American Academy of Family Physicians
 

search
 
Advanced Search

About UsNews & PublicationsMembersCME CenterClinical & ResearchPractice MgmtPolicy & AdvocacyCareers
FP Report
January 2002 • Volume 7 • Number 12

St. Paul drops policies
Availability of Malpractice coverage threatened

BY JODY McAULAY GLOOR

The St. Paul Cos. announced Dec. 12 that it's getting out of the medical liability insurance business worldwide. The company is the second largest U.S. provider of such insurance.

photo
Many cars display this language in West Virginia, a state in the midst of a medical liability crisis.

Medical liability policies for the 40,000 U.S. physicians now insured by St. Paul will not be renewed when they expire. Earlier this year, the company sent nonrenewal notices to covered obstetricians, general surgeons and emergency room physicians.

St. Paul opted to leave the medical liability business because of the financial burden of ever-increasing claims. Last year, the company collected premiums of about $530 million for medical malpractice policies, according to a Dec. 12 press release. However, St. Paul forecasts an underwriting loss in 2001 of about $940 million.

Recently, the company limited coverage for Georgia physicians to a surplus lines-basis only, a company spokesman said Dec. 4. These policies, he said, "allow physicians to customize coverage to fit their practices, and the company can charge an adequate premium." Now, those policies also will be dropped at renewal time.

"Adequate premiums" were skyrocketing in other states as well, driving practices out of business, said Thomas Stevens, president of Government Relations Specialists in Charleston, W.Va. An expert on medical liability issues, Stevens is the lobbyist for the West Virginia AFP.

"Physicians already are closing their offices because they can't afford medical liability insurance," Stevens told attendees at the AAFP Legislative Conference, held Nov. 16 ­ 17 in Bernalillo, N.M.

"Now that St. Paul has stopped writing policies, only a handful of insurers will be left, which will drive costs up further," he said Dec. 12.

"Just look at the fate of physicians practicing obstetrics in the Delta," said FP Randy Easterling, M.D., of Vicksburg, Miss., at the conference. Rising liability costs are causing doctors to move out of the region, leaving thousands of patients without obstetric care.

"Even industries recruited into Mississippi are very concerned that adequate health care can't be provided in that area," Easterling said. And many companies may pull out, adversely affecting the entire state's economy.

Before the Dec. 12 announcement, St. Paul sent nonrenewal notices to every covered physician in West Virginia. St. Paul's actions and excessive premiums prompted a medical liability crisis in the state, Stevens said. Physicians are struggling to find coverage elsewhere and keep their practices open. "In fact, one of the most popular bumper stickers in the state reads, 'Sick? Call a trial lawyer!'"

In response, the West Virginia House of Delegates passed a bill Nov. 27 that would create a temporary medical liability insurance plan operated by the state. If similar legislation is approved by the state Senate, an estimated 200 ­ 300 physicians will have alternative malpractice insurance.

Stevens believes the only way to deal with this crisis nationwide is to advocate tort reform. Many attending the legislative conference agreed.

"We need to be more proactive," said Timothy Alford, M.D., of Kosciusko, Miss., who serves on the AAFP Commission on Legislation and Governmental Affairs. "The blood that has to be spilled to get reform in this area is sometimes fatal when doctors leave practice."

Effective tort reform, Stevens said, must include:

"But even if states enact tort reforms -- and courts don't interfere -- it doesn't mean medical malpractice insurance will be available," Stevens told the crowd. "Politics is not a spectator sport anymore. Get involved in the legislative process."

Tort reform alone won't solve the medical liability problems physicians have faced during the last 200 years, said AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis. In fact, some tort reform actually could raise insurance costs. The problem involves the judicial system as well as insurance companies, physicians and patients.

"Medical liability is a complex and frustrating issue for physicians and patients," he said. "The AAFP remains very concerned about the need to develop a fair and efficient system for resolving malpractice disputes. We will continue to advocate for our members to that end."

Alford called on the Academy to "give members ammunition to take to legislators by measuring this crisis, measuring the outcomes and helping us take action before the next crisis hits."

The Mississippi State Medical Association and Mississippi AFP plan to encourage state lawmakers to introduce a tort reform bill that will "ease the current physician burden" of medical malpractice, said Alford.

