 January 2003 • Volume 9 • Number 1 |
 "We don't want to turn anyone away, but we have to pay our bills," says AAFP President James Martin, M.D., left, during a Nov. 19 AMA-sponsored news conference urging Congress to fix the Medicare fee schedule. |
IIn a landmark decision, the AAFP Board of Directors has asked family physicians to engage patients in the fight for fair payment for Medicare services. A 4.4 percent cut in Medicare payments looms for 2003, probably effective in February, on top of the 5.4 percent cut in 2002. If the formula used to set Medicare fees is not corrected, payment will have plummeted 20 percent from 2001 to 2005.
Family physicians have already let Congress know what they think about the arcane formula for setting Medicare fees. FPs have sent Congress more than 12,000 e-mails since September 2001, when word first spread about the 5.4 percent cut for 2002. AAFP leaders testified to Congress on the issue -- for patients' sake -- and many medical organizations, including the Academy, lobbied Congress repeatedly.
The House of Representatives got the message.
Last June, the House passed an AAFP-endorsed bill that would have increased physician payment rates under Medicare for 2003 2005 and would have given Congress time to fix the formula.
News conference
AAFP President James Martin, M.D., of San Antonio asked the Senate to do its part when he participated in an AMA-sponsored news conference Nov. 19 in Washington. "More and more physicians simply cannot afford to provide health care while Medicare payments continue to decline," said Martin. "We don't want to turn anyone away, but the payment shortfall makes it difficult to keep our offices open, pay our bills and meet our payrolls."
The Senate, however, failed to follow the House's lead. No vote; no bill for President Bush to sign; no change.
President's Letter
Now there's a narrow window of opportunity early this month for Congress to take action. So the Academy has tried to galvanize citizens' support for fair reimbursement for Medicare services.
"Medicare patients will undoubtedly suffer from these payment cuts," said Martin in a letter to AAFP active members last month. "As we find it difficult and perhaps impossible to accept new Medicare patients, they will have dwindling health care options, longer waits for fewer available physicians, more out-of-pocket expenses and perhaps longer trips to more distant health care facilities."
| "My own experience with
patients indicates they are able and willing to take action on health care
issues if given some support." -- James Martin, M.D. |
Martin asked family physicians to meet with lawmakers face to face. "Tell them to fix the Medicare payment problem," he said.
Then he offered AAFP members talking points to use to broach the topic of the Medicare fee schedule with patients. He also attached a sample letter patients could send their lawmakers.
"My own experience with patients indicates they are able and willing to take action on health care issues if given some support, such as the sample letter," said Martin.
Martin's letter to AAFP members, along with the talking points and the sample letter for patients to send legislators, is at http://www.aafp.org/presidentsletter.xml.
Medicare participation
Since Medicare payments are dropping, you may wish to review your options concerning Medicare participation. Check AAFP's Web site at http://www.aafp.org/mcareoptions.xml for information prepared by the AMA on the three participation options.
Briefly, you may choose to be a participating physician, be a nonparticipating physician (charging patients up to about 9.25 percent more than the Medicare allowed amount for participating physicians), or use private contracting with each Medicare patient (opting out of any Medicare payments for two years and having no limits on charges).
The Academy advises members to contact their state medical boards to determine whether their states require being a participating physician in Medicare as a condition of licensure.
 "Far too often in the tort reform movement, we aim our message at those folks we already have," says Texas lobbyist Kim Ross. "You have to know where to go to get your votes, and your votes are in the swing." Ross addressed attendees at the State Legislative Conference. |
Like any other health care lobbyist, Kim Ross would love nothing more than to spend less time dodging "friendly fire." He's exercised that skill as vice president for public policy and director of public affairs for the Texas Medical Association.
In the statehouses or on Capitol Hill, friendly fire refers to harmful -- or at least unduly time-consuming -- acts unwittingly perpetrated by well-intentioned lawmakers on those making every effort to further said lawmakers' legislative goals. When it comes to professional liability legislation, the term takes on a very specific meaning. Ross explained it during a panel discussion on medical liability at the AAFP State Legislative Conference here Nov. 15 16.
"There's a category of legislators who will vote for anything with tort reform in the caption, up to and including shooting trial lawyers randomly selected from the Yellow Pages," Ross told physicians, chapter executives, health lobbyists and others attending the meeting. As you'd imagine, this situation usually works to the advantage of lobbyists supporting such reform measures.
