June 2002 • Volume 8 • Number 6 |
They jawboned. They cajoled. They told it like it is -- on behalf of their patients as well as themselves. About 50 family physicians and AAFP chapter staff stormed Capitol Hill April 15 16. In small groups, they visited more than 60 senators' and representatives' offices.
 Medicare cases are often very complex, says Maryjean Schenk, M.D., right, explaining the need to reverse plummeting Medicare pay rates. Schenk and Peter Scuccimarri, M.D., center, lobby Sen. Debbie Stabenow, left, a member of the Senate Budget Committee. |
Many groups targeted the Bush administration's proposal to cut funds for the Agency for Healthcare Research and Quality from $299 million in 2002 to $251 million in 2003. The White House budget also calls for National Institutes of Health funds to increase from $24 billion in 2002 to $27 billion in 2003.
Maryjean Schenk, M.D., of Detroit and Peter Scuccimarri, M.D., of Ann Arbor, Mich., talked with Sen. Debbie Stabenow, D-Mich., and her aides about declining Medicare payments and the need for more funds for AHRQ. Stabenow serves on the Senate Budget Committee.
"There is such a lack of primary care in the Detroit area that folks go throughout most of their adult lives without medical care. Suddenly, they turn 65 and have coverage, and they're very complex cases," said Schenk. She asked Stabenow to restore the funds cut this January from Medicare payments to physicians.
Regarding AHRQ, Schenk said, "AHRQ research is done through practice-based research networks; it's done in our offices. It translates research into practice."
Scuccimarri suggested, "We should be bringing the AHRQ budget up to $1 billion to keep pace with the NIH research and development work, which is reaching astronomical levels. The extensive wealth of medical science is not being applied to the general public."
Stabenow replied, "Bush prepared a defense budget that is way over what is needed for the war on terrorism. Security is more than tanks; it's teachers. Security is more than helicopters; it's health care."
In another congressional office, Elissa Palmer, M.D., of Altoona, Pa., told Peter Stein, an aide to Sen. Rick Santorum, R-Pa., "NIH has so much funding it can give about 74 grants a month. AHRQ can give about 74 grants a year. We need more funds for AHRQ to be able to translate those NIH biomedical studies into practice."
"I'll pass that on to the senator," said Stein.
Bradley Fox, M.D., of Fairview, Pa., and Mark Burd, M.D., of Bradford, Pa., also visited Santorum's office. Fox asked that Santorum defend Title VII funds for family practice training.
"The senator sits on the Senate Rural Health Caucus. Title VII is one issue we'll take up in the budget appropriations process," said Stein. "We hope to help you find a stable funding level."
Sharing perspectives from rural Missouri, Bruce Preston, M.D., of West Plains visited with Annissa McDonald, an aide to Rep. Roy Blunt, R-Mo. "I'm in a town of 10,000, and we've had two physicians leave, so our office has four or five people calling each day, asking us to see them. They're the older people with more problems," said Preston. "If we correct the reimbursement problems, people will be more able to come to the doctor's office."
 Elissa Palmer, M.D., says AHRQ needs more funds -- not less -- to be able to translate biomedical research into practice. Palmer talks with (from left) Mark Burd, M.D.; Peter Stein, an aide to Sen. Rick Santorum; and Brad Fox, M.D. |
In a briefing for the family practice lobbyists, John McManus -- staff director for the health subcommittee of the House Ways and Means Committee -- said Medicare regulations are four times as long as IRS regulations. Preston repeated that information to McDonald, saying, "For a lot of physicians, it costs them money to see Medicare patients. We need regulatory reforms to save our costs."
In the office of Sen. Kent Conrad, D-N.D., family physicians discussed plummeting Medicare payment rates with aide Louis Kazal, M.D., an FP doing a Robert Wood Johnson health policy fellowship in Conrad's office.