Specialty to get new research journal

San Francisco

BY PAULA BINDER

A clinical research journal for family medicine will begin print and online publication in late 2002, the Academy and four other organizations an-nounced here Dec. 4.

AAFP President Warren Jones, M.D., of Ridgeland, Miss., said the need for such a journal has in-creased recently. The Journal of Family Practice has shifted from a focus on entirely original research to an emphasis on articles translating research into practice, he noted. That left a gap within the discipline, already constrained by the demise two years ago of AMA's Archives of Family Medicine, which was dedicated to original research.

photo
Marjorie Bowman M.D.
"As soon as people learned this journal was going to happen, I started to get e-mails asking how to submit."

The new journal won't be just for family physicians, Jones said. "We expect that the Annals of Family Medicine will be acknowledged as the premier journal for those who are looking for better ways of delivering care."

In addition to the AAFP, these organizations are supporting the Annals of Family Medicine: the American Board of Family Practice, Association of Family Practice Residency Directors, North American Primary Care Research Group and Society of Teachers of Family Medicine.

Representatives of all five groups participated in the press event announcing the journal during the interim meeting of the AMA House of Delegates.

The new journal will "foster the knowledge base for the generalist health care disciplines" by publishing the best new primary care research, methodology, theory and commentary, said NAPCRG President Kurt Stange, M.D., Ph.D., of Cleveland.

"As soon as people learned this journal was going to happen, I started to get e-mails asking how to submit," said ABFP President Marjorie Bowman, M.D., of Philadelphia. She edited AMA's family medicine journal and is president of the Annals of Family Medicine Board of Directors.

AFPRD members are "extremely excited about the educational and publishing opportunities offered by the Annals of Family Medicine," said AFPRD's representative, Ted Epperly, M.D., of Boise. "America will be healthier because of this publication."

"We welcome this tool as an aid in our teaching and training of future family physicians, as well as a major resource for publication of our contributions to the discipline's research base," said STFM Past President Jonathan Rodnick, M.D., of San Francisco.

AAFP members will be able to request a free subscription to the Annals of Family Medicine when the first edition is published.

Academy steps up its role as bioterrorism information resource

The Academy takes a back seat to no one when it comes to bioterrorism preparedness. That leadership was recently recognized in a big way: Member journals of the Association of Medical Publications asked AAFP to share its Web-based bioterrorism resources with other front-line medical professionals.

photo

So AAFP last month developed and will maintain the new site, http://www.btresponse.org, with pro bono advertising support from the AMP (see ad at right). Clinical and educational resources on the site mirror those on AAFP's own bioterrorism Web page at http://www.aafp.org/btresponse/.

Among numerous materials available on each site are the latest bioterrorism-related disease updates published in the CDC's Morbidity and Mortality Weekly Report. Also featured are information about and links to Webcasts from the CDC and other organizations, as well as Academy CME activities, enabling health professionals to recognize and treat bioterrorism-related illnesses.

Directories of state health agencies and FBI field offices will help facilitate timely and accurate reporting of suspected bioterrorism events. And links to patient-oriented resources allow medical professionals to educate and reassure their patients. One such piece, a patient handout titled "Bioterrorism: What You Need to Know," is also available on AAFP's familydoctor.org site for your Internet-savvy patients. Alternatively, you can obtain a copy via fax for posting in your office (see "Quick Fax").

The Academy site continues to provide members access to resources specific to AAFP members, such as a letter from AAFP President Warren Jones, M.D., of Ridgeland, Miss., describing the role of the sentinel family physician in bioterrorism preparedness. Also available on the AAFP site is a link to an e-mail discussion list allowing members to share news and views on bioterrorism issues.

Session explores 'vicarious impact' of Sept. 11

BY TONI LAPP

Seattle

A mericans' psychological responses to the Sept. 11 attacks have been proportional to their distance from New York City, said a speaker at a special session on dealing with fear at the Patient Education Conference held here Nov. 15 ­ 18.

