Fairness Coalition. By press time, the coalition had succeeded in helping prevent Halt 2000 from being added to congressional bills.
The coalition represents more than 350,000 family physicians, pediatricians, internists, dermatologists, oncologists, osteopaths, rheumatologists and nephrologists.
What are the differences between the full RBPE at 2002 and Halt 2000? Two things: The new proposal has a $2 billion price tag and would wreck a carefully designed process. Practice expenses were reimbursed in 1998 according to historical charges that favored surgical services. Congress approved a gradual transition to RBPE based on data confirming that costs for overhead, staff and supplies for office-based services were underpaid.
Halt 2000, in a bow to primary care, calls for 19 Medicare codes for office visits/consultations to jump in 2000 to their expected 2002 levels. But thousands of codes would remain at their 2000 levels.
"If we approve Halt 2000, we continue the inequities of the historical charge-based system," Douglas Henley, M.D., told an AMA reference committee. He is an AAFP past president and the Academy's new executive vice president.
On June 21, AAFP President Bruce Bagley, M.D., of Albany, N.Y., wrote the House Ways and Means Committee: "Please understand that the Halt 2000 proposal not only divides medicine, but would encourage the groups that advocate it to continue to come to Congress each year for more modifications. By contrast, if we stay with full implementation of RBPE, the Congress need not reconsider the issue. A fair process will be in place that can be refined as necessary without congressional involvement each year."
On June 26, the Practice Expense Fairness Coalition encouraged Congress to continue the transition to RBPE. The coalition suggested that if there are additional funds for Medicare physician payments, Congress should commit $2 billion to increasing all physicians' payments by about 3 percent over the next two years. How? By increasing the conversion factor used to set the Medicare fee schedule. This across-the-board solution would maintain RBPE intact. Funds could come from the budget surplus. And all specialties would receive a 3 percent increase instead of having the some-win-some-lose result of Halt 2000.
Go to http://www.aafp.org/gov for a sample e-mail/letter urging Congress to support the full RBPE transition and an increase in the Medicare conversion factor. Click on "Speak Out," then on "Write to Congress," then on "Support Fair Payments for ALL Physicians!"
AAFP speaks up for access to reproductive health care
BY JANE STOEVER
With a boost from the Academy, the AMA House of Delegates voted recently for greater access to reproductive health care.
Delegates adopted a compromise resolution, saying it was not about terminating pregnancy but preventing pregnancy. At issue are hospitals that stop offering such services as vasectomies and tubal ligations after mergers with Catholic health plans or other organizations opposed to birth control.
The original resolution from AMA's California delegation said health facilities should lose federal funding if they don't provide birth control services.
The first to testify before the reference committee considering the resolution: Chicago's Cardinal Francis George. He charged the resolution could help tear Medicaid and Medicare funding away from Catholic hospitals that, on moral grounds, refuse to sterilize men or women.
Delegates said some women in rural areas have wanted tubal ligations right after childbirth, have not been able to have them where their children were born and had to travel later to distant hospitals for the procedure.
Dale Moquist, M.D., of Bryan, Texas, vice chair of the AAFP delegation, told the reference committee the AAFP supported the provision of reproductive services: "Many of our Academy members are in rural health care, where there is only one hospital, and we see this as an access-to-care issue."
The reference committee revised the resolution, deleting reference to federal funding. The committee retained the resolution's support for requiring health plans to provide enrollees with reproductive services when the services are covered benefits. The committee's revision reaffirmed AMA policy that no health care providers (including hospitals) should be required to perform any act violating their moral principles.
During debate on the floor of the house, an amendment was proposed: "In the case of mergers and/or acquisitions of health care systems, our AMA support(s) action to ensure continued patient access to pregnancy prevention services within the community, including tubal sterilization and vasectomy."
AAFP Director Deborah Haynes, M.D., of Wichita, Kan., said, "Consolidating health care systems have changed our health care environment and made access more difficult. We serve patients with diverse views and beliefs, and patients who desire pregnancy prevention should be able to obtain these services. We support the amendment."
The voice vote on the amendment was too close to call, so a standing vote was held, and the amendment passed 247-184. Then the resolution as a whole passed by voice vote.
The AMA meeting was June 11-15.