The problem arises when these lobbyists reject, for example, an amendment offered by just such a well-meaning legislator to an otherwise workable bill. The lobbyists know the modification will lose votes for the measure. The legislator views their resistance as an attack on the core proposal and launches a counterattack -- on the lobbyists.
Thrust, parry, riposte. Meanwhile, a perfectly acceptable piece of reform legislation languishes.
Make hay while the sun shines
Assuming all parties can agree to agree, the next task is to get the right votes on board.
"Far too often in the tort reform movement, we aim our message at those folks we already have," Ross noted. Alternately, reform proponents go after the most dug-in of opponents, figuring a victory there will open the floodgates of acceptance and ensure passage.
The plurality of legislators, though, camp out in the middle ground on such issues, trying not to antagonize this or that special interest. And it is often there, in the center, where the debate ends. "As a practical matter, you have to know where to go to get your votes, and your votes are in the swing," Ross said.
What're we fightin' for?
It's easier to understand legislators' reluctance to declare their allegiance one way or the other once it's clear what they're declaring for or against. Namely, the right of jurors to voice an opinion about the worth of a patient's pain and suffering.
"This is not a frequency crisis. This is a severity crisis," Ross explained. It's not so much that the number of suits is up, but that damage awards have grown by leaps and bounds over the years. "The largest component of those damages is the part that the jury has entire discretion on. In other words, noneconomic damages," he said.
Focusing reform efforts on this area is politically touchy because doing so involves taking away juries' discretionary power -- not a particularly appealing prospect for legislators counting on those constituents for re-election.
But state-based initiatives that include caps on noneconomic damage awards -- such as California's model Medical Injury Compensation Reform Act, better known as MICRA -- work, said AAFP Past President Richard Roberts, M.D., J.D., of Madison, Wis. Physicians in states implementing these initiatives have managed to keep malpractice insurance rates in check.
Other successful tort reform strategies include reducing the statute of limitations, limiting contingency fees, implementing some form of collateral source rule and utilizing periodic payments.
Strategies such as limitations on expert witness testimony, alternative dispute settlement systems, "loser pays" scenarios, joint underwriting ventures and expansion of states' medical examiners board authority have also been tried, said Roberts. "But we have no evidence that these reforms work, and they may, in fact, cause problems."
Two steps forward, one step back
Whatever positive strides you're able to make in passing liability reform in your state, said Ohio AFP President-elect Jeffrey Bachtel, M.D., of Tallmadge, the greatest challenge may be holding that ground in the courts.
Ohio passed sweeping tort reform in 1996 -- only to have the law thrown off the books three years later by the state's Supreme Court, he said. At the time of this meeting, reform bills were on hold in the state senate awaiting judicial election results. Only then were reform advocates able to begin planning how to head off another judicial attack.
West Virginia has likewise faced setbacks in the courts and elsewhere, said David Avery, M.D., of Vienna. In 2002, only one FP in the entire state still offered OB services, quitting at the close of the year, he said. Small wonder: The annual OB malpractice premium was $96,000; as of Jan. 1, that amount increased by 17 percent.
"So now the only OB that's being done in the state is being done at the university health centers under a program that's draining the state," said Avery, a past president of WVAFP.
A series of television commercials produced by a coalition of hospitals, physicians and insurers to educate West Virginians about the impending medical liability crisis and its impact on access to care met with staunch opposition. One such commercial was forced off the air earlier this year. Why? "The trial lawyers association called Marshall University (in Huntington) and said they would stop all their donations to the university instantly if (the commercial) ever showed again," said Avery. "That was the last time it showed."
To make matters worse, three of the state's five Supreme Court justices are trial lawyers, he pointed out. So no matter what tort reform might pass in the legislature, it's sure to be squelched by the high court once a tort case is heard.
When that's the kind of pool that's being played, you can pretty much forget a legal challenge, said Avery. "We need court reform, not just tort reform."
The Academy has long had an immunization schedule for children. Now it has an immunization schedule for adults as well. Together, the two schedules provide a comprehensive summary of recommendations for prevention of vaccine-preventable diseases for Americans from birth until death.
Richard Clover, M.D., of Louisville, Ky., a member of the AAFP Commission on Clinical Policies and Research, chaired the group that developed the adults' schedule, which was endorsed by the AAFP, the American College of Obstetricians and Gynecologists, and the CDC Advisory Committee on Immunization Practices.
