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BY SHERI PORTER
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Not worried about the Oct. 16 deadline for making all your electronic health claim transactions compliant with the Health Insurance Portability and Accountability Act? You should be.
This fall, when the HIPAA transactions and code sets standards go into effect, Medicare and other health plans will deny non-HIPAA-compliant claims. According to David C. Kibbe, M.D., AAFP's director of health information technology, it's entirely possible that millions of claims could be rejected, resulting in severe cash flow problems for physician practices all over the country.
To avoid financial disaster, physicians must talk to their practice management system or billing system vendors to determine their practices' readiness to send HIPAA-compliant claims to payers. Without end-to-end testing now, from your practice to each payer's computer system, there's no way to know what glitches in the system might kick claims out come October.
It's not just FPs tangled up in this red tape -- physicians in every specialty will be affected by this impending crisis.
Rick Ruther-ford, director of practice management at the American Urological Association, said he recently spoke with a member of a four-physician urology group in Florida.
The practice partners did exactly as they were advised -- they began testing live claims in April after their system vendor informed them that their system was ready to submit claims in the new HIPAA format.
The first batch of test claims included 390 Medicare claims. Within 10 days, Medicare rejected all 390 of those claims. Within a few weeks, more than 1,000 claims had been denied by Medicare and Blue Shield of Florida, causing a severe cash flow problem within the practice.
Clearly, the system vendor was not ready for HIPAA, reported the urologist.
Steve Fisher, manager of practice management affairs for the American Association of Orthopaedic Surgeons/American Academy of Orthopaedic Surgeons, has talked to enough physicians in his organization to know that trouble is brewing.
"The practices think that the software vendors are doing what they're supposed to be doing -- physicians are making that assumption," said Fisher. In fact, he has learned through conversations with physicians that many of them don't even know what additional data elements they're supposed to be collecting -- elements that under the law have to be provided as of Oct. 16 in order for a claim to be processed.
"If physicians don't know what the data elements are, I think it's highly unlikely that they're going to collect them," said Fisher. "What's going to happen is that people are going to be merrily submitting claims on Oct. 17, and the claims are going to go nowhere. People are not going to get paid.
"It's sort of like everybody is ignoring the fact that a meteor is streaking towards the earth. Physicians are saying, 'Well, it'll probably miss me, or maybe it'll just end up in Antarctica.'"
Kepa Zubeldia, M.D., is in the transactions testing and certification business. He is the chief executive officer of Claredi, a company that provides software that can identify errors in a batch of claims -- errors that, come October, may cause those claims to be rejected.
Zubeldia estimates there are half a million medical practices in the country. His company, the largest provider of independent testing, currently has about 1,000 customers. If advance testing is the only way to ensure HIPAA readiness, "then these numbers show that the readiness level is very low," said Zubeldia.
"It's extremely important that physicians not rely on hollow statements from their vendors and clearinghouses saying that they're going to be compliant and not to worry. Physicians need to get proof for their own offices as to the readiness of their own transactions," he said.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
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Most practices are behind in the HIPAA transactions and code sets testing effort. Most vendors, clearinghouses and health plans are also behind. But there are steps you can take right now to prevent disruption of claims payments in October, said David C. Kibbe, M.D., AAFP's director of health information technology. Here are four steps to get you started. The online story has the complete list of actions to take to protect the financial security of your practice.
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The AAFP has been fighting for fairness for its members ever since the Health Insurance Portability and Accountability Act passed Congress.
The latest advocacy effort was in the form of a hand-delivered letter to HHS Secretary Tommy Thompson on June 30. The AAFP joined 35 other medical organizations in a chorus of rising concerns about the health industry's readiness for the Oct. 16 compliance date for the HIPAA transactions and code sets standards.
"The possible rejection of nonstandard electronic transaction and the resulting reversion to paper transaction could result in a major disruption of payment flow to providers under Medicare, Medicaid and private sector health plans," said the letter.
The letter expressed concern about the adverse impact that the disruption in payment could have on the delivery of quality health care across the country. Zeroing in on the hazard to health care, the letter continued, "We believe the federal government must act immediately to avert this possibility by developing and disseminating a comprehensive contingency plan to circumvent any negative impact associated with the Oct. 16 deadline."