But even though most Americans have not been directly affected by the attacks, "I was struck by how interconnected we all are. Even at a geographic distance, everybody had a connection with what happened," said Steven Shearer, Ph.D., a clinical psychologist at Franklin Square Hospital Center in Baltimore. He spoke about those who have been "vicariously impacted" during his talk at the conference, which was co-sponsored by the Society of Teachers of Family Medicine and the AAFP.

photo
Cindy Barter, M.D., says she was stymied in her attempt to get a live voice when calling CDC about a postal worker with a rash.

The discussion sparked heated debate when participants began talking about the public health response to the anthrax threat. Some decried the failure to detect the infection of postal workers who later died. Others said it was justified to be caught off­guard, given the minimal threat of anthrax before now.

"Helping Patients -- Dealing With Fear in America" featured discussion by Shearer and Linda Prine, M.D., medical director at Sidney Hillman Family Practice in New York City. She spoke of the problems of persons directly affected by the Sept. 11 events.

Shearer addressed normal responses to vicarious trauma such as persistent re-experiencing of the attacks, be it intrusive images of mourners or of planes striking the towers. Other patients report recurring nightmares and being unduly startled by airplanes or sirens. Hyperarousal may occur, he said, causing insomnia, difficulty concentrating, irritability and anger.

Shearer originally was scheduled to speak at a conference session on an area of expertise for him: counseling patients with a fear of flying. One might think that business would have picked up for Shearer, but "most patients who were fearful before are now saying, 'Thanks, but no thanks,'" said Shearer, conceding that even he now views low-flying airplanes with trepidation.

His observation has been that outside of New York City, mental health offices have not been overrun by people seeking therapy, contrary to what he has found reported in the media. Patients who were already on edge experienced a reverb, but, for better or worse, society seems to be getting back to normal, he said.

Participants had a chance to comment, and the public health response to anthrax became the focus. Donald Bosshart, Ed.D., chair of the National Center for the Evaluation of Residency Programs in Kent, Ohio, objected to the criticism and blamed the media for negative coverage of the public health system. "When was the last case of anthrax?" he said. "We have to look at probabilities."

"I suggest that we take some time out from the news," he said.

Some FPs told of their own encounters with worried patients. FP Cindy Barter, M.D., of St. Louis said she faced uncertainty when a postal worker presented with a rash. Unsure of what tests to request, she was stymied in her attempts to reach a live voice when she made calls to the CDC. "We need to question how we communicate among ourselves to try to get answers when something comes up quickly," she said.

STFM President Denise Rodgers, M.D., of New Brunswick, N.J., said she volunteered for a state health department hot line to answer questions on anthrax. "You want to be able to reassure people, but the anxiety level is sky-high" in her area, she said. "The thing for me that is the scariest is the realization of just how unprepared as a country we really are."

Perception of anxiety across the U.S.

Are people suffering from increased anxiety since Sept. 11? "Not out here. Not my patients," says Leonard Fromer, M.D., who has a family practice in Santa Monica, Calif. His assessment lends support to the theory that Americans' psychological responses have been proportional to their distance from New York City.

More patients have asked about bioterrorism issues, Fromer said, "but in terms of people saying, 'I can't tell why, I'm more fearful than normal' -- I haven't seen that."

A Midwest physician concurs in part: "People have been affected by the threat, the changes in their lives and the fear, but not to the same degree as people who have been personally affected by it," said FP Larry Rues, M.D., residency program director of Goppert Family Care Center in Kansas City, Mo. "It isn't a personal loss for most."

But personal losses have been staggering in the East. Stress is still high, and physicians and patients alike are losing sleep over it, said FP Joseph Wiedemer, M.D., of Stockton, N.J.

The challenge is twofold, he said: People who were displaced by the terrorist attacks are now moving back and are reliving the event or realizing the destruction for the first time, he said. And then there's the fear over anthrax; one post office that was affected is just 30 minutes from his practice. On a scale from 1 to 10, Wiedemer said the stress level at his office during the height of the anthrax scare was a high 8 or 9. "We're looked to as physicians to provide professional answers" to concerns over anthrax, he said, and there's still uncertainty.

He said he realizes the stress has abated in other parts of the country, and he sees this as a healthy sign. "We've all gone through the shock, anger and disbelief, and now it's time to move on," he said.