"This is a major step forward to balance the emphasis between child and adult immunizations," said Clover, noting that vaccinations are just as relevant for adults as they are for children. Having a schedule that can be posted in physicians' offices will hopefully improve vaccination rates, he said. Furthermore, part of the chart is age-based and the other part is disease-based to promote ease of use, he said.
ACIP will annually review and approve both immunization schedules. The adults' schedule can be accessed at http://www.aafp.org/adultimmunizations.xml.
At press time, President Bush had just announced his plan calling for smallpox vaccination of at-risk U.S. military personnel and designated health care and emergency response workers. The plan does not at this time recommend offering the vaccine to the public. Go to http://www.aafp.org/smallpoxupdate.xml for more information on the president's vaccination plan.
 Genetic profiling: Marketing DNA tests directly to patients is gaining popularity. But some physicians question the practice, fearing what patients may -- or may not -- do with the results. Here's an example of what a patient who's submitted a self-obtained DNA sample for analysis might expect to receive via return mail. |
It's hard not to get caught up in the drama inherent in unraveling the mysteries of the human genome. The stakes are high: At issue is the hope that someday the information gleaned from those twisting tendrils of DNA will allow us not only to cure debilitating health problems but also to prevent them.
Given that hope, having the chance to glimpse our so-called health future may be difficult to refuse.
And although each day seems to bring another revelation about the origins of many hereditary illnesses -- perhaps triggering development of some new means of gauging individual risk for those ailments -- it doesn't necessarily follow that pursuing such testing is the best course.
Sometimes, says AAFP Past President Richard Roberts, M.D., J.D., of Madison, Wis., the adage "knowledge is power" doesn't apply. No matter how well-informed a patient may wish to be, if nothing stands to be gained by testing, what's the point?
"We Americans cling to a belief that knowing more is doing better. Unfortunately, this is not always the case," says Roberts, who often has been AAFP's spokesperson on genetic issues.
"Regarding genetic testing, there are very few conditions that are driven exclusively by our genetics -- much of their adverse outcomes also are driven by our environment and our behaviors," he says. "As an example, we know that alcoholism represents a genetic susceptibility. Yet if we never use alcohol, we don't fall victim to the disease."
Passing the "screening" test
Three components are required to ensure the usefulness of any screening test, according to Roberts. They are evidence that:
"This is something we regularly deal with already," Roberts says, citing a common example: A man goes to a hospital-sponsored health fair and receives a prostate-specific antigen assay for prostate cancer. He brings the full report to the office, demanding to know what it all means and what you plan to do about it.
"You go back to the beginning and ask the man what he wants," Roberts says. He cites a Sept. 12, 2002, New England Journal of Medicine report on a Swedish study that showed surgery for early-stage prostate cancer resulted in a reduced risk for death from prostate cancer but no change in overall death risk. "Men interested in such surgery need to balance that against the impotence and incontinence that are likely to result from the procedure," he says.
The same goes for genetic testing. The expectations it creates for patients, whether negative or positive, can be psychologically damaging, says Roberts.
"I am reminded that the genetic code consists of four letters representing the main building blocks of DNA: A (adenine), C (cytosine), G (guanine) and T (thymine)," he says. "Many believe that genetic testing, given its current state of development and lack of proof of improving health outcomes, also consists of four letters: H-Y-P-E."
"Genetically Customized" Results
Part of the lure of self-administered genetic tests may have to do with the ease of at-home collection of a reasonably reliable DNA specimen, says Louise Acheson, M.D., associate professor of family medicine and assistant professor of reproductive biology at Case Western Reserve University, Cleveland, Ohio. Acheson has done work on the application of new genetic knowledge to clinical practice.
"Taking a specimen for DNA testing is very easy," Acheson notes. "A swab of cells from inside the mouth or a blood sample that contains white blood cells is all you need for getting DNA from that person. So it's technically feasible -- and very easy -- for a patient to take a buccal swab at home. That DNA can then be analyzed for various genetic markers."
For example, United Kingdom-based Sciona says it "tests for common variations in genes which affect your individual response to medicines, food and the environment."
Using a simple cheek swab and a completed lifestyle questionnaire, Sciona's "team of geneticists, molecular biologists, medical doctors and dieticians" evaluates the person's genetic risk for chronic illnesses such as osteoporosis or cardiovascular disease and devises a tailored dietary regimen and lifestyle advice intended to minimize or eliminate that risk.