The letter presented Thompson with this stark scenario: "As of today, only 3 1/2 months remain before the deadline, and relatively few providers have successfully completed external testing. Providers that have attempted to test are finding the process difficult and confusing. In addition, we anticipate that just prior to Oct. 16, a large percentage of providers will attempt to initiate testing. This will result in a substantial number not being able to complete this process in time to meet the deadline."
The letter suggested three contingency plans:
In addition, the federal government should "facilitate this process by providing clarification and direction on critical issues," said the letter to HHS. The letter suggested some issues that warrant "fundamental directives" from Thompson, including assuring health plans that they will not be considered noncompliant if they accept claims from providers who are in good faith trying to achieve compliance; encouraging health plans to communicate to provider clients specific testing dates and procedures to send test transactions; and asking health plans to develop contingency plans to handle the expected increase in paper claims submissions as a temporary solution.
The medical organizations also asked HHS to "significantly expand its current education outreach campaign to providers."
"These proposals in no way suggest a delay in the implementation of the HIPAA standards. Rather, through our recommendations outlined in this letter, we seek to ensure that the migration to these new standards occurs as orderly as possible and prevents any interference in the delivery of health care," the letter concluded.
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Kepa Zubeldia, chief executive of Claredi, a transactions testing and certification business, has pulled together a list of the top 12 most frequent errors his company finds during claims testing. The errors are listed in descending order of frequency. Zubeldia is preparing a similar list of vendor errors. "If we can get these common errors corrected, the compliance rate will jump from zero percent to 99 percent," said Zubeldia.
The list:
This list is provided by Claredi to assist the industry in its HIPAA compliance efforts. This generic list reflects common provider errors. It does not reflect any one provider, vendor or clearinghouse. Your particular experience may vary. Claredi makes no representation or warranty of any kind. An error list like this is only a general guidance and should not be used in lieu of testing your own transactions. For more information on HIPAA transactions testing, visit http://www.claredi.com.
(©) 2003 Claredi. All rights reserved. Reprinted with permission.
 Edward Schuurman, P.A.-C., examines Kristy Thomas, who can breathe more freely since she began getting care at Mont Alto Family Practice in Pennyslvania. Physician assistants and other staff members played key roles in the teams of the Asthma Learning Collaborative. |
BY J.M. BRODIE
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Kristy Thomas is breathing a lot easier these days. "I have a lot more control over my breathing than I did before," says the 10-year-old with asthma, smiling after seeing a favorable reading on her peak flow meter.
She's making one of her regular visits to the Mont Alto Family Practice in south central Pennsylvania.
Mont Alto is a picture postcard of bucolic bliss, dotted by lush trees, ripe fields and vast farmland. It is also a haven for pollen and other allergens. It's a place where children with asthma have a hard time.
"Kristy was like most asthma patients we get. The first time we see them, they are in crisis," says Edward Schuurman, P.A.-C. He works in the Mont Alto offices of FPs Greg Lyon-Loftus, M.D., Ph.D., and Diana Lyon-Loftus, M.D., husband and wife.
Two hours to the east in Philadelphia, urban grime, car exhaust and industrial fallout pose serious challenges to people with asthma. FP Elaine Reed, M.D., tucked in her basement office, gets an update from Barnard College student Randie Welles, 17, on how she's dealing with her asthma and allergies. Welles tells the doctor she has been under the weather lately and admits she hasn't kept up on her medications. Without scolding, Reed convinces her to be more diligent in monitoring her own care.
"Randie is not like a lot of my patients because I can go into more detail about her illness," Reed says after the visit. She peers out from behind a stack of patient folders in the converted home, now a clinic -- Penn Care University City Family Medicine, a part of the University of Pennsylvania's health system -- just blocks away from downtown and the university. "For most, I have to boil things down to the very basics. The patients we serve here are, for the most part, very poor and not as well-educated," says Reed.
In both practices, the physicians and their assistants struggle to get patients to be more proactive in coping with their illnesses. A large percentage of patients in both areas have allergies. The physicians see the asthma problem getting worse. They ask patients to reverse the trend of waiting to seek medical help until they have severe attacks.