'Our touch really matters to our patients'

WARREN JONES, M.D.

Today's family physicians face tough challenges -- including ones brought on by the heightened concern about terrorism. In this interview, AAFP President Warren Jones, M.D., of Ridgeland, Miss., talks about those challenges, about the FP's role as the "sentinel family physician," and about the strengths FPs and the Academy bring to the medical profession.

photo

photo

photo

What key issues face family physicians today?

Let me note a few concerns.

What do patients look for in a family physician?

Compassion, competency and effective communication.

Our touch really matters to our patients. I have often asked people who go to other family physicians, "What do you think about your family doctor?" They've repeatedly said their family doctor touched their lives.

Our health care system is broken. Lots of times, patients receive compassion and down-to-earth explanations from family doctors but not from other doctors. When people don't care and don't communicate, it makes traversing the broken health care system much more difficult.

You've called on members to be the nation's sentinel family physicians in the war on terrorism. What does that mean?

Our Academy is gathering resources (see "Academy Steps Up Its Role as Bioterrorism Iformation Resource") to help us:

Current disaster plans -- for floods, earthquakes, fires -- focus on hospital care. The dollars are for inpatient care, the training is for hospital-based professionals, the equipment is for hospitals.

So who will identify the patient who comes to the doctor's office with an unusual set of symptoms? Family doctors need to be able to tell public health authorities, "I don't usually see these symptoms at this time of year." We need to make sure family physicians help plan for disasters and are interwoven into response strategies, community by community.

You've said caring for adolescents and preventing teen violence are especially important to you. Why?

A lot of people are combating gun violence and, specifically, violence among teens. That's important, but even more important is realizing that the violence erupts when people don't know how to eliminate a conflict at its lowest level. The conflict finally leads to a major injury, homicide or suicide.

I had 11 brothers and sisters. My dad moved away from our home in New Orleans when I was 5. He never lived far away, but he never lived with us again. In large measure, I think his leaving was due to our family's inability to resolve conflicts early.

As I reached my mid-teens, I became a juvenile delinquent and ended up almost going to jail. Were it not for some people who saw a future in me, I would have been a statistic. Eventually, I learned conflict resolution skills; that helped turn me around.

I'd like family physicians who are helping parents or youngsters resolve conflicts to contact this newspaper at fpreport@aafp.org or (800) 274-2237, Ext. 5216, and share techniques for de-escalating conflict.

What does the complexion of the AAFP Board say to America?

We are black, brown, white, women, men, young, old, rural and urban. I -- and some other Board members -- can make sure that when we talk about issues, we don't miss the inner-city component, the poor, the un-derrepresented. The woman at our table who is brown can make sure we don't overlook migrant workers and immigrants. And so on.

What that says to America is that our organization addresses concerns of the full scope of our population -- rich, poor, people of different colors, of many backgrounds. Our Academy has voted into leadership people who've walked miles in different kinds of shoes.

Do FPs sense how important they are to their communities?

When family physicians are sick, retiring, shifting from full-time to less-time practice or moving to another town, patients come out of the woodwork and say, "We miss you! We love you!"

During our typical years of practice, however, many patients thank us with a smile or comment we might not heed. Occasionally, a patient might bring in a cupcake and say, "I know you've got a sweet tooth." In the bayou, where people go shrimping, it might be a little freezer bag of shrimp. What a measure of love!

The Academy is working hard to minimize the irritants that hinder us -- coding issues, reimbursement problems, legislative boondoggles. It's up to us in our practices to focus less on these hassles and reclaim the joy of our specialty.

AAFP Reference Guide -- your source for quick info

Would you like information on a particular AAFP service, product or meeting, but don't know the right person to call? Do you need to talk with knowledgeable staff about an issue, whether it's computer software or hospital privileges?

Use the 2002 AAFP Reference Guide, which lists contact persons ready to help you.

Visit the members-only section of the AAFP Web site at http://www.aafp.org/members/staff/resource.html to access the guide online, using your AAFP ID number. Or request a copy by calling (800) 274-2237, Ext. 4201.

Passion can turn FPs into powerful advocates

BY JODY McAULAY GLOOR

Bernalillo, N.M.