"Sen. Conrad sees problems with the Medicare reimbursement formula -- it's not fair -- and he recognizes it needs to be fixed," said Kazal. "How you do that when there's a budget deficit is the challenge."
The Hill visits were highly successful this year for three reasons, said Kevin Burke, director of the AAFP Government Relations Division. First, many visitors were first-timers. "This experience trained a new set of congressional contacts," said Burke. Second, the timing of the visits worked well -- legislators were already focusing on Title VII, AHRQ and Medicare issues.
Third, many FPs asked Congress to support AHRQ. "Family doctors are the only large group speaking up for AHRQ," said Burke. "Legislators understand family doctors are promoting AHRQ not because they expect to get a grant -- they're talking about their patients."
Rule No. 1: Physicians should never see patients. Rule No. 2: Physicians should keep all patients deliriously happy at all times.
Sound ridiculous?
Impossible?
Of course -- but only by following these rules can physicians avoid all potential liability lawsuits, said AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis., during a May 6 teleconference on the issue. In other words, practicing medicine inevitably involves certain risks, such as the risk of being sued.
The teleconference was designed to help FPs cope with the medical liability crisis. About 300 AAFP members, leaders and staff participated in the teleconference, which is available to other members online at http://www.aafp.org/confcall/ (see the instructions on the bottom of the Web page).
Insurers continue to leave the physician liability business because of high loss ratios. The frequency of liability cases is on the rise, and juries are awarding larger and larger awards.
The result? Exorbitant liability insurance premiums in many states, Roberts said. For example, physicians practicing obstetrics and gynecology in some Florida counties now pay $209,000 annually for $250,000 of insurance coverage. "That's very nearly being self-insured," he said.
Insurance prices and pressures also are prompting significant changes. "Malpractice is a profound experience," Roberts said. "It changes how physicians look at themselves and how they practice."
To illustrate the point, Roberts cited a study of 220 Cook County, Ill., physicians who had fought medical liability cases.
The study found, he said, that 90 percent of the doctors suffered significant mental effects from the lawsuits. After the cases ended, half of them stopped offering certain services; another 50 percent dropped certain types of patients. However, the most disturbing effect was that 10 percent of the doctors contemplated suicide.
Patients also suffer when they initiate a lawsuit, Roberts said, "and we shouldn't forget that."
When patients consider filing a lawsuit, they must weigh their personal costs as well. If they sue, plaintiffs face only a 25 percent chance of winning, and they, too, must reveal much of their personal lives in the public arena, he said.
"And the public is still confused about who should take the blame," Roberts said. "We all look like villains to them -- lawyers, doctors and insurance companies."
Medical organizations across the country, including the Academy, continue to fight for judicial reforms in state medical liability systems. This year, several states passed tort reforms that could lead to lower insurance premiums.
The most effective tort reforms, Roberts said, place a cap on noneconomic damages (usually $250,000), reduce the statute of limitations (from the time of injury to the filing of the suit) to three years or fewer for adults, and limit attorney fees so more money goes to the injured patient. Together, these reforms could help decrease premiums by up to 25 percent, Roberts said. California was the first state to enact such reforms, back in 1975.
On April 25, the battle moved to the national level when Rep. James Greenwood, R-Pa., introduced legislation seeking federal medical liability reform. H.R. 4600 very nearly mirrors the reforms listed above. At press time, the bill was being considered in the House Subcommittee on Health and had 18 cosponsors. The Academy supports the bill because "the reforms in this bill have already brought stability and fairness to the California legal system for the past 25 years," Roberts wrote in an April 24 letter of support addressed to Greenwood.
"What are the chances of H.R. 4600 passing?" FP Timothy Alford, M.D., of Kosciusko, Miss., asked Roberts during the teleconference.
"My own view of the probability of getting a national fix is pretty low," Roberts answered. "Any federal help would be great! However, I favor helping people like you in the individual states."
In the meantime, doctors should continue to educate their patients about important health issues and take every opportunity to talk to them, Roberts told conferees during the May 6 call.