Tap into resources on asthmaTeams within AAFP's Asthma Learning Collaborative have posted their team stories and contact information at http://www.aafp.org/x3857.xml. Feel free to ask the participants for tips on caring for patients with asthma. Other help is on the way: The Academy is planning a late 2003 rollout of print and online versions of the Asthma & Allergy Resource Guide, a collection of tips and tools for use in everyday family practice. And if you're attending the AAFP Annual Assembly in New Orleans, you may want to take this Oct. 3 course: "Improving Chronic Illness Care in Family Practice: Lessons From the AAFP Asthma Collaborative." |
The physicians have sought out new methods and procedures.
Their search led them to AAFP's Asthma Learning Collaborative, a yearlong project that began in May 2002 with a meeting in Kansas City, Mo. The collaborative was organized by the AAFP and the National Initiative for Children's Healthcare Quality. Asthma, one of the most prevalent chronic diseases in the world, is especially common among children.
Physicians, physician assistants (including Schuurman) and other office staff members from 13 family practice centers -- serving about 150,000 patients -- took part in three one-and-a-half-day sessions to learn ways to measurably improve the care they give children with asthma. The project was supported by an educational grant from Schering Pharmaceuticals.
"There are a lot of practices that are eager to improve asthma care, and bringing a team to the collaborative was really important," says Barbara Yawn, M.D., of Rochester, Minn., past chair of the AAFP Commission on Clinical Policies and Research and a faculty member for the project. "You can't implement change when it is just the physicians who are doing it."
The collaborative focused on improving the systems that support quality asthma care in a variety of family practice settings. Participants used tools such as a registry of patients with asthma and a process for ensuring that the severity of asthma was assessed for each of those patients at every visit.
Reed came away from the collaborative with an array of new forms she could use to monitor patient visits and get patients more involved in their own care.
Diana Lyon-Loftus gained a better sense of how the Mont Alto health care professionals were doing from sharing ideas and best practices with colleagues across the country. "It let us know that we were doing some things right," she says.
"As family physicians, we are in a unique position to play a key role in providing asthma care, and the collaborative empowered us with the tools to provide that care," says Greg Lyon-Loftus.
All Kristy Thomas knows is the air seems a lot clearer.
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
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Practical tools -- those are what the just-completed Asthma Learning Collaborative gave family physicians, says FP Kurtis Elward, M.D., of Charlottesville, Va., a faculty member for the project.
"We provided practical tools that every family physician could use in a busy practice where you are moving from one patient to another. We provided them with tools to create a framework of care in the office," says Elward. "We also gave participants the tools to track their own progress and get some good feedback on what they were providing. That kind of information is very difficult to get, and the tools for that are difficult to obtain."
Elward made a presentation on the collaborative at the National Conference on Asthma June 19 - 21 in Washington, D.C.
The collaborative was part of AAFP's Quality Initiative, which aims to improve the health status, outcomes and satisfaction of patients while enhancing the viability and vitality of family physicians' practices. The collaborative encouraged health professionals to implement practices and community strategies to significantly reduce asthma-related mortality and morbidity by the year 2010.
"Each team is committed to disseminating their experience in the collaborative and using the Chronic Care Model in their practice," says Christine Pullman, AAFP's manager of quality initiatives and the project manager for the collaborative. "The teams are sharing what they have learned at national conferences, such as AAFP's 2003 Scientific Assembly, and at state meetings and at the community level."
Barbara Yawn, M.D., of Rochester, Minn., a faculty member for the collaborative, chaired the National Conference on Asthma. She says it is significant that a family physician headed up the gathering, sponsored by HHS and NIH.
"When the NIH asked a family physician to chair, they were recognizing the importance of family practice in asthma care," says Yawn. "This conference said that what we're doing works. Instead of telling us what we needed, they were asking us what we needed. It's really different than anything they've done before."
The month of July saw the re-emergence of West Nile virus, with the first human fatality in 2003 being reported and human infections being confirmed in 11 states.
Many more states have reported the virus in birds, horses and mosquitoes.
It is speculated that the virus could be more widespread in 2003 than in 2002, when there were more than 4,000 reported cases of the virus reaching 44 states.
"It is impossible to predict what this year’s season will hold," said CDC Director Julie Gerberding, M.D. "However, the recurrence of West Nile virus in humans is a compelling reminder of the importance of individual preparedness in preventing disease. Knowing how rapidly West Nile virus spread last year, we urge everyone who spends time outdoors to take steps to protect themselves from mosquito bites.”
