BY J.M. BRODIE
Sen. Grassley meets with
AAFP members, receives award (Online-only content)
About 50 AAFP leaders and members "hit the Hill" May 19 20 -- Capitol Hill. They made a case for changes related to medical liability insurance, patient safety, Medicare reimbursement, prescription drug benefits and funding for medical training. Daniel Onion, M.D., of Augusta, Maine, zeroed in on federal tort reform as a way to address the liability insurance crisis in many states.
"Family medicine and real docs are in trouble throughout the country, and anything we can do to try to fix little pieces of it until there's a bigger fix, we have to try," Onion told a legislative aide during AAFP's annual Spring Legislative Conference.
 Making a pitch for federal tort reform is Daniel Onion, M.D., second from right. He speaks with Nicole Moore, legislative correspondent for Sen. Lamar Alexander, R-Tenn. Listening are Jeffrey Bachtel, M.D., on the left, and James King, M.D., on the right. |
 The Medicare Incentive Payment Program needs to be beefed up, Eddie Turner, above, explains to a legislative aide to Sen. Bill Frist, R-Tenn. |
"In Ohio, we are a couple of years farther down the road of liability crisis than other states, but what we are facing is what other states are going to face if something doesn't change," said Jeffrey Bachtel, M.D., of Tallmadge, Ohio. In meetings with legislators and their aides, he described the situation in his state as severe.
"The rates are skyrocketing, and physicians are having to limit their practices, especially in the area of obstetrics. If we can get (liability reform) on the federal level, great. If it happens on the state level, that's fine, too," said Bachtel. "The point is that something has to happen."
Medicare issues
"We are concerned about the Medicare Incentive Payment Program," third-year medical student Eddie Turner of Memphis, Tenn., told a legislative aide. Turner laid out a list of Academy members' concerns, including the need to tackle MIPP's bureaucratic problems and beef up its incentives for providing rural care.
Medicare reimbursement resonated with the Hill visitors as an issue "important to practicing physicians, because a lot of them are closing their doors to Medicare patients," said Susan Rife, D.O., of Orland Park, Ill., during a meeting with a legislative aide to Sen. Bill Frist, R-Tenn. "It's a shame that the sickest and most vulnerable are not able to have access to care," said Rife.
The aide told the FPs that the senator agreed the fee structure needed work. "The formula is flawed," she said. "It's completely ridiculous that payments decrease as you go on through the years."
The aide said Frist and other senators would soon introduce a comprehensive Medicare bill, which they hoped Congress would pass by midsummer. "The number one thing about this bill is that it is going to give prescription drugs to seniors, and we are trying to see if we can get the physician fix in," said the aide, referring to correcting the formula for Medicare reimbursement. "I don't know if at the end of the day it will get in, but if it doesn't, it is going to be something that we may introduce afterwards as a separate bill."
 Sen. Charles Grassley, R-Iowa, tells AAFP members he is committed to eliminating geographic discrepancies between rural and nonrural physicians' Medicare payments. |
Coverage for all
The issue of health care coverage for all came up both during the visits to legislators' offices and when Del. Donna Christian-Christensen, M.D., D-Virgin Islands, gave a luncheon address to conference participants. As chair of the Congressional Black Caucus' Health Braintrust, she outlined health projects the caucus has championed.
"Our centerpiece is insuring the uninsured," said Christian-Christensen, a family physician and the first woman physician ever to serve in Congress. "We have to broaden the coalition to look at different approaches to come up with one that is doable."
Coming next: follow-up
Conference participants said they were generally pleased with their interactions on the Hill and felt they had gotten their messages across. "You can't tell the lawmakers too many times about what's going on with our practices back home," said James King, M.D., of Selmer, Tenn., chair of the AAFP Commission on Legislation and Governmental Affairs, following several Hill visits.
"I think it went really well," said Turner, who met with Sen. Lamar Alexander, R-Tenn., on the second day of his Hill visits and conferred with several legislative aides the first day. "They were receptive to the issues we were talking about. I think something will come of this. I am going to keep in contact and follow up on the issues."
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
Online-only content
The chambers of the Senate Finance Committee served as the breakfast setting for Academy leaders and members May 20 as they honored Sen. Charles Grassley, R-Iowa, the committee's chair, with the AAFP National Leadership in Government Service Award.