Also, use risk management in your practice, he said. For instance:
"Medical liability is a huge problem," Roberts said in closing. "Ultimately, it affects the public's health. So don't lose faith."
To advocate passage of H.R. 4600, visit http://capitol.aafp.org/aafp/issues/?style=D at Speak Out: AAFP Legislative Action Center, and click on "Support H.R. 4600 and Bring Stability Back to the Professional Liability Market." Enter your ZIP code, and e-mail the letter to your federal lawmakers.
Technology is your friend. You know it, yet you've delayed purchasing practice management software that would automate functions such as billing, tracking appointments and filing insurance claims -- which would give you more time to spend on patient care.
Or maybe software you bought in the not-too-distant past has already become outmoded.
Either way, AAFP is here to help.
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With so many medical software packages to choose from, it can be a challenge to select the right technology and software for your practice. To help steer you through the selection process, AAFP has collaborated with Microsoft to evaluate nine practice management systems, all of which work on the Microsoft platform. The evaluation is available online at http://www.aafp.org/practice/techguide/. A link is also available to install Acrobat Reader, which is required to view the guide.
The evaluation, made public by President Warren Jones, M.D., of Ridgeland, Miss., at the AAFP Annual Leadership Forum here on April 26, offers a comprehensive listing of each system rated for a variety of criteria.
The guide will enable physicians to make better-informed choices about information technology, an area where some doctors may feel ill-equipped to make a decision, said Jones.
"This is really one of the better benefits we've offered members in a long time," Jones said. "I talk all the time with family docs who say they're being asked to do more and more with information technology. This project gives us a lot of the background we need to do that."
Reviewers looked at criteria such as functionality, reliability and current customer satisfaction. In addition, the guide includes information on the financial viability of each product's vendor.
The report sparked immediate interest at the forum among physicians who were planning to purchase systems. John Sattenspiel, M.D., of Salem, Ore., said that even though his practice is small, his staff is getting bogged down by paperwork.
"You can't effectively maintain quality, accountability and good preventive care with paper records," he said. "Besides, our liability risk increases as we continue to use paper records."
The research for the report took place over two years. FP Robert Flaherty, M.D., of Bozeman, Mont., served as AAFP's technical adviser. Vendors evaluated for the guide were Compusense, e-MDs, Greenway, InfoSys, MedStar, Millbrook, NextGen, PerfectPractice and Visionary.
More than 150 AAFP members voiced opinions and voted on resolutions at the 2002 National Conference of Special Constituencies, held here April 25 27.
 Networking's half the fun: NCSC delegates relax and talk between sessions. |
The NCSC provided fertile ground for the planting -- and pruning -- of a host of resolutions put forth by the five constituencies: women physicians; minority physicians; new FPs (those in practice seven or fewer years); international medical graduates; and the gay, lesbian, bisexual and transgender constituency. Here's a sample of this year's work.
GLBT DELEGATES
The gay, lesbian, bisexual and transgender constituency should have delegate status in the AAFP Congress of Delegates, said the NCSC participants, voting unanimously for the measure. The resolution, to be considered by the Congress Oct. 14 16 in San Diego, would require amending the AAFP Bylaws, a process that could be completed by the 2003 Congress.
Other resolutions described here will be sent first to the AAFP Board of Directors, which may forward the measures to the Congress for action.
J-1 VISA WAIVER
When the U.S. Department of Agriculture decided in March to end its participation in the J-1 visa waiver program, which allows sponsored foreign physicians to practice in underserved areas, international medical graduates in the Academy were shocked, said IMG participants at the NCSC.
The USDA stated that national security considerations after the Sept. 11, 2001, terrorist attacks were the reason for its decision. However, a few weeks after the March announcement, the USDA reversed its decision and said the program would continue for now.