Cost? About $175.
Closer to home, GeneLink of Margate, N.J., sells a test that analyzes several genes linked to cancer and eye disease, among other ailments. GeneLink made strategic alliances this past spring with Berwyn, Pa.-based NuGenix and Garden State Nutritionals of West Caldwell, N.J. Purchasers of the GeneLink test receive "genetically customized" nutritional supplements -- personalized vitamin pills -- along with their genetic report. All for about $200.
"Can" versus "should"
But again, just because you can doesn't mean you should: Although this sort of testing may be feasible, says Acheson, taking the time to properly counsel patients about genetic testing -- especially when they trundle into the office with test results they may have obtained elsewhere -- simply isn't always possible during the average primary care visit. "It's not feasible with the time of the visit that we usually have with our patients," says Acheson.
Furthermore, knowledge about genetic issues is growing by leaps and bounds. Practicing physicians can have difficulty keeping up. That's why Acheson says comprehensive genetic counseling is often best left to health professionals with specialized education, training and experience in medical genetics and counseling. For more information about these professionals, visit the National Society of Genetic Counselors Web site at http://www.nsgc.org/.
Of course, in the real world, patients ask their family doctors about this stuff, right? Right.
Here's how Roberts suggests responding when patients come to the office with results from a self-administered DNA test:
| January 2003 • Volume 9 • Number 1 |
 *Reported to the AAFP via the online Health Plan Complaint Form. |
Open the door just a crack -- and a peek inside the world of third-party payers sheds light on some poor payer habits. In October, the Academy asked members to participate in a collaborative project it was undertaking with the AMA and other medical associations. Project organizers encouraged physicians to air their complaints about third-party payers via an online Health Plan Complaint Form. Complaints are still being collected; it's not too late to participate.
The first batch of specialty-specific data, recently reported to the Academy, revealed that 35 members had generated 79 complaints against 22 identified plans (and 12 unnamed plans). The largest number of complaints were filed against HMOs, the next largest number against PPOs.
Which plans gave FPs the most hassles? United Healthcare ranked worst, followed by Cigna HealthCare and Aetna. The highest volume of complaints originated from Ohio and Texas; however, 11 forms had no state designated.
The number one physician complaint was "denial of modifier," followed by "bundling of services" and payer "late payment."
More specifically, payers' treatment of the CPT "modifier 25" drew the most ire under the denial of modifier category. According to CPT, modifier 25 is applied when a physician requests payment for a "significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service."
The Academy urges members to continue to file complaint forms at http://www.aafp.org/complaint.xml and requests that members fill out the form in its entirety.
The feedback will serve as a road map for the Academy, said James Bare, policy analyst in the AAFP Socioeconomics Division. "Complete answers will allow the Academy to craft responses and pursue initiatives with clear direction and purpose, helping us to use our resources wisely as we search for solutions to these problems."
All physician information will remain confidential. The duration of this project, and the frequency with which the results are released, will depend solely on the volume of responses received.
A new resource can help your practice develop a strategy to comply with the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996. The AAFP collaborated with more than a dozen medical specialty organizations to create a Web site designed to ascertain the HIPAA-readiness level of practice management software vendors.
The directory, located at http://www.hipaa.org/pmsdirectory, allows vendors to self-report the HIPAA-readiness level of their products. Physicians can access this site free of charge to establish the readiness level of their own vendors or to review the compliance status of potential new software.
Currently the directory offers more than 80 vendor profiles, but organizers hope to amass information on up to 500 vendors.
"This is an effort to reach out to our members and their office managers and tell them to go online and look for their software vendors," said David C. Kibbe, M.D., director of health information technology in the AAFP Socioeconomics Division. "If your vendor isn't there, call and say, 'Please get listed in the directory.'"
Kibbe said it is likely some business processes will be interrupted in 2003 as a result of poorly implemented HIPAA compliance strategies by vendors, clearinghouses and health plans. "This is all about getting paid after Oct. 16, 2003. You need to know what your vendor can do for you to make your practice compliant." Direct any questions related to the directory to Kibbe at dkibbe@aafp.org.
Act now, warned Kibbe, or next September, you could find yourself without a vendor and "rushing to find a HIPAA-capable software vendor or product at the last moment, along with thousands of your colleagues."