The power of family medicine isn't limited to the art and science of patient care. Family physicians are faced with an ever-increasing need to speak out on behalf of their patients and their specialty in the public arena, where FPs can unleash their power and effect change, said FP Wanda Filer, M.D., of York, Pa.

What's the first step in power brokering? "Become the resource for information about improving health and patient care" for local, state and national leaders as well as the media, she said.

photo
"Decide what needs to be done, and put those actions into words," says Wanda Filer, M.D. "Then put those words into action."

Although some family physicians still struggle with their identity, and morale among them may be low, it's time to "rediscover the passion of being an FP and establish our specialty as the premier patient and community health advocate," Filer told nearly 100 chapter leaders at the AAFP State Legislative Conference held here Nov. 16 ­ 17.

"We have a tremendous breadth of knowledge," she said. "When I walk into a room and I see a newborn and then walk into the next room and see a patient who's 106 years old, that's critical. That's what we as FPs do. We need to let people know that."

How? Physicians can mobilize the power of family medicine by "tuning in" to current medical issues and re-examining the political process -- especially, said Filer, relearning how a bill becomes a law.

Also build public speaking and media skills to effectively convey health information, she said. "Learn how to make your point in 60 seconds or less. Sound bites and quotes must be brief and succinct."

Recognize your own expertise, and offer it to the community, she suggested. Explain your profession and the depth of your health care knowledge to local, state and federal lawmakers. "We can talk to them from a very humanistic level because of the way we care for our patients. We lose opportunities when doctors don't talk to legislators," Filer said.

Speak to other medical organizations, public health officials and advocacy groups, she said, and create alliances with them as well as with business organizations, educators and philanthropic groups.

"Find people who have key contacts with legislators if you don't," Filer said. "Talk to the media and offer your services as a consultant when medical issues come up. Get on boards and meet their members. Get involved in some way." Position yourself and the Academy in such a way that when medical issues arise, legislators and the media come to you. "Our patients are their customers. Our patients are their constituents, and our patients are their readers and viewers. Don't let them forget that!" she said.

Building these relationships takes time, and most FPs experience "extreme shortages" of time, said Filer, "but we can overcome that by prioritizing what we need to advocate for and defining our role in that effort."

"Be active listeners with your patients and your community," she added. Then testify on issues important to them before task forces, state lawmakers and even Congress.

"But how do you get the nerve to become a witness and testify?" asked one FP at the conference.

"Testifying is a piece of cake," Filer answered. "To prove it, consider this. Remember performing your first rectal exam?" The audience roared with laughter.

Filer practices in York and is founder of the Strategic Health Institute. She previously served as Pennsylvania's first physician general and is a health correspondent for a Lancaster, Pa., TV station. She also is involved with many organizations working for health policy improvement and advocacy development.

Opportunities for advocacy

Family physicians face many advocacy opportunities each day, said Wanda Filer, M.D., of York, Pa. One area of great interest nationwide continues to be women's health.

"For American women, the leading cause of death is heart disease, not breast cancer," Filer said. "The leading cause of injury to them is domestic violence. The leading cause of cancer death among women is lung cancer, not breast cancer, as commonly believed. Are we telling everyone this? We should be!"

Advocacy efforts also are needed, she said, on issues such as:

Diabetes: It affects more than 8 million women and 6 percent of the nation's total population.

New epidemics: Arthritis patients lack affordable insurance benefits and need safer and more effective treatments. Osteoporosis causes a new fracture every 20 seconds.

Mental illness: It affects one-fourth of Americans in any given year, including about 13 percent of children ages 9 ­ 17.

Use personal approach to influence lawmakers

Bernalillo, N.M.

When it comes to making decisions about health care policies, most legislators don't have the medical knowledge to deal with the issues. That's why family physicians must share their expertise with lawmakers, said FP John Redwine, D.O., of Sioux City, Iowa.

"Yes, you can buy legislators' attention. But buying their attention is not buying their votes," says John Redwine, M.D.

First, you have to get in the legislator's door. Redwine, a state senator in Iowa, said to start by making appointments through the legislators' district offices.

"See them in your neighborhood," he told attendees at the AAFP State Legislative Conference, held here Nov. 16 ­ 17. "And do your homework first. When you call, you need to know at least a little about the issue for which you want to garner support."