Dora Saforo, M.D., of Ocean-side, Calif., said in many physician shortage areas, IMGs provide the only access to health care. Defending a resolution the IMG constituency passed, Saforo said, "We want the Academy to support the J-1 visa waiver program in a policy statement to help prevent this (termination of the program) from happening again."
With a J-1 visa waiver, foreign physicians can practice in underserved areas of the country for three to five years. Then they must return to their home country for two years before applying for an immigrant visa, permanent U.S. residency or a nonimmigrant visa.
 Should AAFP keep exploring a combined family medicine/emergency medicine residency? The voice vote was close -- so Anand Shah, M.D., of Long Prairie, Minn., makes sure his hand vote is counted. The resolution passed. |
EQUITABLE LICENSURE CRITERIA FOR IMGs
Several states have different requirements for granting licenses to physicians educated in the U.S. and to IMGs. The IMG constituents want the AAFP to support equitable licensing criteria for all medical school graduates, said Angelo Patsalis, M.D., of Livonia, Mich.
"We know residency graduates who have had to get licenses in states other than the ones they trained in just so they can practice medicine," said Patsalis. "Why? We all get the same training in our residencies."
The group voted for the AAFP to encourage constituent chapters to work with their respective licensing boards to seek equitable criteria for all medical school graduates.
DEMONSTRATING COMPETENCY
The new physicians adopted a resolution asking the Academy to develop the means for family physicians to do two things: self-monitor their practice patterns and document procedures in a way that will help demonstrate competency in areas such as prenatal ultrasound and endoscopy.
MATERNITY CARE SUBCOMMITTEE
NCSC participants sought the creation of an AAFP subcommittee on maternity care issues, including liability, credentialing, training and the development of evidence-based standards. "I have privileges to teach OB at the hospital, but I can't do OB," said Cindy Barter, M.D., of St. Louis, underscoring the need for the resolution. The OB department in her hospital granted her the teaching privileges; she had provided maternity care for eight years before coming to the hospital.
Also supporting the resolution, Lt. Cmdr. Maureen Padden, M.D., of Gig Harbor, Wash., said maternity care is one of the most valuable services she performs in the military. "Active duty military personnel are able to focus on their jobs when they know their wives and children are being taken care of at home," she said.
HEALTH PLAN MEMBERS' MATERIALS
The women physicians voted for the Academy to ask health care plans to use language making it clear to plan members that FPs provide women's and children's health services.
Susan Rife, D.O., from Orland Park, Ill., said her Blue Cross and Blue Shield patients "are told they have to pick an OB-Gyn."
 Leslie Hoy, M.D., of Bayamon, Puerto Rico, a member of the IMG constituency, testifies during NCSC. |
HEALTH CARE DISPARITY
The minority constituency adopted three resolutions on disparity in care. One measure asks the AAFP to investigate underlying factors causing health care disparities. Another urges increased participation of minority physicians in practice-based research. A third requests that the AAFP reaffirm its commitment to educate AAFP members -- physicians, residents and medical students -- on cultural diversity. "We have to educate the future physicians," said James Opara, M.D., of College Place, Wash., discussing the resolution on training in cultural diversity. "This resolution will help address this issue."
SECOND-PARENT ADOPTION
If one partner in a gay or lesbian relationship has adopted a child, the second partner should also be able to gain legal parenthood, the NCSC participants said in a resolution they adopted. Proponents quoted the 2002 American Academy of Pediatrics policy supporting second-parent adoption.
Opposing the resolution, some NCSC participants suggested the studies the AAP used to support its policy were flawed. Other objections included negative feedback the AAP has received and the possibility the AAP might change the policy.
In an interview after the NCSC, AAP Executive Director Joe Sanders, M.D., said, "A growing body of evidence suggests that kids raised in this kind of situation have just as strong a possibility for positive outcomes as do children raised in the 'traditional' family." Sanders has responded to about 100 AAP members who objected to the policy, and 22 members have resigned from AAP (which has 55,000 members) because of the policy, he said.