The disease is most active during peak mosquito season -- July through October.
On the diagnostic front, the FDA has cleared the first test for use in screening the illness. The PanBio West Nile IgM assay detects levels of the antibody to the disease in a patient's serum and can be used within the first few days of the onset of illness.
The new test correctly identified antibody in more than 90 percent of West Nile cases. Because the virus is similar to other viruses in the same family, positive results should be confirmed with an additional test or by using CDC diagnostic guidelines. CDC information for clinicians can be found at http://www.cdc.gov/ncidod/dvbid/westnile/resources/fact_sheet_clinician.htm.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
 FP and newly elected AMA Trustee Edward Langston, M.D., says the AMA must become "leaner, more responsive and more efficient" for the future. |
Delegates at this year's annual meeting of the AMA House of Delegates stopped short of calling for a major overhaul in the AMA governance structure.
Rather, delegates at the June 14 - 19 meeting in Chicago affirmed the AMA's current structure as "an association of voluntary, individual medical student and physician members ... individually funded and organizationally governed through representation in the House of Delegates."
At the 2002 annual meeting, delegates had voted to investigate transforming the AMA into an "organization of organizations" -- an umbrella group comprising state medical societies and medical specialty associations. However, a special committee appointed to develop a business plan for creating such an entity concluded the move was neither feasible nor advisable.
So this year's delegates called for a review of AMA governance costs, with an eye to decreasing those costs without adversely affecting the association's mission. That exercise will be undertaken by the AMA Board of Trustees, with delegates' directives to continue streamlining AMA operations and to consider priorities assigned to AMA products and services in efforts to create a "more focused and strategic AMA."
Newly elected AMA Trustee Edward Langston, M.D., of Lafayette, Ind., will be involved in the review process. Information generated to date will be used in that review.
"AAFP had an integral and important part in the workings of the study committee that reported back to the House of Delegates," said Langston. "This was not a whitewash process." The thorough work of that committee, he said, will make the task at hand that much easier.
The AMA board is to report back to delegates on its activities and recommendations at AMA's interim meeting in December.
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While acknowledging patients' freedom to enter into specialized care arrangements with their physicians, the AMA House of Delegates warned that retainer contracts raise "ethical concerns that warrant careful attention."
Meeting June 14 - 19 in Chicago, the delegates adopted guidelines developed by the AMA Council on Ethical and Judicial Affairs for physicians who offer retainer services, also known as "boutique care."
Retainer fees are those paid by patients over and above the cost of their regular health insurance for more individualized health services, such as longer office visits or guaranteed access to the physician by phone or pager.
On the one hand, patients should be free to "select and supplement insurance for their health care on the basis of what appears to them to be an acceptable trade-off between quality and cost," the delegates agreed at their annual meeting. Yet they also recognized a need to reassure the public and health policy-makers that proliferation of such practices would not hamper patients' access to quality health care services.
"Retainer practices provide an opportunity for patients to develop a more personalized relationship with their physicians," said CEJA Chair Leonard Morse, M.D., regarding the guidelines. "But physicians should also make sure that all patients -- including those who do and do not pay retainer fees -- continue to receive the same quality of care."
The guidelines remind physicians of their professional obligation to provide care to those who need it, regardless of their ability to pay. "Physicians who engage in retainer practices should seek specific opportunities to fulfill this obligation," the guidelines conclude.
Patient privacy concerns should oust drug reps
Responding to growing concerns about drug sales representatives vying for ringside seats during interactions between physicians and patients, AMA delegates also voted to "oppose the presence, inclusion or involvement of pharmaceutical sales representatives in clinical situations without the full knowledge and informed consent of patients."
Proponents of a resolution introduced by the American Psychiatric Association and American Academy of Child and Adolescent Psychiatry claimed that such incidents -- referred to as "shadowing" -- raise serious questions about patient privacy and confidentiality. In reference committee testimony, a former drug sales representative pointed out that as nonclinicians, reps are not bound by ethical or legal constraints to safeguard patients' medical information. In addition, many times the patients involved are not told who the rep is or why he or she is present.