Medicare drug coverage plans spark political firestorm
Mrs. Smith, an elderly widow, needs two medicines for her heart disease. When money's tight, she buys one drug over the other and tries to get by.
Mr. Jones is on a top-dollar new drug for ulcers. He sometimes takes his pill every other day instead of each day to stretch his prescription.
Are these patients rare exceptions? Not a chance. They exemplify some patients of Daniel Heinemann, M.D., of Canton, S.D., a member of the AAFP Commission on Legislation and Governmental Affairs.
"I've never had patients pick between food and medicine, but they tend to skimp on their medicines," says Heinemann.
Complications from skipping medicines have landed a few of Heinemann's patients in the hospital. "Ironically, expensive drugs can help people stay out of the hospital," says Heinemann. "That saves the Medicare system. But it's a savings borne on the backs of the elderly."
With elections this year, Democrats and Republicans want to claim success in helping to cut seniors' drug costs. But the AAFP says a bill the House of Representatives passed 217-214 on June 28 -- the Medicare Rx 2000 Act, H.R. 4680 -- falls short of what America needs.
AAFP principles
The Academy is measuring various proposals according to these principles:
- Medicare beneficiaries at or below poverty level should receive full premium support for a prescription drug benefit (coverage at no cost).
- Some premium support should be offered to those with incomes at 100 percent to 150 percent of poverty level.
- Out-of-pocket expenses should be capped at $3,000 a year.
- There should be no annual or lifetime limit on the benefit.
- There should be no national Medicare drug formulary.
- Except for those within 150 percent of poverty level, beneficiaries could have a deductible of up to $300 per year and a copay of up to 20 percent.
- There should be a tax deduction or credit for out-of-pocket expenditures above $2,000 in any year.
Lanny Copeland, M.D. "Medicare without prescription drug coverage is an anachronism that must be righted by Congress."
Proposals in Congress
H.R. 4680 calls for a prescription drug program to be administered by a Medicare Benefits Administration and offered by private insurers and Medicare+Choice plans.
"There is no guarantee that private insurance companies will offer this benefit, and a separate program would add complexity and confusion to the Medicare program," says AAFP President Bruce Bagley, M.D., of Albany, N.Y. "We support coverage under the Medicare program."
H.R. 4680, backed by House Republican leaders, would cover prescription costs over $6,000 but would require many beneficiaries to pay nearly $5,000 of the first $6,000 per year. That "would be a burden, if not outright prohibitive, for some of our patients," says Bagley.
The AAFP supports a House Democratic proposal even though it would set the cap on out-of-pocket expenses at $4,000 (AAFP is calling for a $3,000 cap). The proposal would establish the drug benefit program within the current Medicare program and -- in a significant improvement over earlier drug coverage proposals -- would have no deductible.
The estimated five-year cost of H.R. 4680 is $40 billion, and that of the Democratic proposal is $80 billion. At press time, Senate leaders had yet to decide whether to back any Medicare prescription drug bill this year.
However, the Senate Finance Committee was working on a Medicare prescription drug benefits proposal. "Medicare without prescription drug coverage is an anachronism that must be righted by members of Congress," AAFP Board Chair Lanny Copeland, M.D., of Albany, Ga., wrote the committee July 12.
He listed elements the Academy hopes the committee will endorse and suggested what to avoid. "Proposals that rely on a separate insurance program, provide variable benefits to seniors or are too costly for beneficiaries to take advantage of would not meet the (AAFP's) standard," said Copeland.
In addition to assessing proposed legislation, the AAFP has objected to politicizing prescription drug coverage.
"This benefit has become a political firestorm," says Bagley. "Some seniors are already struggling with their bills. Don't make them struggle with the politics, too."
Contemplating cultural competency
Zainab Kalokoh, right, a recent immigrant from Sierra Leone, cradles her son, Ibrahim Sesay, while Kim Bullock, M.D., confirms acute otitis media.
Cues for care
If this mother and baby from Sierra Leone were your patients, information about that nation could prove helpful in your evaluation and treatment:
- Adult literacy rate is 33 percent.
- Infant mortality rate is 129 per 1,000 births.
- Life expectancy for males and females is 34 years.
- English is the official language, but most people speak Krio.
- Rice is a staple food, but malnutrition is wide-spread among children.