Personal visits influence lawmakers. Even if they end up voting against you on one issue, they may side with you in the future. "Get to know your legislators personally, any way you can," Redwine said. "Establish that relationship before there is something you need."

Keep their attention by contributing to political action committees and candidates' campaign funds, but know the rules and limits in your state, he advised. "Yes, you can buy legislators' attention. But buying their attention is not buying their votes."

Also, he said, form letters work well, especially when lawmakers receive them in large quantities.

"So when the Academy alerts you to act, act now!" Redwine said. "Believe them, and be quick about it. When a vote is imminent, that's the time to strike."

Visit AAFP's Speak Out: Legislative Action Center at http://capitol.aafp.org for more information about working with government officials. Click on "Elected Officials" to find your lawmakers and their contact information. Click on "Issues and Legislation" for the Academy's calls to action and information on other hot topics and legislation. And while there, check out "Capitol Hill Basics" for more tips on communicating with Congress and to learn how bills become laws.

Rise to challenges posed by genetic screening

BY TONI LAPP

Seattle

The ability to genetically screen for diseases far outpaces the ability to treat such conditions as breast cancer, Alzheimer's disease and prostate cancer. Plenary speaker and FP Howard Brody, M.D., Ph.D., issued that warning to attendees at the 23rd annual Conference on Patient Education here on Nov. 18.

Illustration
Evidence should include the physician's hunches and the patient's wishes, as well as data from randomized clinical trials.

Such a disconnect should prompt physicians to view genetic tests in the larger framework of evidence-based medicine, suggested Brody, professor of family practice and philosophy at Michigan State University, Lansing.

In fact, genetic tests for breast cancer, Alzheimer's disease and prostate cancer "are not ready for prime time," said Brody, noting that the companies that own the tests are the source of data on the tests' accuracy.

One concern is that money, not science, is driving the push toward genetic testing, said Brody. He foresees a future in which companies with vested interests in genetic testing will go directly to patients, much as direct-to-consumer advertising is now being conducted. Physicians should arm themselves with evidence-based knowledge in preparation for this, said Brody.

Yet evidence-based medicine need not exclude "clinical hunches" and patient values, said Brody. Medical information should be managed so that the best available evidence is used to guide treatment decisions. That evidence should include the physician's hunches and the patient's wishes, as well as data from randomized clinical trials, he said.

Problematic is the fact that not all physicians are on the same page with evidence-based medicine. One example Brody cited of medical practice not following evidence: starting to give mammograms to women at age 40, regardless of the screening's proven effectiveness for women that young. (AAFP recommends counseling women ages 40 to 49 about risks and benefits of mammography and clinical breast exam, and offering mammography and clinical breast exam every one or two years to women ages 50 to 69.)

Another concern Brody has is the misguided belief among the public that screening itself confers some sort of protection against a disease. Some patients are shocked when a test actually comes back positive, thinking that they had somehow earned "gold stars" by being screened, said Brody.

One concern about genetic testing that's not being addressed is the implication for family members, said Brody. Physicians must acknowledge that disclosures made about a person's bloodline affect the whole family. To illustrate, he pointed to the descendants of Sally Hemings and Thomas Jefferson. Because one or two descendants consented to genetic tests, revelations concerning all family members were made public. "What gave us the right to know?" Brody asked.

He suggested that a "family covenant" be made before going through genetic screening. Such a document would be negotiated among family members with the help of a physician. Family members who "opt in" set conditions and are privy to the knowledge that comes out. However, the concept of a covenant is lagging behind advances in genetic testing. "Where we most need the covenant is where we have the least expertise," said Brody.

AAFP fuels fire
'Unfunded federal mandates' come under attack at AMA

BY PAULA BINDER

San Francisco

The Academy came to the fore on two different issues related to "unfunded federal mandates" for physicians during the AMA House of Delegates interim meeting here Dec. 1 ­ 5.

INTERPRETER SERVICES

Thanks in part to efforts by the AAFP delegation, the AMA will urge that payments for medical interpreter services for patients with limited English proficiency, or LEP, be made directly to the interpreter. In addition, the AMA will continue to oppose requirements that hold physicians responsible for interpreter expenses.

photo
Dale Moquist, M.D.
"The house of medicine really needs to take a look at the whole issue"of HIPAA.