In presenting the award, AAFP President James Martin, M.D., of San Antonio said, "Sen. Grassley's ability to build consensus across the political spectrum has earned praise from Republican, Democrat and Independent lawmakers. He consistently fights hard for fair treatment of family physicians and their patients."
Earlier in May, the senator took the lead in an effort to remedy geographic discrepancies between rural and nonrural physicians' Medicare payments. He introduced his remedy as an amendment to the Senate version of the federal tax bill.
"Rural providers practice some of the best medicine anywhere -- scholars, think tanks, policy people understand this -- but the Medicare formula doesn't reflect this," Grassley said during the breakfast meeting. "This amendment ends, once and for all, the historic discrimination against rural health care providers."
The Senate passed Grassley's amendment 86-12, but the joint House-Senate conference committee deleted the amendment in its final work on the bill. President Bush signed the tax bill May 28 and noted he did support Grassley's measure that had been deleted from the bill. Whether the amendment would resurface in other legislation was not known at press time.
Grassley, perhaps anticipating the amendment's demise, told AAFP leaders that if the amendment failed to make the cut on the tax bill, he would include it in a wide-ranging Medicare improvement bill that would include prescription drug coverage. "We've got two bites of the apple," Grassley said, referring to the Senate vote and a possible amendment to the prescription drug bill. "We might get three bites -- if we don't get the prescription drug (amendment), then we might try it some other way, as a stand-alone bill or as part of some other bill down the road."
A May 15 Associated Press story on the Grassley amendment quoted AAFP Board Chair Warren Jones, M.D., of Ridgeland, Miss. Jones called the measure a large step toward correcting the inequities between urban and rural health care professionals. He noted that low reimbursement rates have forced many of these professionals to cut staff and offer fewer medical services.
BY SHERI PORTER
Arlene Brown, M.D., of Ruidoso, N.M. recently referred a 19-year-old patient to a psychiatric hospital emergency room for court-ordered evaluation and hospitalization.
But when Brown, a member of the AAFP Board of Directors, called the hospital for routine follow-up on her patient, she was shocked by the anything-but-routine response. It stemmed from problems interpreting the privacy rule for the Health Insurance Portability and Accountability Act.
"I was told out and out that they could not release any information to me because of HIPAA," said Brown. "Even though I'm the attending physician, I was not allowed to be part of the information loop."
Eventually, Brown received a patient update from her patient's mother. "But I have yet to see anything from the psychiatrist," she said. "Obviously, it's a problem in terms of continuity of care. How am I supposed to do the follow-up when I'm not allowed to know what was done?"
The HIPAA privacy rule went into effect April 14. Overzealous interpretation of the regulations has been frustrating physicians ever since. Even people well-acquainted with HIPAA -- created to benefit patients by safeguarding their private health information -- have been surprised by the unintended ripples it has caused.
Consider this scenario in Brown's 11-bed hospital: Patients' names and room numbers are no longer listed on the board in the nursing station. Instead, physicians are given a list of occupied rooms.
"We have to go wandering up and down the hall looking in patient rooms to find our patients because we're not allowed to know what room they're in," said Brown. "It was a corporate decision -- and it's their interpretation of what HIPAA means."
Misinformation
Much of the problem, speculated Mary Elizabeth Roth, M.D., of Allentown, Pa., is misinformation. "The rule was changed after it was first promulgated," said Roth, "and some people are still stuck on what the original version said."
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Roth is dealing with the patient records of a retiring physician. All the patients must be contacted and their charts transferred to other physicians and hospitals, said Roth.
"I just spent half an hour trying to explain to someone in another hospital that it's not a violation of anything to send them the original patient chart," said Roth. The hospital, citing the HIPAA privacy rule, refused to accept the chart even though the patient had given written consent for the transfer.
Darlene Lawrence, M.D., of Washington, D.C., tangled with a misinformed health plan employee. Lawrence was trying to refer a pregnant patient to an obstetrician to schedule a Caesarean section. "I got so much flack from a staff person," said Lawrence. "She quoted HIPAA to me three different times on the phone. She said she couldn't give me an appointment for my patient because she couldn't break HIPAA."
Flustered families
Patients' nerves are fraying as well. "We have found it difficult and time-consuming to explain to patients and their families why we cannot communicate health information to spouses and children without patient consent," said FP Lindsay Phillips, M.D., of Rochester, N.Y.