- Extreme poverty affects two-thirds of the population.
- Government-provided health care is considered inadequate.
- Citizens have a limited knowledge of nutrition and preventive care.
- Common illnesses include anemia, gastrointestinal disease, malaria and tuberculosis, and the HIV infection rate is high.
- Civil war in 1998 and 1999 inflicted terrible atrocities on the population.
Source: CultureGrams, 1305 N. Research Way, Orem, Utah
Kim Bullock, M.D., center, and second-year medical student Africa Wallace, left, discuss Andrew Epps' dislocated shoulder at Providence Hospital in Washington, D.C.
Desperate for a translator? Try Language Line Services, available 24 hours a day, seven days a week, translating more than 140 languages. Call (800) 752-0093 for information and fees.
BY SHERI PORTER
The results of a 1997 census survey won't surprise you if cultural competency is an issue on your personal radar screen: One in every 10 persons living in the United States is foreign-born.
Today's immigration rates are fast approaching the peak rates of the 20th century, reached between 1901 and 1910 when 8.8 million immigrants were admitted. Recent U.S. immigrants hail predominantly from Asian, Latin American, African and Caribbean nations. Currently, in seven states, more than 20 percent of residents do not speak English at home.
So if you're an FP who's been dodging the topic, America's changing demographics may prod you to examine your own cultural proficiency.
Why should you care? For a variety of reasons, says FP Kim Bullock, M.D., of Washington, D.C., who has written and lectured extensively on the topic. "Unless your comfort level is such that you know how to communicate -- even if it's not linguistically -- with people from different cultures, you are really stuck, professionally as well as personally," Bullock says.
Bullock makes a compelling case for upgrading cultural awareness because doing so will:
- help eliminate health care disparities among ethnic groups;
- improve the quality of health care and outcomes;
- help FPs gain a competitive edge in the marketplace;
- meet accreditation mandates; and
- decrease their liability and malpractice claims.
As an assistant clinical professor in Georgetown University Medical Center's Department of Family Medicine, Bullock wants the residents and medical students on her watch prepared to face the challenges of America's burgeoning diversity. She points out current demographic data and shares journal articles highlighting health care disparities among minority groups. She wants to impress upon them the impact that cultural competency will have on their practices.
"It used to be that you could choose to practice in an area that was very homogeneous -- small-town America. Well increasingly, there are fewer and fewer small-town Americas, where there's a real homogeneity to the entire population," Bullock says.
To help assess patients, Bullock, who is also assistant director of Providence Hospital Emergency Department in Washington, takes a cultural history right along with a medical history. "We ask questions related to religion, vocation, social history and family history, so that we can put that together as part of the picture when we're creating a management plan for the patient," Bullock says.
She insists that practitioners don't need extensive clinical knowledge or experience with ethnic groups to become culturally competent. "Most people think it requires a lot of expertise and training -- but there are some universal applications that we use every day with patients," she says. Good communication skills, appropriate use of interpreters and effective body language are good starting points.
"The increased number of malpractice cases doesn't necessarily have to do with a mistake or negligence; a large percentage of those have to do with communication errors," Bullock says. Try allotting more time for patients with communication limitations -- those not proficient in English, those with low literacy levels or even the hearing-impaired.
"What's important to all of us is our cultural background," says Bullock. "Our beliefs, our traditions, our history, our background -- that's what makes us who we are, and unless we as FPs are asking about that, we are missing a part of our patients that is critically important."
Read up on cultural awareness
Online resources
- "Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care," Society of Teachers of Family Medicine at http://www.stfm.org/corep.html
- Office of Minority Health Resource Center at http://www.omhrc.gov/
- Cross Cultural Health Care Program at http://www.xculture.org; offers ethnic community health profiles for a small fee
- CultureGrams, briefs on 173 countries of the world for a fee at http://www.culturegrams.com
Books
- Managing Diversity: A Complete Desk Reference and Planning Guide by Lee Gardenswartz and Anita Rowe; McGraw-Hill; 1998.
- Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions by Rena Gropper; Intercultural Press; 1996.
- Assessing and Treating Culturally Diverse Clients: A Practical Guide by Freddy Paniagua; Sage; 1998.