According to an AMA Board of Trustees report on medical interpreter services, in August 2000 the HHS Office of Civil Rights published requirements for health care organizations that treat patients with LEP. Under those requirements, physicians face an unfunded mandate to provide a clinical interpreter for each LEP patient if the physician receives any federal financial assistance, including Medicaid payments.

Hiring an interpreter could cost between $30 and $400, the report said, while physician payment for a Medicaid office visit could range from $30 to $50 in many states.

The report recommended that the AMA actively oppose the inappropriate extension of the Office of Civil Rights' LEP requirements to physicians in private practice, and that it continue efforts to correct the problems imposed on physicians in private practice by the OCR language interpretation requirements.

Dale Moquist, M.D., of Bryan, Texas, vice chair of the AAFP delegation, rose on the house floor to propose an additional recommendation, which directs the AMA to urge that interpreter payments go directly to the interpreter. The house adopted all of the recommendations.

"Direct, adequate reimbursement to interpreters would help patients with limited English proficiency get the services they need," said Moquist. "It would also relieve physicians of a financial burden and hassle imposed on them by the federal government."

HIPAA

The AAFP delegation took on another unfunded mandate by suggesting the AMA adopt the language of an AAFP policy on the Health Insurance Portability and Accountability Act.

The Utah and Oklahoma delegations brought resolutions about HIPAA concerns to the house; then the delegates adopted an amended substitute resolution that incorporated much of the Academy's HIPAA language.

The adopted language reads: "Resolved, that our AMA shall continue to make it an urgent priority to undertake a comprehensive review, including unfunded physician costs, of HIPAA transaction, privacy and security rules to identify provisions that should be clarified, improved or repealed, and communicate these urgently needed changes to the Department of Health and Human Services and Congress for prompt action, including any necessary delays in implementation, as appropriate."

AMA PSA directs patients to FPs, Web site for bioterrorism information

In a nationwide bioterrorism education effort, the AMA last month distributed a televised public service announcement directing patients to consult their family physician and the AMA Web site for up-to-date information on biological and chemical terrorist attacks.

The PSA is part of a comprehensive AMA program to educate patients and physicians on how to respond to such attacks. The Web site is http://www.ama-assn.org -- at the site, click on "Bioterrorism and Medical Preparedness."

In addition, all physicians in the AMA will receive a CD-ROM with clinical information on biowarfare threats such as anthrax and smallpox, as well as details on hospital preparedness and the medical management of biological and chemical casualties.

Marching orders for AMA

The AMA House of Delegates, during its interim meeting last month, took these actions on the following issues.

Tort reform

Medicare reimbursement

Screening lipid profiles and blood sugars

Influenza vaccine

Vaccine and drug shortages

With the new year come new CME opportunities

BY CINDY McCANSE

Raise a toast to a new Academy educational initiative! Beginning this month, AAFP-accredited CME providers gain the option of incorporating the principles of evidence-based medicine into their CME activities.

"It's very exciting," said Nancy Davis, Ph.D., director of the AAFP Continuing Medical Education Division. "We think this new option provides a real value to physician learners. It assures them that practice recommendations made during an evidence-based CME activity result from a systematic review of all the available evidence."

Goal of new system: to determine whether evidence-based learning improves physician performance and, ultimately, patient care.

Defined as "the integration of current best research evidence with clinical expertise and patient values," EBM has played a key role in medical school clinical training for several years. Early in 1999, the AAFP took up the challenge of reassessing its clinical CME accreditation system. Why? Partly in response to concerns by state medical licensing boards that accreditation systems then in use allowed CME credit for activities teaching or promoting unproven therapies. The reassessment led to new criteria for evaluating and categorizing CME clinical content.

Several external organizations provided input in developing the new initiative -- the Accreditation Council for Continuing Medical Education, American Board of Family Practice, American Osteopathic Association, AMA and Federation of State Medical Boards.