Delegates further directed the AMA to work with the pharmaceutical industry to develop and promulgate meaningful guidelines protecting patient privacy and prohibiting intrusion on the physician-patient relationship.
Spare docs the burden of paying for interpreters
At the December 2001 interim meeting of the AMA House of Delegates, delegates voted to continue to oppose requirements holding physicians responsible for medical interpreter services for patients with limited English proficiency, or LEP. Under those requirements, developed by the HHS Office of Civil Rights in August 2000, physicians received an unfunded mandate to provide a clinical interpreter for each LEP patient if the physician receives any federal financial assistance, such as Medicare or Medicaid payments.
An AMA Board of Trustees report reviewed at that interim meeting recommended that the AMA actively oppose the inappropriate extension of the Office of Civil Rights' LEP requirements to physicians in private practice.
At this year's annual meeting, delegates again confronted the medical interpreter issue, this time calling for the AMA to "seek legislation to eliminate the financial burden to physicians, hospitals and health care providers for the cost of interpretive services for patients who are hearing-impaired or who do not speak English."
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The AMA House of Delegates went to bat for medical students by voting to "oppose the implementation of the Clinical Skills Assessment Exam as part of the United States Medical Licensing Examination by any means, including possible legal action."
No one questions the importance of teaching and evaluating clinical skills in medical schools, the delegates said. What was cause for concern at the AMA's June 14 -19 annual meeting in Chicago, however, was the proposed implementation date of the exam -- as early as June 2004. Delegates were concerned that this timetable could delay graduation for some students. That's because some schools require students to take and pass Step 2 -- soon to include this clinical skills component, in addition to the current clinical knowledge component -- in order to graduate. Such a delay could, in turn, mean a late start in residency training.
According to the National Board of Medical Examiners and Federation of State Medical Boards, which co-sponsor the USMLE, the new requirement pertains to all U. S. and Canadian medical students with graduation dates in 2005 or later. It will also affect students with earlier graduation dates who "have not passed the current clinical knowledge component of Step 2 taken on or before June 30, 2005."
For further details on the exam and the rationale behind it, go to http://www.usmle.org/news/cse.htm and click on "Clinical Skills Exam: FAQs."
The pending exam has been on the radar screens of AAFP student members for quite a while. Delegates at the 2002 National Congress of Student Members asked the Academy to "urge the National Board of Medical Examiners and Federation of State Medical Boards to delay implementation of the clinical skills assessment exam pending NBME investigation of methods to decrease the financial and travel burdens on students taking the CSAE and release of those findings."
Since that resolution was introduced, however, "it has become crystal clear that NBME is going forward with this no matter what," said Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education. "The decision was made to focus, instead, on encouraging NBME to try to minimize the costs to students and to ensure that the exam is available in as many sites as possible to mitigate travel costs," Pugno said.
Cost information is also available at http://www.usmle.org/news/cse.htm under "Costs of the Clinical Skills Exam."
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Family physician Edward Langston, M.D., was elected to the AMA Board of Trustees during the annual meeting of the AMA House of Delegates June 14 -- 19 in Chicago. Langston, of Lafayette, Ind., was nominated by the AAFP.
A past chair of the AMA Specialty and Service Society, Langston has been a member of the AMA Council on Medical Education since 1997. He served on the AAFP Board of Directors from 1991 to 1993 and was Board vice president in 1994.
Langston's campaign focused on three areas:
BY TONI LAPP
It's becoming commonplace: Local governments, strapped for cash, are cutting back on services.
In one California county, those "services" are two clinics operated by Alameda County Medical Center. Rising health care costs, combined with lower reimbursements for low-income and indigent patients, led the hospital system to close the clinics in June.
Such a cost-cutting move could be replicated around the country as local governments struggle to get by, said David Reynolds of the AAFP Division of Government Relations. "Most states are required to adopt balanced budgets and are now cutting their budgets, sometimes in excess of 10 percent, and it exacerbates the situation."
California, with a $38 billion deficit and no budget in place as of mid-July for the current fiscal year, is in a particularly dire situation, Reynolds noted.
In the case of Alameda County Medical Center, the hospital had run deficits for several years and, despite the clinic closings, is still $2 million in the red each month, said Rachael Kagan, a public information officer at the center. "It is a public health crisis. We can only provide the care that our financial sources allow us to provide."