AAFP tackles cultural competency issue
In an effort to help members function in an increasingly diverse cultural environment, the Academy has begun work on production of a cultural competency clinical practice teaching module, "Quality Care for a Diverse Population." This project is in response to information gleaned from focus groups sponsored by the Academy and should be completed by early 2001.
This module features a video with nine vignettes, each exploring ethnic and sociocultural issues commonly encountered in a medical environment.
The project is a collaborative effort coordinated by an advisory group including Kim Bullock, M.D., (see story above) and Robert Like, M.D., director of the Department of Family Medicine Center for Healthy Families and Cultural Diversity at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. The project's senior advisor
is Jeannette South-Paul, M.D., chair of family medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md.Multiple studies demonstrate that clinicians sometimes provide a different level of care for patients from other cultures, said South-Paul. "This project will provide training in the delivery of high-quality care to all patients."
Complementary and alternative medicine
Do you know what your patients are up to?
BY CINDY McCANSE
Pop quiz
Name the primary indication associated with each of the following:
- St. John's wort (Hypericum perforatum)
- Echinacea (Echinacea purpurea)
- Ginkgo (Ginkgo biloba)
- Saw palmetto (Serenoa repens) (answers at story's end)
These days, if you're not fluent in "herbalese," you may be shortchanging your patients.
Echinacea purpurea: Help during cold and flu season?
Patient self-medication with herbal medicines and botanicals may be one of the fastest-growing trends in health care today. In fact, more and more patients are turning to alternative medicine providers of all stripes.
One widely known and well-regarded study published in the Journal of the American Medical Association puts the number of patients using complementary/alternative therapies at slightly more than 40 percent; other studies, at closer to 60 percent. What's perhaps even more surprising is the growing body of clinical evidence for the efficacy of many of these types of therapies.
Examples of Evidence
Take ginkgo extract in the management of cerebral insufficiency, for example. Bandolier, one of the premier sources of systematic reviews of clinical trial evidence, upholds the effectiveness of ginkgo for this indication.
Now contrast those results with findings published in the Cochrane Reviews comparing the benefits of routine continuous electronic fetal heart rate monitoring during labor -- a widespread and conventionally accepted practice -- with intermittent auscultation. The evidence shows that although the number of neonatal seizures drops slightly with use of electronic fetal monitoring, the rates of Caesarean section and operative vaginal delivery increase markedly.
Not a stellar performance, by any means. Yet fetal monitoring's the norm among Western practitioners.
Herbal and botanical products line the shelves of many retail pharmacies these days.
Why You Need to Know
These and related issues were addressed at several sessions during the May 3-7 Society of Teachers of Family Medicine annual spring conference in Lake Buena Vista, Fla. Andrea Gordon, M.D., of Puyallup, Wash., discussed her experiences at the University of Washington, Tacoma, teaching about herbs using a case-oriented, evidence-based approach.
"Some of them are useful tools," Gordon said. "Some of them are better tools than what we currently have. But some of them are potentially harmful." St. John's wort, for example, when used in conjunction with the protease inhibitor indinavir, has been shown to significantly decrease the effectiveness of the HIV-1 drug.
Because so many patients are availing themselves of herbal products, Gordon added, it's important for physicians to ask patients about them -- and ask about them in the proper way.
"It's not useful to say, 'You're not using any of that herbal crap, are you?'" she said. "You have to ask in a way that shows patients you care. And it's not just patients with cancer; it's older women coming in for their yearly exam."
Learning the Ropes
How'd you do?
- St. John's wort is used to treat mild depression.
- Echinacea is thought to stimulate the immune system.
- Ginkgo extract is used in the management of cerebral insufficiency.
- Saw palmetto is used in the treatment of urinary problems stemming from benign prostatic hypertrophy.
But there's far more to complementary and alternative medicine than just herbal and botanical products, and physicians need to keep pace with their patients, said Gordon's co-facilitator, Benjamin Kligler, M.D., M.P.H., of the Beth Israel Residency Program in Urban Health in Brooklyn, N.Y. Kligler cited a 1998 survey showing that 31 percent of U.S. medical schools required coursework about various CAM topics. The percentage that offered elective CAM courses was more than double that.