If you haven't been contacted about HIPAA compliance by your practice management software vendor, it's time to become proactive, said David C. Kibbe, M.D., the AAFP director of health information technology. There are specific questions physicians should ask their vendors, including:
Kibbe suggested that physicians request written responses from their vendors.
A new AAFP course, Crash Course on Cash, Codes & Computers, debuts March 13 14 in New Orleans -- an opportunity for FPs to become informed consumers of office software. This course will help members find the most effective way to upgrade their billing software or help them choose a whole new system capable of handling HIPAA transactions. The two-day course will also cover how to properly code diagnoses and procedures, and give instruction on interpreting balance sheets, income statements and financial ratios. For course information, call (800) 274-2237, Ext. 4148, or visit http://www.aafp.org/crashcourse.xml.
 Even when the message to lawmakers is clear, says FP Rhonda Medows, M.D., there's no guarantee they'll "get it." Medows is secretary of the Florida Agency for Health Care Administration. |
Have you heard the one about the frog and the scorpion? Nick Franklin, J.D., senior vice president of public affairs for California's PacifiCare Health Systems, recently told a story about these two critters negotiating a stream crossing. The frog agrees to carry the scorpion across; in return, the scorpion agrees not to sting the frog.
Halfway across, the scorpion stings the frog. As they sink below the water, the dying frog asks, "Why?" "Because I'm a scorpion," the doomed arachnid replies.
The lesson?
Don't put your primary goal at risk by falling back on what you've always done, Franklin told FPs, health lobbyists, AAFP chapter executives and others during the Academy's State Legislative Conference here Nov. 15 16. "We've got to get beyond that," he said.
Don't dilute the message
By expending energy squabbling about whose piece of what pie stands to be nibbled on, for example, at the expense of larger issues such as quality, universal access and privacy, physicians run the risk of alienating patients and turning off legislators, said Michael Ashcraft, M.D., a health consultant to the California Senate Insurance Committee.
"We need to all get behind one issue. If we focus on turf, we've already lost," he said. The real message -- the important message -- goes ignored.
"Do you know what the single most effective lobbying group is?" Ashcraft asked. "Prison guards. There's only one message: It's about pay. How many messages do you have?"
Keep it simple and on target, Franklin advised, and utilize all the resources at your disposal. PacifiCare, in collaboration with the California AFP and the California Department of Managed Health Care, recently succeeded in helping state lawmakers draft clear, concise legislation involving timely patient access to physicians. The bill represented a working solution, Franklin noted, because all stakeholders had a say in formulating the bill.
Divide and be conquered
Still, it's difficult to ignore the spread of expanding privileges among nonphysician health professionals. But what's really important about this proliferation is for physicians to recognize their part in the process, observed Scott Gallant, government affairs director for the Oregon Medical Association.
Experiences in Oregon -- "the land where everybody can do anything they want to do" -- have revealed several major disconnects for lawmakers trying to make sense of proposed scope-of-practice changes, Gallant said.
"Legislators get mixed signals," he noted. "Physicians hire nurses; ophthalmologists hire optometrists. You say these people aren't qualified (for certain tasks), and yet you hire them."
On top of that, Gallant said, physicians know their patients aren't really behind them in scope-of-practice disputes.
"Why do patients go to alternative providers?" asked Gallant. "Because of something organized medicine hasn't been able to say for years -- easy access. Organized medicine isn't organized anymore, and it hasn't been for some years."
The key, he went on, is to focus on resolving the problem -- improving access to care -- without introducing another problem -- defending turf -- into the mix. Until physicians internalize that message and act on it in a unified manner, health care issues will be decided with limited, if any, physician input.
"You're some of the most powerful, influential people in the country," said Gallant. "But you're letting it get away from you."
 "We need to all get behind one issue," advises Michael Ashcraft, M.D., a health consultant to the California Senate Insurance Committee. Engaging in turf battles dilutes physicians' message to legislators, he told attendees at the AAFP State Legislative Conference. |
Drive your point home
Even if you're focused on a single, significant message, however, there's no guarantee that legislators will automatically "get it," said FP Rhonda Medows, M.D., of Tallahassee, Fla. You've got to drive your point home. And that can take some chutzpah.
As secretary of the Florida Agency for Health Care Administration, Medows oversees the state's Medicaid system. In all, 2.1 million people are served by the system, which employs only 600 people working out of 12 locations around the state.