Kagan said the turning point for Alameda County Medical Center came in January when it lost $7 million because of cuts in the disproportionate share hospital program -- or DSH, a federal Medicaid program that helps support hospitals that serve large numbers of indigent patients.
As a result of the closings, up to 25,000 displaced patients will have to travel elsewhere for their health care.
FP William Wallin, M.D., of Richmond, Calif., who worked in one of the clinics, said many of his patients were Asian refugees who won't seek care elsewhere.
"This is a disaster," Wallin said. "They can save money (by closing clinics) for six months, a year, but when the people start becoming so sick they end up in the ER or are hospitalized, they're going to lose money so much faster."
Many public hospitals are looking to Congress for help, said Skip Moskey, communications director of the National Association of Public Hospitals.
"Our hospitals are looking at a range of measures to deal with budget cutbacks in a time of increasing demand and diminishing resources," he said.
Kagan is succinct about what needs to be done to turn the situation around: "The only way to address it is to provide a larger subsidy (to public hospitals) or provide coverage through insurance. Decide as a society that health care is something that everyone is entitled to."
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
HHS recently announced two efforts to shore up U.S. defenses against potential bioterrorist attacks -- even as a report released July 8 criticized the readiness of five key federal biodefense agencies to handle such events.
One initiative will boost the number of officers entering the Public Health Service Commis-sioned Corps and enhance their training for public health threats, including bioterrorist events. The other effort is the product of an HHS-funded research drive -- a computerized staffing model for use in the event of a bioterrorist attack or large-scale natural disease outbreak.
In the July 8 report, the Partnership for Public Service said the CDC, FDA, National Institute of Allergy and Infectious Diseases, Animal and Plant Health Inspection Service, and Food Safety and Inspection Service lack the medical and scientific expertise needed to deal effectively with a bioterrorist attack. That assessment was based on a review of the technical literature and on interviews with leading biodefense authorities from the private and public sectors.
Among problems plaguing the federal workforce are an "anachronistic" hiring process and "rigid pay schedules" that frustrate recruitment and retention attempts, said the report. Biodefense experts who enter civil service aren't supported in their work, the report added. Consider, too, that half of the experts in the current federal workforce will become eligible for retirement within five years, and the looming crisis in "human capital" becomes clear.
What's needed, the report said, is a cohesive strategy to attract and hold "the best minds in medicine and biology." That strategy should include four actions:
The report may be downloaded as a PDF file at http://www.ourpublicservice.org/usr_doc/Homeland_Insecurity_Report_(July_2003).pdf . For help using PDF files, visit http://www.aafp.org/pdf.xml.
Shortly before the report was released, HHS Secretary Tommy Thompson announced the availability of a computer model to help hospitals and health systems plan their responses to a bioterrorist event or large-scale natural disease outbreak. The model can be downloaded as a spreadsheet and used to calculate the specific personnel needs of local health systems based on current staff numbers and the anticipated influx of patients after a bioterrorist attack.
Thompson praised Weill Medical College of Cornell University in New York, which developed the tool, and other HHS-funded research institutions "providing health care systems with the critical information and tools they'll need in responding to the unthinkable." A press release with links to the model is at http://www.ahrq.gov/news/press/pr2003/btmodpr.htm.
On July 3, Thompson announced a plan to revitalize the Public Health Service Commissioned Corps. The agency, he said, would begin recruiting more health professionals and enhancing officer training to better respond to the nation's emergency health needs.
"As we face an uncertain future of possible terrorist attacks, emerging infectious diseases, natural disasters, and other prevention or public health needs, this transformation will help us strengthen our public health infrastructure and response system to better serve the American people," Thompson said. Visit http://www.hhs.gov/news/press/2003pres/20030703.html for more information on this HHS initiative.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
Plan A didn't materialize -- but Plan B waits in the wings. So says AAFP EVP Douglas Henley, M.D., regarding the Academy's proposed electronic health record project, first announced to members in the March FP Report. (See story at http://www.aafp.org/fpr/20030300/3.html.)
The AAFP Board of Directors envisioned the establishment of an independent foundation that would develop, distribute and support an affordable open-source EHR.