A common example, she noted, is calling to change a patient's warfarin or levothyroxine doses. "The patient may have some dementia, be hard of hearing or difficult to reach," she said, explaining the patient's need for help in managing medications. Phillips hopes that once all patient charts have been updated with the proper consent documentation, the situation will improve, but she said that may take more than a year.
Kathryn Stewart, M.D., medical director for care management at Mount Sinai Hospital in Chicago, said her facility is also grappling with family communication issues.
"Patients' families are stopping physicians in the hallway and wanting to talk about what's going on with Dad," said Stewart. And the family doesn't simply want to know whether Dad's critical or stable. "The family wants to know what Dad's cardiac cath showed," said Stewart.
"I think our policy is going to state that those kinds of discussions must occur in the presence of the patient," she added.
Phone calls from family members -- routine in the past -- now create havoc because patient information cannot be given out over the phone "just because someone calls in and identifies themselves as a family member," said Stewart.
"Don't get crazy"
People are having problems because the HIPAA privacy rule is complex, said Leon Goldman, M.D., chief compliance and privacy officer at Beth Israel Deaconess Medical Center in Boston. "The rule allows for people to use their best clinical judgment in any given situation."
Despite extensive and ongoing staff training on the privacy rule at his facility, "we'll still make mistakes," said Goldman. "First ask what's good for the patients and make sure they're cared for. Then protect their information, but don't get crazy about it."
This is a confusing rule, said Goldman. "We've done our best to interpret it correctly, but even the best is not perfect."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
You've just had your third negative HIPAA encounter of the day -- a real doozy this time -- and you feel yourself wilting. Government sources, hospital administrators and family physicians suggest these steps for keeping your cool and coping.
There is an upside to implementing the Health Insurance Portability and Accountability Act's privacy standards (aside from the obvious intended protections afforded to patients). Consider these unexpected benefits reported by members.
"On a positive note, this has opened the door to some frank discussions about relationships," said Lindsay Phillips, M.D., of Rochester, N.Y. "Even in what appear to be good partnerships between spouses or parent and child, I have relearned that things are not always as they seem. We should not assume it's OK to discuss any health information with a family member."
"The upside is the patient has privacy from nosy neighbors, nosy in-laws, nosy reporters."-- Mary Elizabeth Roth, M.D. |
Patients are asking good questions about the privacy of their health information, said Darlene Lawrence, M.D., of Washington, D.C., and the frequency of the questions is increasing the knowledge base of both patients and staff.
In addition, Lawrence likes the subtle shift of responsibility away from the doctor's office and back to the patient. "It's up to the patient to understand why we can no longer leave their forms in a box outside the office door after hours or give lab results over the phone without proper authorization," said Lawrence. When patients complain about these inconveniences, now she can say, "Sorry, it's the law."
Mary Elizabeth Roth, M.D., of Allentown, Pa., said the privacy rules highlight the intimacy of small communities and the intimacy of the practice community.
Even in small-town America, "no one has the right to know about a patient's visit except for the doctor and people caring for her," said Roth. "The upside is the patient has privacy from nosy neighbors, nosy in-laws, nosy reporters."
Then there is that ultimate compliment -- patient trust -- that makes it all worthwhile. "So far the only effect on our practice is that the patients have a lot of questions about the HIPAA forms and then usually just say, 'Yeah, I trust you, doc,' and sign," said Helen Story, M.D., of Evergreen, Colo.
The June 16 Newsweek pointed out, "there are 30,000 scientific journals in the world, and most of them are unreadable. Do we really need another? Yes, yes, yes, at least in the case of the Annals of Family Medicine."
Newsweek said Annals will appeal to physicians and patients because it "focuses on issues that may be overlooked in more specialized, esoteric journals, but are crucial in real life."
Another indicator of Annals' success: an agreement to make its content available on Medscape.
AAFP active members received the first issue of Annals in June and can request a free one-year subscription. Readers can also access Annals and its interactive discussions at http://www.annfammed.org/.
BY TONI LAPP
What do Tar Wars® and racing have in common? They both have a fan in AAFP EVP Douglas Henley, M.D.
Yes, the North Carolina native now living in Leawood, Kan., has long been keen on motor sports. And as a physician interested in seeing the tobacco epidemic snuffed out, Henley is glad several race car drivers are taking up the Tar Wars cause.