"We crafted this statement for the children and carefully did not comment on people's lifestyles," Sanders added. "I am unaware of any intention on the part of our board to retract this statement."
DOMESTIC PARTNER BENEFITS
The Academy should support domestic partner benefits, especially health insurance for partners and dependent children, the GLBT constituency voted. The resolution also asked the AAFP to encourage constituent chapters to lobby state lawmakers for legislation recognizing domestic partnerships.
Head for the Web for a list of leading myths about the liability insurance crisis. At http://www.aafp.org/ad/, click on "May 17, 2002," and then on "Tort Reform Only Part of Solution for Liability Crisis." The story presents the top 10 myths according to AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis.
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Cynthia Romero, M.D., of Norfolk, Va., was nominated as the first new physicians' representative on the AAFP Board of Directors during the National Conference of Special Constituencies. New physicians are those in practice for seven or fewer years. Romero's nomination will be forwarded to the Congress of Delegates for confirmation this fall. |
 Cynthia Romero, M.D. |
• Cancer & the FP •
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" Life's not fair!" You've heard that expression so often that it just seems trite. But when it comes to health, no other truism says it better. For if you're born into life with brown skin or almond-shaped eyes -- or any of a number of other gene complements -- you might be more likely to suffer from certain diseases. And you might get less effective care.
Study after study has demonstrated that health disparities exist among specific patient groups. The phenomenon is twofold: Certain diseases occur more often in certain racial and ethnic populations, as well as in people in the lower socioeconomic tiers. And disparate levels of care are accorded these different groups.
EXTENT OF THE PROBLEM
These disparities involve numerous chronic and acute health conditions, including many types of cancer. A few statistics help illuminate the extent of the problem:
NO EASY FIX
Unfortunately, there's no easy fix, said M. Norman Oliver, M.D., of Charlottesville, Va. Oliver, assistant professor of family medicine and director of the Center for Improving Minority Health at the University of Virginia, Charlottesville, recently presented "Racism and Racialism: The Impact on Cancer Disparities in America" at a conference on reducing health disparities. He advocates a systemic approach to the problem.
"Those cancers that you could directly relate to some sort of genetic difference actually make up only a small portion" of the overall cancer picture, said Oliver. "It's more than the genetics; it's more than the individual practices. It goes well beyond what the individual physician can do. It's changing policy. When you look at racial and ethnic disparities, you'll find that although some of these cancers do occur more frequently in certain groups, it's much more likely that they're related to social factors."
Lack of access to care, suboptimal nutrition and exercise practices, and difficulty in establishing rapport with health professionals are some of the factors Oliver cited.
LONG-TERM SOLUTIONS
Some physicians feel that one way out of the disparity-of-care quagmire is to get more minority physicians into practice.
Diego Osuna, M.D., M.P.H., agrees with this viewpoint. He's medical director of Latino services at Colorado Kaiser Permanente and a senior instructor at the University of Colorado Health Sciences Center in Denver, and is a frequent participant in AAFP's e-mail discussion group on minority health issues. In a recent interview, he cited these reasons:
"When a Hispanic patient sees a Hispanic doctor, there's a certain amount of inherent trust," said Osuna. The shared background means the patient is more likely to share critical health information.
Osuna said he'll soon be serving on the admissions committee for the University of Colorado School of Medicine, Denver. He encouraged other minority physicians to do the same. "Often, they (admissions committees) are seeking input from practicing physicians who recognize the worth of minority applicants," he said.
But Joshua Freeman, M.D., chair of the family medicine department at the University of Kansas Medical Center in Kansas City and another participant in the e-mail discussion on health care disparities, wrote that the problem goes deeper. "The committee can only admit who applies," he said. When Freeman served on the admissions committee for the College of Medicine at the University of Illinois at Chicago, he saw a shortage of qualified minority applicants. "That's where pipeline programs in colleges, high schools and middle schools become critically important," he said.