"Everybody has a pretty heavy case load," she quipped to conference attendees. And she has had more than her share of dealing with lawmakers. Florida is just one of many states around the nation looking to cut Medicaid to offset budget shortfalls.
"I am probably the least political person in this room," Medows said. Initially reluctant to lobby policy-makers in the statehouse and elsewhere, she changed her ways to defend Medicaid patients. "When I got mad enough to stand up for the program, it was surprisingly easy," she said.
She told of a recent Washington hearing at which she presented testimony. One senator said providing preventive services seemed to be a waste of time and resources. Why not simply wait until illness developed, the senator said, and then, if treatment failed or was not offered, let nature take its course?
"Do you know how chilling that was?" asked Medows. "It took a lot for me not to jump out of my seat and run screaming out of the room after hearing that.
"These are patients just like any other patients, and they deserve our respect."
There are multiple ways to become involved, she said:
Make no mistake, Medows advised: "If you're not there speaking for your patients, someone else will. And I guarantee you they won't share your perspective."
| January 2003 • Volume 9 • Number 1 |
The Robert Graham Center in Washington recently released three one-page research summaries. The new data offer insight into practice patterns of family physicians.
The first one-pager says family physicians are the predominant source of care for the Medicare population, particularly for underserved minorities and those living in rural areas. Using the most recent Medical Expenditure Panel Survey, researchers found that 91 percent of respondents 65 and older reported having a usual source of health care. Of those, 60 percent identified their source as a family physician or general practitioner. The next most frequently identified usual source of care was the general internist. Facilities such as clinics and hospitals were named by 28 percent of respondents as their usual source of care.
The second one-pager reports a substantial decline in prenatal care by family physicians over the past 20 years in all geographic regions of the United States. Using data from the National Ambulatory Medical Care Survey, researchers found that FPs/GPs provided 17.3 percent of all prenatal visits in the early period examined (1980 - 1992), but only 10.2 percent of visits in the later period (1993 - 1999). Most strikingly, the report states, there was a 50 percent drop in prenatal visits to FPs/GPs in nonmetropolitan statistical areas. The Midwest saw the greatest percentage drop in prenatal visits, from 15.5 percent in the early period to 6.1 percent in the later period.
Despite the decline in prenatal services, the third one-pager notes that over the past 20 years, FPs/GPs, as well as pediatricians, have upheld their commitment to preventive care for infants. In fact, FPs/GPs have increased their overall provision of well-infant care, from 11.1 million visits in the early period (1980 1992) to 12.6 million visits in the later period (1993 1999), although the percentage of total well-infant visits performed by FPs/GPs declined slightly, from 20.9 percent to 18.9 percent. FPs/GPs made their greatest percentage contribution to well-infant care in nonmetropolitan statistical areas, the report states, increasing from 43 percent in the early period to 45.6 percent in the later period.
To read the documents, go to http://www.graham-center.org/library.xml and scroll down to "One-Pagers."
When the Academy announced in late August that it would no longer provide total funding for Tar Wars®, there was some concern over whether the tobacco-free education initiative would be able to secure full external funding by the mid-2003 deadline.
So there was a little sigh of relief in October when Schering announced a pledge -- $75,000 for fiscal year 2003 2004 -- and challenged other AAFP Foundation corporate members to do likewise.
And now, news that the board of trustees of the AAFP Foundation at its November meeting elected to pledge $75,000 per year for five years has brought another sigh of relief. The foundation has gone a step farther by sending a letter to all corporate members encouraging them to accept Schering's challenge and offering an incentive: Those who meet the challenge will receive an automatic upgrade in foundation membership status.
Foundation EVP Sandra Panther said that Tar Wars is an important public health initiative with goals that complement those of the foundation.
"Tar Wars represents a community-based program that meets our mission as a public charity to improve the health of all people," said Panther. "We are proud to have this opportunity to join with chapters in getting the message out."
More good news for Tar Wars: Janssen Pharmaceutica has committed $10,000 for the annual poster contest.
This is all positive news for Tar Wars. However, the budget battle is not over. Tar Wars has still not met the AAFP Board's goal to gain full external funding, said national manager Sarah McMullen. "The program is eagerly seeking partnerships from potential supporters and organizations that share in the goal of tobacco prevention and reducing youth tobacco use."
McMullen noted that the program reaches 400,000 youths annually, with far-reaching effects. The most recent evidence of its adaptability was the feedback of a presenter -- in Nepal. In fact, Tar Wars staff is so proud of this latest missive, they have put pictures from the presenter online at http://www.tarwars.org/x1384.xml.