 "I can't believe people would want tobacco on their breath; what it does to the inside is bad enough," says Jennifer Jo Cobb, a racer who promotes Tar Wars. |
"In a sport that historically has depended on tobacco company sponsorship, it is great these drivers are choosing to support Tar Wars. They're engaged in an effort to mentor kids and their parents about the need to avoid this unhealthy habit" of smoking, says Henley.
It's good news for Tar Wars, the Academy's tobacco-free education program, that new drivers are carrying the no-smoking banner onto racetracks across the country. Tar Wars participants may remember that the effort started with California driver John Baumgartner three years ago.
Well, now Baumgartner has company. Four new drivers, in fact.
What gives? After all, racers receive no money from Tar Wars through the sponsorships.
"It's free advertising for us, and the drivers are connected to this successful education program," says Pamela Rodriguez, Tar Wars national manager.
And the drivers are more than happy to educate youngsters about the ills of tobacco.
"The age of kids that Tar Wars targets is a vulnerable age," says Jennifer Jo Cobb, a racer from Kansas City, Kan. "It's important that these kids hear how uncool it is to smoke." Cobb has competed in the NASCAR Weekly Racing Series and the ARCA/Remax Series. Besides sporting the Tar Wars logo on her car and her tracksuit, Cobb plans to present the Tar Wars program at schools.
Then there's Joe Wutke of Hillsborough, N.J. He drives a truck in the Championship Off Road Racing series -- events often televised nationally. When he began racing with the Tar Wars logo on his truck last year, he was surprised by the number of kids coming to the races who already knew about Tar Wars, he says.
Wutke feels he can reinforce the message.
"I can honestly and proudly say I've never tried any tobacco products," he says. "It's a terrible habit, and (tobacco companies) are making tons of money on other people's suffering."
In January, Wutke received full backing from Nissan, a "dream come true," he says. Nissan officials asked Wutke about his other sponsors. "They wanted to know what Tar Wars was, and when they found out, they were all for it," he says. So now the Tar Wars logo will be in high-profile company -- positioned near Nissan's emblem on Wutke's truck, helmet and tracksuit.
In the Indy Racing League, Ronnie Johncox of Jackson, Mich., competed under the Tar Wars logo in the Freedom 100 in May at the Indianapolis Motor Speedway. He invited Evansville, Ind., student and former Tar Wars poster contest winner Jenny Beck to be "honorary crew member" at the race, where he finished in eighth position before viewers on ESPN2.
Johncox became familiar with Tar Wars through presentations at his daughter's school. Later, he decided to race under the logo. "When the opportunity came about to get involved, I didn't hesitate," he says. "In today's world, there are far too many negative messages directed at kids, and as a father of three, I wanted to give them a positive message to hear."
In Idaho, stock car driver John Peterson carried the Tar Wars logo to a trophy finish in May in a regional beginners' race called Future Stocks. Peterson, an ex-smoker, says having not one but three anti-tobacco groups sponsoring his car -- named "Smoke-Free 83" -- will motivate him to resist the urge to smoke.
Race car sponsorships are the perfect way to target kids, says Peterson. "It's exciting because a lot of kids come by after the race, and it's an opportunity to reinforce the 'don't-smoke' message."
Tar Wars staff caught onto that three years ago with Baumgartner.
The Tar Wars car has been a popular attraction at the AAFP Scientific Assembly for two years running. Look for a Tar Wars driver to appear during the Assembly this fall in New Orleans, courtesy of a grant from Novartis.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
The redesigned Tar Wars Web site was launched in June. Go to http://www.tarwars.org to check out the colorful new look, improved navigation features, increased online content and resources, and information on new initiatives. While there, you can order any of the four new Tar Wars posters now available.
Other Tar Wars news:
All 55 AAFP constituent chapters and the Tar Wars state and regional coordinators have been sent a five-minute video describing Tar Wars and the people involved -- from state coordinators to poster-painting kids. The video is designed to increase awareness of and participation in the program.
Keep your eyes peeled. Tar Wars public service announcements will soon be sent to television stations across the country. You just might catch the PSAs during your favorite shows.
This year's Tar Wars poster conference will take place July 13 - 14 in Alexandria, Va. The 2003 event is being supported with a new grant from Janssen Pharmaceutica, along with grants from the Center for Tobacco-Free Kids, Schering and the AAFP Foundation.