(For more on recruiting minorities, see "The Color of Medicine: Strategies for Increasing Diversity in the Workforce" at http://www.commmunitycatalyst.org/index.php3?fldID=143.)
CONTINUITY COUNTS
Another tool for lessening disparities is continuity of care. "Screening for cancers is greatly improved when patients have a usual source of care," Oliver said. It's not so much a matter of looking for particular conditions in particular patients. Instead, continuity of care facilitates detection of cancer at an early, more treatable stage. "You'll see patterns when you're doing the family history. Patients who have a significant history -- like having four relatives with breast cancer -- those are the ones you really want to discuss this with," he said.
"Practices vary in their racial and ethnic makeup, and the evidence shows that FPs are quite good at providing screening for their racially and ethnically diverse patients," said Oliver. "We have to continue to emphasize this general clinical attitude of doing thorough preventive screening in all patients."
• Cancer & the FP •
Would it surprise you to learn that, when it comes to deciding between cancer treatment options, some of your patients may very well value your opinion over that of their surgeon or their oncologist?
That's precisely the case, according to initial results of a small qualitative study presented during the 2002 convocation of practices conducting practice-based research, held here this spring.
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The study's purpose was to provide an initial feel for the role family physicians play in the care of their patients with cancer, said John Hickner, M.D., director of AAFP's National Network for Family Practice and Primary Care Research and principal investigator for the study. "There's been virtually nothing written about how family physicians are involved in the care of their patients once they're diagnosed with cancer, yet we know many family physicians are heavily involved in that care."
In designing the study, researchers made a concerted attempt to ensure variability in both physician and patient demographics and other characteristics. Physician participants were chosen from different geographic areas and practice settings, with some practicing in large academic centers and some in smaller clinical settings.
One particularly intriguing finding was the respect cancer patients accord their family physicians: "Some patients come into your office, and even though they've been to Mecca and heard the expert opinion, they still want to know what you think," said Hickner. "They'll say, 'Well, I've been to Mayo, and they say I ought to do this, but I wasn't sure. I wanted to come back and talk to you about it first.'"
Phyllis Naragon, AAFP organizational research marketing manager and co-presenter of the session, gave a brief overview of other study findings:
Responses from the patients interviewed reflected similar themes:
FPs at the convocation shared some of their experiences with cancer patients. Michael Hartsell, M.D., of Greeneville, Tenn., negotiates with the patient the extent to which he or she wants Hartsell to remain involved. The key, he said, is to help patients feel they're in control of their treatment.
He described an experience with one of his patients -- a woman with ovarian cancer who'd been through two harrowing chemotherapy rounds, was suffering serious side effects and was ready to throw in the towel. "I told her, 'Do me a favor -- tell them what a difficult time you're having,' and the next time I saw her, she was absolutely radiant," said Hartsell. "She was still engaged in the process and was very much empowered. So, not only do we help them with advice but we also help keep them engaged."
Yet, it can be difficult to maintain that connection with patients, said Andrew Eisenberg, M.D., of Madisonville, Texas. He's concerned about patients in his practice who are treated at facilities from 30 to 90 miles away. "The problem is that with the place that's 90 miles away, I don't get any reports whatsoever," Eisenberg said. "That's very frustrating because the rest of the family may be in my community. They'll come in and ask, 'Well, what's going on?' and you just don't know.
"There are some patients who go to cancer centers, and they just get lost. My personal feeling is that they don't get the best care in that situation because the care gets fragmented."
Donya Powers, M.D., of East Providence, R.I., agreed with Eisenberg's assessment. "There are too many people between me and the person who's providing the treatment," she said. A lack of ready access to medical records and test results can be a significant drawback when providing ongoing care. "You worry about these patients being in limbo when they should have a very structured follow-up, something that's been written out for them," said Powers.