The concept is straightforward: CME clinical content is considered evidence-based if it is presented with practice recommendations supported by research evidence that has been systematically reviewed by an AAFP-approved source. See "AAFP-Approved Source of Sytematic Evidence Previews" for a list of those sources.

PROVIDERS HAVE OPTIONS

Under the new system, CME providers will indicate on the AAFP CME credit application form how many total Prescribed and/or Elective credit hours they are requesting and, of those, how many hours are being submitted for review as evidence-based CME. Evidence-based CME is optional and requires special documentation.

CME content based on customary and generally accepted medical practice remains eligible for Prescribed and/or Elective credit with no new documentation requirements.

Content that is neither evidence-based nor based on customary and generally accepted medical practice but is not dangerous is eligible for Elective credit only.

PACKETS RECEIVED; EVALUATION TO CONTINUE

AAFP-accredited CME providers and medical colleague organizations last month received a packet of information including an overview of the new system; categories, definitions and criteria for classifying CME clinical content; application forms; and step-by-step instructions on how to document evidence-based CME content, should this option be chosen.

It's expected that implementation of the new system will be phased in over the coming year, with continuous ongoing evaluation. After that, said Davis, "the next big step will be outcomes studies to look at the impact of all this." The goal, of course, is to determine whether evidence-based learning improves physician performance and, ultimately, patient care.

AAFP-approved aources of systematic evidence reviews

New For You
Order from AAFP at (800) 944-0000 unless otherwise noted.

Get connected! Put the point of care in the palm of your hand. The new AAFP Customized Personal Digital Assistant Program allows you to select hardware, software and accessories for your own customized PDA. Visit http://www.aafp.org/members/, using your AAFP ID number, and scroll down to the PDA program link for information or to place your order.

Photo

Interested in practice redesign? The "Practice 2010" video illustrates how concepts such as patient e-mail communication, open access (same-day appointments) and group visits can make your practice more efficient and satisfying for patients and staff. The video (product #R706) is available for $12.

In follow-up to the Annual Clinical Focus 2001 on asthma, allergy and respiratory infections, visit http://www.aafp.org/afp/cases/ for an American Family Physician online CME case, "Management of the Adult Patient With Unstable Asthma." Download a patient handout on allergic conjunctivitis at http://www.aafp.org/acf/2001/Allergic_Conjunctivitis.pdf.

ACF

Check out the 2002 AAFP Catalog online at http://www.aafp.org/catalog/ for the newest AAFP educational resources, services and products. Support your Academy and specialty with the updated line of AAFP apparel and high-quality gift items. If you didn't receive your catalog, order one by phone (item #R493, free).

A shipping fee may apply; Kansas residents pay a 7 percent tax.
Quick Fax

Available on AAFP Express

Call the AAFP Express toll-free number -- (800) AAFP EXP [223-7397] -- and supply your AAFP ID number to have selected materials sent almost immediately to your fax machine for free. Some documents available:

Description of document Doc. no.
Bioterrorism: What You Need to Know (Patient Handout) 3014
   
Information on the 2002 conferences
  
Advanced Life Support in Obstetrics Instructor Courses
July 23, Salt Lake City
 2015
Sports Medicine Review
Feb. 6 - 10, 2002, St. Louis
 2000
Selected Internal Medicine Topics for Family Physicians
Feb. 11-15, Freeport, Bahamas
 2001
National Network Convocation of Practices
March 13 - 16, 2002, Kansas City, Mo.
 7015
Women's Health in Primary Care
March 13 -16, Seattle
 2008
Colposcopy Update and Review
March 16 - 17, Seattle
 2007
Family Practice Board Review
April 7 - 13, Seattle
April 28 - May 4, Kansas City, Mo.
June 2 - 8, Greensbotro, N.C.
 2005
National Conference of Special Constituencies
April 24 - 27, Kansas City, Mo.
 8003
Annual Leadership Forum
April 25 - 27, Kansas City, Mo.
 8003
Skin Problems and Diseases
June 12 - 16, Ft. Lauderdale, Fla.
 2003
Family-Centered Maternity Care
July 24 - 28, Salt Lake City
 2010

FP Report is published by the AAFP News Department.
Copyright © 2002 by American Academy of Family Physicians.

FP Report | Headlines | AAFP Home | Search