Abipartisan coalition is urging the government to initiate hearings on the effects of litigation on health care.
Common Good, a New York-based initiative to overhaul what it calls "America's lawsuit culture," is sponsoring an online petition drive to sway legislators to create a new system of medical justice. "Fear of litigation has undermined our freedom to make sensible decisions," the organization states on its Web site. "Doctors, teachers, ministers, even Little League coaches, find their daily decisions hampered by legal fear."
The organization wants judges and legislatures to draw the line on who can sue for what. "Society needs red lights and green lights," the organization states on its Web site. "Today, because anyone can sue for almost anything, Americans creep through the day, fearful of being blindsided."
Petition signers include medical school deans; medical association heads (such as AAFP President James Martin, M.D., of San Antonio); college presidents; and other community and organization leaders.
To read more about the group's efforts and, if you wish, sign the petition, go to http://www.aafp.org/x21384.xml and click on "The Common Good -- Reforming America's Lawsuit Culture." Under "Healthcare Leaders Petition Congress to Restore Reliability to Our Legal System," click on "Read the petition" and "Add your name to the petition."
About 3,000 Illinois health care professionals, including several Illinois AFP leaders, rallied May 13 in Chicago's Daley Plaza to ask the public to support federal tort reform. The Chicago Medical Society organized the rally.
"I am glad that family physicians and our medical colleagues could come together on the same issue," Ellen Brull, M.D., of Niles, Ill., the Illinois AFP first vice president, said after attending the rally.
 Signs such as this one drive the crowd's message home. |
 A crowd of nearly 3,000 Illinois health care professionals express support for federal tort reform at a Chicago rally. |
The protesters argued that malpractice reform was essential to the survival of many medical practices. They also said they wanted to raise awareness of the impact of the medical liability crisis on patients' access to medical services.
"If liability reform does not occur, I will have to turn away some patients," said FP Frederic Ettner, M.D., of Evanston, Ill., after participating in the rally. "It costs more for me to see them than I am currently being paid. My liability premiums have increased 45 percent in the last two years, and I am in solo practice."
Without meaningful tort reform, there will be fewer physicians in Illinois, where rising insurance premiums could drive many health care professionals to cut back on their practices.
"On every rotation I go through, from family practice to surgery, I hear about the medical malpractice crisis," said third-year medical student Todd Novak of Chicago. Reflecting on the event, he said, "I hope this rally wakes people up and gets people talking."
Plan now to attend the 2003 AAFP Annual Assembly. It begins with the Congress of Delegates Sept. 30 Oct. 2 in the Grand Ballroom of the Hilton New Orleans Riverside. The Scientific Assembly, with almost all of its CME sessions at the Morial Convention Center, will be held Oct. 1 5.
 "I used to be a doctor, then I was a provider, now I'm a 'covered entity,' says William De Alva, M.D., of Tucson, Ariz., at a 2002 Assembly town hall meeting. |
 An instructor in the colposcopy clinical procedure workshop at the 2002 Scientific Assembly assists Theresa Wang, M.D., of Reedsburg, Wis. |
Update your knowledge, skills
Keep abreast of new medical knowledge and sharpen your treatment skills during the Scientific Assembly. Many sessions were designed to meet members' demands, including offerings on musculoskeletal exams, diabetes, hormone replacement therapy, new imaging modalities, cardiovascular problems, headache, weight control, new infectious diseases, headache, chronic pain, early detection of cancer, and documentation and coding.
Visit the new hands-on practice exam area in the exposition hall -- lecturers will train you in the exam techniques they taught in the musculoskeletal clinics.
For more information on the Scientific Assembly, go to http://www.aafp.org/assembly.xml.
Speak up at reference committee hearings
Feel free to speak your mind at the reference committee hearings of the Congress, AAFP's policy-making body, and listen to the debate during the Congress' general sessions. The delegates will receive an update on the Future of Family Medicine project and will discuss issues such as Medicare reimbursement, government regulations and the number of delegate seats for special constituencies.
Each year, the Congress elects new Board members and officers. The Academy has already set up an online Q-and-A forum so you can pose questions to the 2003 candidates (see the story below).
Note: The Congress will be in session on different days of the week this year, compared with the days of the last few Congresses. This year, the Congress will meet from Tuesday morning to Thursday noon.