In the end, said Hartsell, the level of physician involvement is up to the patient -- for better or for worse. "I have a number of folks in my practice with prostate cancer whom we might potentially be following for years and years, and it's their comorbidities that'll eventually get to them," he said. "Yet they still get so paranoid, thinking, 'I have cancer,' even in the face of cardiomyopathy or advanced COPD. It's that diagnosis -- that word -- and where it drives them that determines how we participate in their care."
• Cancer & the FP •
Let's face it: Being screened for colorectal cancer isn't high on your list of "Things-I-can't-wait-to-do," is it? Chances are, your patients feel the same way.
But solid evidence shows screening saves lives. And when you're talking about the second-leading cause of cancer deaths in the United States, that translates into some heavy-duty numbers.
Consider a few salient points:
Yet compared with screening rates for breast or cervical cancer, for example, colorectal cancer screening rates remain low, says the CDC. Recent surveillance data reveal that only 44 percent of U.S. adults age 50 or older had been screened using at least one of three recommended methods -- fecal occult blood testing, colonoscopy or flexible sigmoid- oscopy. These statistics are especially hard to fathom given the fact that Medicare covers the cost of these screening tests, as well as that of a fourth option, double-contrast barium enema.
In response to this lackluster showing, HHS recently established a joint task force with the American Cancer Society to coordinate efforts to increase public awareness of colorectal cancer. In addition, HHS has released four new public service announcements as part of its "Screen for Life" campaign. Go to http://www.cdc.gov/cancer/ScreenForLife/ to read more about the campaign, which represents a collaboration of the CDC, Centers for Medicare & Medicaid Services and National Cancer Institute.
There's no shortage of reliable resources on this topic. A visit to NCI's Web site at http://cancer.gov/ plugs you into everything from the latest research news to nationwide clinical trial listings. You can go to http://www.cdc.gov/cancer/colorctl/calltoaction/ to access patient education materials for use in your office. And, of course, you can always steer patients to AAFP's familydoctor.org site at http://familydoctor.org/handouts/556.html for information about this serious health threat.
• Cancer & the FP •
AAFP's 2002 Annual Clinical Focus on cancer offers Academy members up-to-date patient education materials and CME opportunities designed to improve prevention and detection efforts, as well as to help navigate the tricky terrain of dealing with a cancer diagnosis. Here's what you can expect:
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ACF 2002 is a program of the AAFP developed in cooperation with the American Cancer Society, National Cancer Institute, American Society of Clinical Oncology and National Human Genome Research Institute. The 2002 initiative is supported by grants from Bristol-Myers Squibb Company, Pharmacia Corporation and Novartis Pharmaceuticals Corporation.
• Cancer & the FP •
The Academy continually reviews and refines its listing of recommended clinical preventive services for patients, including cancer screenings and other health interventions. Go to http://www.aafp.org/exam/table3.html for a summary of those recommendations for the general adult population.
Come to the new AAFP Candidates' Web site to ask candidates their views and get their answers.Take a look at http://members.aafp.org/members/congress/candidates/. Click on a person's name, and you'll see his or her personal statement and links to a biography and curriculum vitae. To fire away with your questions, click on "Q&A," the candidate's name, and then "Post a New Topic." That's where you can type your question and post it on the Web site.
The Q&A process, a new service for members, will help you learn the perspectives of those running for AAFP offices. After you've learned more about the field of candidates, suggest your choices to the delegates representing your chapter in the AAFP Congress of Delegates, which will elect officers and Board members Oct. 16 in San Diego.
Your lawmakers can learn from you. Your patients will benefit from your contacts with legislators. A few ways to share your views:
Face to face. Nothing beats a visit to your legislator's office, either to an aide or the legislator. Contact the local office to set up time to talk. For backgrounders on health care topics, go to http://www.aafp.org/fedgov/bg.xml .