According to the survey, Kligler said, when CAM was taught in medical schools, it was more likely to be offered by departments of family medicine than any other specialty department. Not surprisingly, this appears to affect how family physicians perceive and react to CAM.
In another session at the STFM meeting, presenters Janice Probst, Ph.D., and Bruce Schell, Ph.D., discussed the results of a survey about CAM mailed to primary care physicians in South Carolina. Overall, family physicians were more likely than other primary care providers to ask patients about CAM and encourage them to use certain alternative therapies. They were also more likely to use particular CAM practices themselves and more eager to learn about unfamiliar CAM modalities.
Adding it all up
A 1995 survey* of family physicians' attitudes about complementary/alternative therapies found that:
- Over 90 percent considered counseling or psychotherapy, biofeedback, diet and exercise training, and behavioral medicine to be legitimate medical practices.
- Over 50 percent considered hypnotherapy, massage therapy and acupuncture to be legitimate medical practices.
- Well over 50 percent referred patients to nonphysician providers for diet and exercise training, counseling or psychotherapy, biofeedback and chiropractic services.
* "Physicians' Attitudes Toward Complementary or Alternative Medicine: A Regional Survey" by B.M. Berman, et al.; Journal of the American Board of Family Practice; September-October 1995.
CAM resources and related info
Online Resources on CAM
National Center for Complementary and Alternative Medicine at http://nccam.nih.gov/
The Alternative Medicine Home Page at http://www.pitt.edu/~cbw/gov.html
Evidence-Based Research Resources
Bandolier: Complementary and Alternative Therapies at http://www.jr2.ox.ac.uk/Bandolier/booth/booths/altmed.html
Index to abstracts of Cochrane Reviews at http://www.cochrane.org/cochrane/revabstr/mainindex.htm (full-text copy available by subscription only)
Related Academy news
"Staying ahead of the game: AAFP poised to revamp clinical CME accreditation system" at http://www.aafp.org/fpr/20000700/12.html
"What's all this ruckus about EBM?" At http://www.aafp.org/fpr/20000700/15.html
Stay tuned --
The September FP Report will take a look at how some family physicians are integrating complementary/ alternative medicine into everyday practice.
1999 ACF survey results reflect complexity of diabetes care
BY CINDY McCANSE
Results are in from two member surveys on diabetes care, one mailed before and the other mailed after AAFP's 1999 Annual Clinical Focus, "Management and Prevention of the Complications of Diabetes." All in all, the results give voice to a common adage: The more you learn, the more you realize there is to know.
The two questionnaires, each mailed to 4,400 AAFP members, compared self-reported levels of skill and knowledge about several areas of diabetes care. Although most respondents reported improvement in both their knowledge about and performance of various components of diagnosis, evaluation and treatment of patients with diabetes, the results identified modest -- although not necessarily statistically significant -- declines in some areas, a not unexpected finding for what is, after all, an ongoing educational program.
Physicians' overall comfort level in managing diabetic patients markedly rose. Respondents said that their ability to identify risk factors for type 2 disease increased, as did their familiarity with the complex set of diagnostic criteria for diabetes. Improvement was also seen in the regularity with which they referred diabetic patients for ophthalmologic screening.
Management and Prevention of the Complications of Diabetes Questionnaire Results
Before ACF initiative
After ACF initiative
Physicians cited the following as areas in which they desired further education to expand their expertise and practice skills:
- identifying intervention strategies to ameliorate risk factors;
- choosing the latest approaches to treating patients with type 1 diabetes;
- helping patients become more compliant with their treatment regimens, including adherence to dietary and exercise recommendations;
- boosting the percentage of diabetic patients who receive annual foot examinations; and
- using a multidisciplinary health care team to manage patients with diabetes.
According to ACF medical director Stephen Spann, M.D., of Houston, the survey results reflect the complexity of diabetes care, especially care of patients with type 1 disease. "Family docs don't see many patients with type 1 diabetes, and it's not surprising that they desire more confidence in managing this condition," he said.
"Compliance is always a challenge, and everyone would like to know how to improve this, including the diabetologists," Spann said. "The desire to do better with foot exams is positive, as is the desire to better utilize a multidisciplinary team." These and other practice issues will be addressed through several follow-up intervention strategies, the first of which -- a Video CME program, "Evaluation and Management of Lower-Extremity Diabetic Ulcers" -- is scheduled for release in September.