The Academy's Web site, aafp.org, won a first-place Platinum Award for Best Site Design in the 2002 eHealthcare Leadership Awards. Also taking honors was the Academy's Web site for family health information, familydoctor.org, which won a Distinction Award for Best Overall Internet Site. More than 1,000 entries in 16 classifications were received by sponsor eHealthcare Strategy & Trends. For a complete list of winners, go to http://www.strategichealthcare.com/Awards.html and click on "Award Winners."
Prospects are grim for continued federal funding for family practice training, but the loss of the support is not a foregone conclusion, Kevin Burke, director of the AAFP Division of Government Relations, said recently.
"Some members of Congress say they will fight for Title VII," said Burke.
This month, Congress is expected to pass an omnibus appropriations bill that will keep most government programs funded through 2003. Given the federal deficit, it's likely the omnibus bill will concur with President Bush's recommendations. In his budget for 2003, Bush called for zero funds for Section 747 of Title VII of the Public Health Service Act, the section for primary care training. There's a chance lawmakers could salvage some funds for the section.
However, at press time, the Office of Management and Budget was expected to recommend that Section 747 be zeroed out in 2004.
"We are deeply disappointed that this program that helps bring family physicians into the health care system is likely to be cut off," AAFP President James Martin, M.D., of San Antonio said last month. He identified family practice as the specialty most likely to serve underserved rural and urban populations.
Research from the Robert Graham Center in Washington indicates that students at schools with Title VII funds for family practice training are more likely to go into family practice or another primary care specialty, to practice in a rural area, or to practice in a whole-county primary care health personnel shortage area.
"This (Title VII) is a government program that's working, and it is not a huge dollar item," said Martin. "It doesn't make sense to cut it when it is serving the American people."
By contrast, prospects remain strong for funding for the Agency for Healthcare Research and Quality. AHRQ is expected to receive 2003 funding similar to its 2002 level of $300 million. The Academy had lobbied for $375 million for AHRQ, the only federal agency with the charge of fostering primary care research.
The Academy continues to seek support in Congress for both AHRQ and Section 747 of Title VII.
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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. |
To the editor:
I read with interest the October 2002 FP Report coverage of a study in the September Journal of Family Practice. According to FP Report, the study found that three out of four FPs surveyed last fall reported they were not prepared to respond to a bioterrorist attack.
The article also stated, "Results from the study have served to inform the Academy's efforts to develop targeted CME programming on bioterrorism. ... Other significant fallout from the study is that the AAFP national research network this summer applied to the Agency for Healthcare Research and Quality for a five-year grant to develop a National Bioterrorism Sentinel Surveillance and Education Network."
In addition to being involved locally in disaster preparedness planning, FPs should avail themselves of educational opportunities that already exist, while at the same time avoiding the creation of CME and other didactic offerings that duplicate what already is available. One example is the Advanced Hazmat Life Support course (www.ahls.org) out of the University of Arizona. I'm an instructor for this 16-hour, two-day course. It covers toxic terrorism as well as the medical treatment of other toxicant exposures, which are also possible weapons of terrorism. Those physicians who feel unprepared for such an event will find this course of interest.
Manuel Mendoza, M.D.
Baraboo,
Wis.
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Watch your mailbox for the debut of a new Academy CME resource -- the "CME Bulletin." This publication will be distributed to active members throughout the year as educational grants are secured from supporters. Each issue will feature a clinical topic for which members can receive AAFP Prescribed credit. The premier issue is the first of a three-part series on breast cancer. E-mail questions about the program to choward@aafp.org. |
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Would you like to purchase brand-name office supply products and furniture at a discount? Your AAFP membership offers you that opportunity through the AAFP office supply program. Order online at www.aafp.org/officesupplies.xml and receive an additional 3 percent discount. Be sure to indicate you are an AAFP member in the "Comments" field on the order form. Order by phone at (800) 942-3311. |
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Proven value: It's time to plan ahead for two spring conferences held annually in Kansas City, Mo. Go to http://www.aafp.org/leader.xml to register online for the National Conference of Special Constituencies May 1 3 and the Annual Leadership Forum May 2 3. Beat the Feb. 28 early-bird registration deadline and save $50. |
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A shipping fee may apply; Kansas residents pay a 7.275 percent tax. |
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FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