Phone. If you've only got a few minutes for the legislation you're fired up about, call your lawmaker's local office and ask for a vote pro or con. Phone numbers are available at http://capitol.aafp.org -- Speak Out: AAFP Legislative Action Center. Under "Congress and President," enter your ZIP code, hit "Go," and then click your elected officials' pictures for their local and federal office information. You can also call the U.S. Capitol switchboard at (202) 224-3121 for your lawmakers' Washington offices.
E-mail. The Academy has developed sample letters on key health topics pending in the U.S. Congress. Go to http://capitol.aafp.org and follow directions to send e-mails. Then check the box for joining the new Family Physician Alert Network -- you'll receive notice of new advocacy messages for lawmakers, plus other legislative information.
Don't underestimate your impact. You most likely know far more about health care than your legislator. You can find suggestions for communicating with your federal and state lawmakers at http://capitol.aafp.org/aafp/issues/basics/?style=comm.
Finally, a tip from AAFP President-elect James Martin, M.D., of San Antonio, a longtime lobbyist: "Tell a story." Put a human face on the issue. A story can help your legislator remember your point of view.
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The night before they tackled Capitol Hill (see story on page 1), family practice lobbyists got a serving of political analysis with their dinner, courtesy of Robert Laszewski, president of Health Policy and Strategy Associates.
The news was sobering. "There is little consensus in Congress on any health care issues," Laszewski told the group. "Until the government has a decided tilt toward Democrat or Republican, look for the key health issues to go unresolved."
Laszewski detailed several opinion splits in Congress. "In the 2002 elections, 25 percent of the voters are going to be seniors," he said. "They're screaming for prescription drug coverage, and the AARP has called for $750 billion over 10 years for a seniors' drug plan."
He also said, "When members of Congress went home for the Easter recess, they got an earful from physicians about the 5.4 percent cut in Medicare reimbursement."
Then he warned, "We have a budget deficit. There may not be money for prescription drug coverage and provider reimbursement. It may be you versus the AARP."
Laszewski also mentioned the 8 percent rise in health care costs last year and said employees would have to cover more health care costs out of pocket. He told the FPs, "You guys are the out-of-pocket guys. The patient sees you first and hasn't yet hit the deductible of $1,000. The subspecialist is the lucky one."
Painting a fairly grim financial picture, Laszewski advised, "Develop programs to more efficiently manage episodes of care for those few who cost the health system the most."
To the editor:
I'm responding to "FPs Should Be Paid for Mental Health Care" in the March FP Report. As a fourth-year combined FP/psych resident, I find it difficult to have enough time to appropriately manage patients with psychiatric issues in a busy family practice setting. I insist that they see me in the psychiatric clinic and/or with other auxiliary mental health care providers.
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To the reader Write us a letter of 200 words or fewer (subject to editing). FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; fax them to (913) 906-6089; call (800) 274-2237, Ext. 5230; or contact fpreport@aafp.org via e-mail. |
Regarding one comment in the article -- "We control costs by providing the care we're trained to offer instead of referring the patient to a subspecialist" -- just because you get four weeks of orthopedic surgery training as a resident does not mean you can go out and practice this on your patients any more than two weeks of psychiatric training allows one to practice psychiatry.
When antidepressants are started by FPs, many do not even inquire about suicidal ideation, psychosis or a history of bipolar disorder. There is often no follow-through after starting medications. If FPs want the responsibility of prescribing and managing mental health care for their patients with psychiatric illnesses, they must also realize they're opening themselves up to the major reason psychiatrists get sued: not routinely asking about suicidal and homicidal ideation.
Laurie McCormick, M.D.
Tulsa, Okla.
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Go to http://www.aafp.org/afp/cases/ to review "Allergic Rhinitis," a new online CME case developed as part of the Annual Clinical Focus 2001 on Asthma, Allergy and Respiratory Infections. CME credit is available for $5.
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A shipping fee may apply; Kansas residents pay a 6.875 percent tax. |
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FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.