Changes in practice that respondents said they would make as a result of their ACF training included learning more about the ever-increasing number of drugs available to treat patients with type 2 disease, focusing more closely on monitoring hemoglobin A1c levels to improve glycemic control and aggressively treating both micro- and macrovascular complications.
Additionally, staff of the AAFP National Network for Family Practice and Primary Care Research and Baylor College of Medicine in Houston have teamed up to conduct a year-long study to investigate patient, physician and practice characteristics associated with varying levels of glycemic control and other outcomes in patients with type 2 diabetes. Spann is the principal investigator for the study, which will lay the groundwork for future research to develop and test interventions to improve outcomes in diabetic patients in the primary care setting.
Unsafe products?
Help get them off the market
The Academy has joined the Consumer Product Safety Commission and other health care organizations in a new campaign to get unsafe products off the market.
Recent reports indicate that many unsafe products are not reported to CPSC, resulting in numerous preventable injuries and some deaths. Children have been particularly at risk.
"It's time for all clinicians' organizations to re-emphasize the need for reporting and to work together in partnership with the CPSC to get unsafe consumer products off the market," the Academy said in a recent statement sent to the White House.
If you see a patient with a serious injury that may have been caused by a defective product, call the CPSC hotline at (800) 638-2772 or go to http://www.cpsc.gov/talk.html to report the product online. Your report might trigger a CPSC investigation that could lead to a product recall.
Reality check
Members weigh in on AAFP's role via member attitude survey
Nearly three out of four AAFP members think the Academy is doing a fine job of representing family practice to the rest of organized medicine, according to results of the 2000 member attitude survey that were released recently. Better yet, the percentage of those who strongly agreed the Academy does well in this respect jumped from 25 percent in 1999 to 39 percent this year.
The message was virtually the same for how AAFP represents family practice to patients and the public: 72 percent of respondents answered positively, and those who strongly agreed increased from last year's 22 percent to 39 percent.
AAFP's representation to government also earned high marks. The percentage of members who strongly agreed the Academy was appropriately representing their views before Congress, the Clinton administration and other governmental agencies leaped from 19 percent in 1999 to 34 percent in 2000.
Academy does good job representing family practice
Research plan helps family medicine
To the editor:
I'd like to share with AAFP members a recent, tangible example of the impact of AAFP's Plan to Enhance Family Practice Research.
At the Society of Teachers of Family Medicine's annual spring conference May 3-7, the directors of the three research centers funded through the AAFP's plan and the director of the AAFP Center for Policy Studies in Family Practice and Primary Care presented "Involving All Family Physicians in the Use and Generation of New Knowledge."
This plenary received a tremendously enthusiastic response and was one of the most highly rated presentations at the conference in recent years. Some members of STFM's board, among other attendees, commented that the plenary could have a palpable impact on attitudes toward research within STFM.
A transcript has been published in STFM's July/August Family Medicine, and audiotapes are available from STFM by contacting Shelly Langerock at (800) 274-2237, Ext. 5415, or recept@STFM.org.
I actually believe that the AAFP's plan has contributed to a change in the way research is being viewed in our discipline as a whole. Although this change in perspective may not be quite as tangible as some of the actual research outcomes that you may see from the plan, I believe that it may be one of the most important. Thanks to the AAFP Board of Directors for their decision to support research in our discipline and for their support of the research leaders who provided us with such a stirring plenary.
Perry Dickinson, M.D.
Chair, STFM Research Committee
DenverConservative proposes 'socialized medicine'
To the editor:
I'm a conservative, but I'm proposing "Socialized Medicine" because the confusion and destruction of health care by Medicare, Medicaid and HMOs are driving us all to desperation.
My proposal combines the principle of medical savings accounts with the annual income tax snafu. Set up a fixed annual premium, say $2,000, for each citizen, against which all medical expenses for the year are to be charged. The citizen is the one who decides which are true medical expenses. The government would pay demands for reimbursement out of the $2,000.
The $2,000 would be considered part of the income tax paid by the citizen. At year's end, any remaining balance would be paid to the patient or rolled over to next year's tax obligation. People below the level of tax obligation would be paid some or all of the unused $2,000, even though they didn't pay tax.