The AAFP Congress of Delegates will elect new AAFP Board members and officers Oct. 2. To see who's in the running, go to http://members.aafp.org/members/congress/candidates/ and use your AAFP ID number to login. You'll find links to the candidates' Web sites.
In addition, you can use the "Question/Answer Forums" to ask the candidates questions and receive answers online. The site is reserved for your questions and candidates' responses (the site is not for responses from members at large).
BY TONI LAPP
Four years ago, the AAFP Board of Directors approved the plan for the Academy's national research network. What's happened since then? Lots. The network has two published studies under its belt, and several projects are in progress.
The mission of the National Network for Family Practice and Primary Care Research is to discover better ways of caring for patients. Network projects actively seek answers to the problems that confront primary care physicians.
"Infrastructure funding from the Academy for the research network has been critical to the network's early successes," says John Hickner, M.D., M.S., of East Lansing, Mich., network director.
The network has published the results of two studies: one on patient safety and the other on the bioterrorism preparedness of family physicians.
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"As with most descriptive research studies, these initial studies have generated more questions than they have answered -- ensuring that we have many more projects for the future!" -- John Hickner, M.D.,M.S. |
Here is an overview of current projects:
• The Pneumococcal Immunizations Among Older Adults study. Data collection began in August 2002 for this two-pronged study. The first goal of the study is to investigate the use of hand-held computers versus traditional paper methods for data collection by medical staffs in 25 practices. The data will be analyzed to compare efficiency, quality, timeliness of data collection and user satisfaction. The second goal of the study, funded by the Agency for Healthcare Research and Quality, is to define what segments of the over-65 population have received pneumococcal immunization, a vaccine that is recommended for elderly people. Co-investigators Richard Zimmerman, M.D., of Pittsburgh and Gregory Doyle, M.D., of Morgantown, W.Va., plan to develop an intervention trial to increase immunization rates.
• Hepatitis C Survey of Family Physicians. This survey was devised with the knowledge that many patients with hepatitis C infection go undiagnosed. The research will be used to study family physicians' clinical practices in screening, diagnosing and treating patients with hepatitis C infection. Data are being compiled and analyzed from surveys that were sent to about 1,000 members of the AAFP, as well as to 243 network members. Participants who completed the 30-item instrument were asked questions ranging from what blood tests they use for screening to their opinion of the risk of hepatitis C infection to society. By identifying barriers to treatment, the research may help improve care for patients at risk for hepatitis C infection. Barbara Yawn, M.D., of Rochester, Minn.; Jonathan Temte, M.D., of Madison, Wis.; and Elizabeth Clark, M.D. of Portland, Ore., are co-investigators for the nine-month study, funded by Schering, which began in January.
• Streamlining the Internal Review Board Process project. Protecting human research subjects is of critical importance to network researchers, who strive to balance that concern with the need to conduct meaningful studies. The time it takes to complete the internal review board process varies from one institution to another, and because physicians may be affiliated with their own separate, local IRBs, there are often duplicative reviews that take anywhere from a few weeks to a few months. The hope that the review process could be improved was the impetus for this project. The desired outcome is to develop reciprocal agreements between the network's central IRB and network physicians' local IRBs and to design a more efficient method of obtaining approval for physicians not affiliated with the network's IRB. James Galliher, Ph.D., the network's research director in the AAFP Division of Scientific Activities, is principal investigator for this project.
• Other projects. To date, network researchers have also studied diabetes outcomes, alcohol screening and cancer care. "As with most descriptive research studies, these initial studies have generated more questions than they have answered," says Hickner, "ensuring that we have many more projects for the future!" *
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
The Agency for Healthcare Research and Quality has made a $50,000 grant to the Academy to hold the first-ever National Ambulatory Primary Care Research and Education Conference on Patient Safety.
The event will be held Sept. 18 - 19 in Chicago.
Academy members can take satisfaction in this tangible example of the success of the National Network for Family Practice and Primary Care Research, says Martin Mahoney, M.D., Ph.D., of Clarence, N.Y., chair of the Commission on Clinical Policies and Research.
"It speaks to the leadership role that AAFP is assuming on this topic, a topic that is of high interest to the public," he said.
The conference is sponsored by the AAFP Developmental Center for Research and Evaluation in Patient Safety -- Primary Care, the Primary Care Organizations Consortium, and the National Patient Safety Foundation, with assistance from the Medical Group Management Association.