"The involvement of other medical associations was crucial to the formation of the foundation," says Henley. "Unfortunately, we couldn't get that core group of folks together to raise the initial funds necessary."
Undaunted, the AAFP team working on the EHR project is regrouping. EHR was on the agenda for the July Board meeting, and a new EHR proposal will be sent to the Board for review in September.
"The Board has made it abundantly clear that the AAFP will try to move the project forward in some form," says Henley. Stay tuned for details.
At press time, the U.S. House of Representatives had voted to cut 2004 funding for family practice training, and it was feared the Senate might slash the funding in late July or September. After the Senate acts, a conference committee will be named to negotiate differences between the two appropriations bills.
The specialty's federal funds come through Section 747 of Title VII of the Public Health Service Act.
The House voted 215-208 July 10 to cut Section 747 from its current level of $92 million to $79 million. A Senate committee voted June 26 to shrink Title VII, as a whole, from the current $308 million to $21 million, but some senators said they would try to protect the Title VII funding when the full Senate votes.
If the Senate votes to dramatically cut the Title VII funds, AAFP news publications will issue alerts to members and urge contacts with Congress.
WEB EXTRA!
The U.S. Senate squashed federal medical liability insurance reform July 9, a move the Academy regretted but policy-makers had predicted.
But during debate on the measure July 8, Sen. John Cornyn, R-Texas, spoke in favor of capping noneconomic damages in medical liability lawsuits and he shared a story about a successful delivery by Lloyd Van Winkle, M.D., past chair of AAFP's Committee on Communications.
Cornyn read this account from the Fort Worth Star-Telegram: "Last summer, a pregnant woman showed up at Dr. Lloyd Van Winkle's Castroville office in south Texas, less than 10 minutes from delivery. Her family doctor in Uvalde had recently stopped delivering babies, citing malpractice concerns, and the woman was trying to drive 80 miles to her San Antonio doctor and hospital. 'She made it as far as Castroville and decided she wasn't going to make it any further,' Van Winkle said."
According to a Texas Medical Association survey last year, the senator added, more than half of all Texas physicians, including those in the prime of their careers, are considering early retirement because of the state's medical liability insurance crisis.
"Personal injury trial lawyers should not be able to drive good doctors out of medicine or to reduce patients' access to health care," Cornyn told the senators.
Van Winkle's story was, in reality, a bit more complex than the newspaper article conveyed.
First, there is not just one family physician in Uvalde who has given up maternity care because of high malpractice insurance costs. "Eight family physicians used to do OB there, as I recall," says Van Winkle. "Five did not renew their OB insurance. The other three certainly couldn't take up all that slack. And they're contemplating whether they'll renew this December or not."
Second, the woman in the story, who is large and had had a tubal ligation, didn't know she was pregnant. She was traveling to San Antonio for care for appendicitis. "She kept saying, ‘I can't believe this!' and I kept saying, ‘Push!'" explains Van Winkle.
Third, mom and baby are fine and are getting care from a San Antonio physician. The little girl weighed 7 pounds, 4 ounces, and arrived by breech birth. "I didn't charge for providing the care," says Van Winkle. "I thought it was a wonderful thing to have happen. What a stroke of luck, to have that happen in your office and go so well."
Fourth, the question physicians ask Van Winkle is this: Did the mother sue anyone? No, replies Van Winkle -- she was in good spirits about the situation.
WEB EXTRA!
Those advocating a cap got a boost from a recently released study that showed states with limits on noneconomic damages in medical liability lawsuits have about 12 percent more physicians per 100,000 county residents than states without such limits. The study was released July 7 by HHS' Agency for Healthcare Research and Quality.
"Our broken medical litigation system is affecting patients' ability to find a doctor," HHS Secretary Tommy Thompson said in a news release. "This study confirms and quantifies the association between reasonable limits in medical lawsuits and the supply of physicians available to treat patients who need them."
In 1970, before any limits were legislated, there was no statistically significant difference among states in their per capita supply of physicians, said the study. By 2000, however, states with limits had 135 physicians per 100,000 county residents, whereas states without limits had a corresponding 120 physicians.
To read the study, go to http://www.ahrq.gov/research/tortcaps/tortcaps.htm.