Expenses above the $2,000 would be covered by major medical coverage, perhaps paid by another $500 or $1,000 premium, non-recoverable by the taxpayer.
The only offensive part is federal government control -- but our medical system is already largely under that control. That would be eliminated by this proposal. The doctor-patient relationship would be restored.
Yes, this would likely cost somewhat more than at present. But Congress and the public must realize that health expenses must take a larger bite if we wish to continue having excellent medical care.
W.E. Manry Jr., M.D.
Lake Wales, Fla.
Martin Mahoney, M.D., Ph.D., left, past chair of the AAFP Tar Wars Advisory Board, appears with this year's national poster contest winner, Jenny Beck, and last year's winner, Matthew Stucky. At right is Jeannette South-Paul, M.D., a member of the Tar Wars Program Advisors. The winning poster is shown below.
Tar Wars poster contest honors young artists
This year's winning Tar Wars poster says it loud and clear: "We the people ... choose not to smoke."
More than 150 of those people attended the annual awards ceremony for the national Tar Wars poster contest July 13, expressing support for fourth- and fifth-graders across the country who used artwork to illustrate their tobacco-free messages.
The event was co-hosted by Rep. Jerry Moran, R-Kan., and the Academy, which operates the Tar Wars program. On hand were Rep. Marion Berry, D-Ark.; Rep. Howard Coble, R-N.C.; Rep. Charles Pickering Jr., R-Miss.; and numerous Congressional staff representatives.
Contest winners honored at the ceremony were Jenny Beck of Evansville, Ind., first place; Kathryn Cox of Washington, D.C., second place; Chelsy Larson of Monroe, S.D., third place; and Ryan Jones of Upper Marlsboro, Md., and Melanie Ezra of Flemington, N.J., who tied for fourth place.
Family physicians and other health care providers present the Tar Wars curriculum in the classroom to build students' awareness of attitudes about tobacco use, tobacco's effects on the body and the ways tobacco ads influence people. Students who participate in the program are eligible to enter a state poster contest; winners proceed to the national contest.
Tar Wars posters are displayed in schools and community sites as alternatives to tobacco ads. Winning posters from the national contest are printed on T-shirts, computer mouse pads and book covers.
For the Tar Wars curriculum and products, call the Academy at (800) TAR WARS (827-9277).
AAFP Congress to consider three Bylaws amendments
The AAFP Congress of Delegates, at its Sept. 18-20 meeting in Dallas, will consider three Bylaws amendments:
The first would delete the definition of "family physician" from the Bylaws because the definition may need to be revised. The Committee on Bylaws considered revisions but decided the current definition is appropriate for purposes of the Bylaws. The committee recommends not adopting the amendment.
The second proposal would clarify that international membership in AAFP is available only to physicians who practice outside the United States and who satisfy all other criteria specified in the Bylaws. The committee recommends adoption.
The third amendment would authorize the executive vice president to appoint one or more assistant secretaries of the corporation, subject to approval by the AAFP Board. The assistant secretary could attest to the authenticity of the EVP's signature and certify corporate actions. The committee recommends adoption.
Note: Beginning this year, the Congress will meet from Monday to Wednesday, a change from the traditional Tuesday-to-Thursday schedule.
To see the proposed amendments, access http://www.aafp.org/members/bylaws or call (800) 274-2237, Ext. 6452, for a copy of them.
Stay in the loop with HCFA's mailing list service
Due for board recertification?
Each year, as a benefit of AAFP membership, the Academy provides the American Board of Family Practice with a list of all Active and Supporting members who have reported sufficient CME to meet the ABFP's requirements.
To ensure that your personal CME record is up to date, check it out at http://www.aafp.org/cme, or call (800) 274-8043 to speak with a CME records representative.
Electronic e-mail updates are a great way for FPs to stay on top of changes in the Health Care Financing Administration's Outpatient Prospective Payment System.
Ongoing revisions in OPPS often have a spillover effect on physician providers. So you may want to sign up for this new service.
The mailing list service will automatically alert providers about OPPS changes, updates and events via e-mail messages. Robert Epps, health insurance specialist at HCFA's regional office in Kansas City, Mo., stresses that the service will not replace conventional methods of communication to hospitals, mental health centers, hospices and other providers, but it will provide a quick alternative source for information.