Go to http://www.aafp.org/ptsafetyconf.xml to read more about the conference. E-mail Claudia Caton at ccaton@aafp.org for conference registration materials.
The AAFP would like to cast a wide net in encouraging members to serve on commissions and committees at the constituent chapter and national levels. Family physicians in these groups help draft policy statements, design programs to meet FPs' needs and sometimes serve as Academy representatives to other organizations.
Take a moment to consider whether you'd enjoy helping lead your chapter or the AAFP. In particular, would you like to help shape AAFP policies and programs? Or do you know someone you think should be nominated for an AAFP commission or committee?
If so, talk with your chapter leaders. See whether the chapter might have need for your services or those of your colleague, or might nominate you or your colleague for an AAFP commission or committee.
The AAFP began accepting nominations from chapters early this month, and the nomination deadline is Oct. 10. So now's the time to consider your leadership opportunities and those of your peers.
BY CINDY BORGMEYER
There's no denying that the quality of the American health care system has come under fire in recent years -- and deservedly so, many would say. The issue came to a head when landmark reports from the Institute of Medicine in 1999 and 2001 brought patient safety and quality-of-care problems to the attention of medical professionals, health policy-makers and the public.
Not surprisingly, numerous would-be quality watchdogs have since stepped forward, proposing ways to measure various components of the quality picture -- including physician performance.
Sensing a growing threat to physician autonomy, the American Board of Medical Specialties, which oversees the individual specialty boards, set about developing a program to reassure the American public about the quality of care the nation's physicians provide. At the crux of that program is a process known as maintenance of certification, or MOC, in which every board-certified U.S. physician will be expected to participate.
Joseph Tollison, M.D., deputy executive director of the American Board of Family Practice, met with AAFP officers and staff last month and spoke about the new process. According to Tollison, ABFP is devoted to implementing MOC with a modicum of hassle.
"We are obligated by ABMS to march this thing out, and we're going to do it in the most constructive way possible," Tollison said. "We hope it will become clear that this process has great value to physicians' practices and to their patients. It may look like a burden on the front end, but there's great potential and great expectations on the back end."
The Nitty Gritty
Here's the gist of the new system.
MOC is designed to continuously measure the ongoing competencies of practicing physicians in every specialty. Those competencies are medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
ABMS has devised a four-part framework for measuring the six competencies and has charged each of its constituent boards with developing mechanisms to assess diplomates in each of the four areas:
• evidence of professionalism -- for now, this will be measured by maintenance of full, valid and unrestricted licensure. ABFP hopes to soon roll out an ABMS-designed peer/patient satisfaction evaluation tool to help physicians review this additional aspect of professionalism;
• evidence of self-assessment and lifelong learning -- diplomates each year will complete a clinical self-assessment module that uses patient simulation technology to test physicians' medical knowledge and clinical skills in a given disease domain;
• evidence of cognitive expertise -- ABFP will continue to measure this aspect via its comprehensive examination, expanding both the number of test sites and the frequency of exams offered, and completing over the next several years the transition from paper-and-pencil to computerized format; and
• evidence of assessment of performance in practice -- ABFP will conduct electronic chart reviews, comparing that information against evidence-based quality indicators and providing feedback. Physicians will then be expected to complete an individually tailored quality improvement plan during the seven-year MOC cycle, with a repeat audit to determine whether the QI plan has proved effective.
Much of this process no doubt sounds familiar, and it should. To paraphrase ABFP Executive Director James Puffer, M.D., the new process refines, rather than shifts, the paradigm currently used to recertify FPs. Puffer discussed the issue at length in an interview in the inaugural issue of Annals of Family Medicine. Go to http://www.annfammed.org/cgi/content/full/1/1/56 to read the article.
New Beginnings, New Bonds
ABFP will begin phasing in the new program Jan. 1, 2004, for those certifying or recertifying in 2003. Every year thereafter, each certifying or recertifying physician will enter the MOC program. That's where AAFP comes in.
The Academy and ABFP are already working closely together to coordinate the roll-out of the ABFP's first two clinical self-assessment modules -- on diabetes and hypertension -- with AAFP CME initiatives.
Another area that has the two organizations working shoulder-to-shoulder involves assessing evidence of physicians' performance in practice, with the ABFP working to ensure that AAFP QI activities now being designed for members meet ABFP criteria for fulfilling this component.
"We want this to be a truly collaborative relationship," said Tollison of the growing cooperation between the two organizations. "The ABFP and its diplomates are really looking to the Academy to partner with us. This has 'opportunity' written all over it."
"I think the changes our Academy members are being asked to make are completely in keeping with what it means to be a family physician," said AAFP Director John Sattenspiel, M.D., of Salem, Ore., about the new system. "Now we need to help our members get to a place where this is all just part of the landscape of day-to-day practice."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
To the editor:
In the May FP Report, pages 4 - 5, AAFP focuses on prevention -- good stuff. No smoking, lots of exercise, no extra pounds -- good stuff. Reserve 30 minutes a day, four days a week, for exercise, just 1.2 percent of an entire week -- good stuff. Finding out why people don't get enough sleep -- good stuff. Web site devoted to prevention -- good stuff.
Page 6 discusses resident work standards -- 80 hours per week. Six days of more than 13 hours each. This is on-site work. Does not count preparation, reading, studying.
Sleep deprivation, code name "call," every third night. Standards allow resident to work 48 hours out of 58-hour stretch (that's including the 10-hour minimum rest period.)
Let me get this straight. Our training programs demand the above work schedule (new and improved) while we promote all that politically correct "good stuff"?
Gentlemen, can you say hypocrisy?
Jeffrey Waggoner, M.D.
Aurora,
Colo.
To the editor:
This is in response to the letter in the March FP Report in which the writer is advocating, "harness the power of midlevel providers." This idea is one of the reasons the specialty of family practice is in danger.
These spurious "practitioners" are slowly undermining the medical profession by obtaining a de facto license by legislative fiat instead of by a proper medical education. Physicians who employ these people are merely obtaining a short-term increase in their cash flow in exchange for a permanent long-term loss for their profession.
If these practitioners can really deliver quality medical care, why are billions of the taxpayers' dollars being thrown away yearly to operate medical schools? The greatest losers are the American public. People are oblivious to what is occurring: the slow demise of the primary care medical profession and top-quality medical care.
Milton Johnson, M.D.
Macon,
Ga.
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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:
"Medicaid cutbacks" was the lead story in the May FP Report. The usual litany of complaints was heard. Nowhere was there even a simple acknowledgment of the fact that Medicaid payments come from taxpayers. Why is it considered routine that one group of people should be able to take money from my kids at gunpoint to pay for other kids' health care?
This is theft, pure and simple. The only reason that doctors pay any attention to it is because our bottom line is affected. If we care so much about these people, let's see them for free.
The real problem is government regulation of medicine, in all its forms (medical practice acts, FDA, etc.), that has driven the cost of medical care beyond the reach of the average citizen. Of course, we physicians have benefited monetarily from this, but that doesn't make it right.
Jeremy Klein, M.D.
Louisa,
Ky.
WEB EXTRA!
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Check out the third and final installment of the evidence-based CME Bulletin series on breast cancer, Women and Breast Cancer, Part III: Treatment.AAFP Prescribed credit is available to members who complete the quiz. To read the materials, take the quiz and report your CME hours online, go to http://www.aafp.org/cmebulletin.xml and click on the bulletin title. |
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Proven value: Looking for quality CME? Look no further than the 2003 Scientific Assembly Oct. 1 – 5 in New Orleans. Choose from 376 courses -- 174 of which are included in your registration fee. Clinical topic areas include asthma, cancer, cardiovascular health and infectious diseases. Looking for practice management help? Pick from a variety of topics including electronic medical records and cost-control strategies. Some high-demand courses fill quickly, so register online today at http://www.aafp.org/assembly.xml. |
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Proven value: It's easy to support Tar Wars and spread its tobacco-free message by displaying Tar Wars posters in your waiting and exam rooms. Each year, elementary school children in every state create posters for the national poster contest; the winning posters are used to promote the Tar Wars program. Visit the redesigned Tar Wars Web site at http://www.tarwars.org/promoitems.xml to place your order. Choose from four wall posters ($3 each). Quantity discounts available. |
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A shipping fee may apply; Kansas residents pay an 8.05 percent tax. |
WEB EXTRA!
FP Report is published by the
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Copyright © 2003 by
American Academy of Family Physicians.