The new mailing list service becomes effective Aug. 1. For more information, check HCFA's Web site at http://www.hcfa.gov/medlearn/listserv.htm, where you can also subscribe to the service.
Congress' agenda
If you'd like to see what issues are bubbling in the AAFP policy pipeline, order the 2000 Congress of Delegates Handbook. It includes chapter resolutions and reports from the AAFP Board of Directors and commissions, committees and task forces. The handbook is sent free to AAFP leaders, delegates and alternates. You may purchase it for $35 by calling (800) 274-2237, Ext. 4214.
The resolutions are being posted at http://www.aafp.org/members/resolutions this month.
Who's running for office?
To see who's running for AAFP offices and the Board of Directors, access the candidate directory. It will be online by early August, complete with candidates' photos and résumés.
The Congress of Delegates will elect the 2000-2001 officers and three 2000-2003 directors Sept. 20.
The Congress will also elect delegates and alternates to the AMA House of Delegates, as well as candidates for the AAFP's position on the American Board of Family Practice Board of Directors. For the first time, photos of candidates for those positions will appear in the candidate directory.
Lobby Congress about collective bargaining, patient rights, tobacco lawsuit
Congress is taking its summer recess: prime time to contact lawmakers. They'll welcome your insights into health issues.
Here's a sampling of subjects the Academy has been lobbying for or against. You might want to cover similar territory with your legislators.
Collective bargaining. Medicine won a victory June 30 when the House of Representatives voted to allow physicians to bargain collectively with large health plans about quality issues and contract terms.
Ask your senators to urge Senate leaders to schedule a vote on the bill, the Quality Health Care Coalition Act, H.R. 1304.
One of the best ways to protect patients is to balance the enormous power of managed care with a little physician power.
Take action: Write or e-mail your senators by going to http://www.aafp.org/gov and clicking on "Speak Out" and then "Write to Congress." Patient bill of rights. Managed care reform suffered a loss June 29 when the Senate voted 51-48 for a bill that would leave millions of Americans with no protections and would offer only a restricted right for patients to sue health plans. The AAFP has sought comprehensive provisions similar to those in the Bipartisan Consensus Managed Care Improvement Act the House passed last year.
At press time, a House-Senate conference committee was still considering patient rights legislation.
Let your lawmakers know that family physicians want a strong bill that would protect all patients in health plans.
Funding for tobacco lawsuit. "It takes courage to stand up for the people at home ... and against the power of Big Tobacco," said an ad the AAFP helped sponsor in Roll Call, a Capitol Hill newspaper. The ad followed a House vote June 22 to take funds from several departments to support the Department of Justice lawsuit against the tobacco industry. The suit could win restitution for tobacco-related health costs covered, for example, by Medicare and Veterans Affairs. A settlement could cause tobacco companies to raise the price of tobacco products, which would reduce their use.
Ask your senators to let the DOJ assess other departments for the cost of the tobacco lawsuit.
Order from AAFP at (800) 944-0000 unless otherwise noted.
"Patient Education in Your Practice: A Handbook for the Office Setting" offers strategies for integrating patient education into your practice. This resource, approved for up to 8 hours of Prescribed credit, helps you develop teaching systems, evaluate your efforts and increase your chances of being reimbursed for your patient education activities (#R953, $34.95).
Study American Family Physician Online CME Cases. Read them free at http://www.aafp.org/afp/cases/ or pay $5 per case for 0.5 hours of Prescribed credit. The first two cases deal with panic disorder as part of the Annual Clinical Focus, Mental Health 2000. A new case will be added every two months or so. Cases in development deal with heart murmurs, refractory hypertension, asthma and allergic rhinitis.
If you've just become certified or recertified by the American Board of Family Practice, let your community know. Use the sample press release on board certification/recertification at http://www.aafp.org/members/cert online; it's also available via fax through AAFP Express (see "Quick Fax").
"Libby's Day at the Office" shows children that a family doctor and a mommy can be the same person. This coloring book looks at mom's work as an FP from her little girl's perspective (#R706, first copy free, others $5 each).
FP Report is published by the AAFP News Department. Copyright © 2000 by American Academy of Family Physicians.
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