The candidates running for AAFP offices and Board positions have their own Web sites. To see who's campaigning, go to http://members.aafp.org/members/congress/candidates/ and use your AAFP ID number to login.
You can link to each candidate's Web site and the "Question/Answer Forums" that let you ask candidates questions and receive answers online.
The AAFP Congress of Delegates will elect the new officers and Board members Oct. 2 in New Orleans. The winners will be announced in the November FP Report.
One deadline coming soon pertains to the 2004 AAFP Annual Assembly; other programs and projects have also announced due dates.
Look ahead to next year's Scientific Assembly and decide whether you'd like to present a CME session during the convention Oct. 13 - 17 in Orlando, Fla. Speakers' proposals, which must be submitted online, are due Nov. 3. Go to http://www.aafp.org/proposal.xml to apply.
Apply by Oct. 31 for the Fundamentals of Management program, a management and leadership training experience approved for Prescribed CME credit. Or send in your application by Sept. 30 and get a $150 discount on your tuition. You can download a program brochure, including an application, from http://www.aafp.org/fom.xml.
Chapter foundations may nominate students for the James G. Jones, M.D., Student Health Policy Scholarship by Sept. 13. This program will allow a student to attend the American Medical Student Association Political Leadership Institute in Reston, Va., Jan. 29 - Feb. 1. For details, call (800) 274-2237, Ext. 4457.
The Resident Scholars Competition has a deadline of Nov. 15 for applications. If you are or recently were the lead author for a research project or scholarly activity as a resident, join this competition. Awards range from "honorable mention" to $300. E-mail pcarter@aafp.org to request details and an application form.
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To the editor:
The national decline of student interest in family medicine over the past several years is well-documented. The trend is discouraging, especially to those of us in predoctoral education who observe students we think would be outstanding family physicians choose to follow other specialty careers. However, I was gratified by a recent experience.
As director of predoctoral education in Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita, I sit down with students completing a six-week family medicine clerkship. One of the questions I ask in these sessions is, “What surprised you on this clerkship?” Here are responses I recently heard from these students, none of whom had expressed serious interest in family practice before the clerkship:
"I was surprised by the variety of things we did. We saw plenty of school physicals, but one day, we admitted a guy to the CCU with a heart attack, and later the same day my preceptor was consoling a lady whose son had been killed in another state."
"I was surprised by how my preceptor treated her patients like her friends."
"I've never been around a group of doctors who had so much fun doing what they do."
I do not know what career path these students will ultimately choose, but I do know they have gained insight into the reasons family physicians do what we do. I want to pass along my appreciation to all of you who volunteer your time to host students in your practice. You are teaching them invaluable lessons, regardless of what happens with national trends in specialty choice.
Scott Moser, M.D.
Wichita, Kan.
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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:
It was good to read in the May FP Report ("AAFP Hosts Think Tank on How to Boost Patient Safety") that AAFP is actively involved in efforts to boost patient safety. However, the list of "directions the Academy should consider" omits two essential features of any effective error-reduction initiative in our complex, sometimes chaotic health care arena.
The first of these is simplicity. Mental overload inevitably occurs when systems become too complex, and no amount of exhortation or computerization can overcome it. Ignoring or denying this obvious fact is like arguing that if one aspirin tablet is good and two are better, four must be really great.
The second is motivation. If those in the trenches see quality as important and feel good about ensuring it, they will achieve remarkable results. If they feel overwhelmed and/or browbeaten, they will retreat into the bureaucratic mode. The result will be lots of statistics and pretty words but little or no substantive progress.
Robert Gillette, M.D.
Poland, Ohio
To the editor:
This is in response to Milton Johnson's letter in the July FP Report in which he laments how midlevel providers are undermining the medical profession. Perhaps Mr. Johnson should climb off his lofty pedestal. The medical profession, in particular family practice, has only been enhanced by the addition of PAs and NPs. My medical education was one semester shy of the medical student's education at the University of Minnesota. While the degree that hangs on my wall may be different from that of Mr. Johnson, the real measure of a competent provider is in patient satisfaction and outcome. My patients in the rural towns I practice in are well-cared for and happy to have my service. My license is not de facto and was hard earned.
Dan
Lillquist, P.A.-C.
Paynesville, Minn.
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Don't miss the 25th Anniversary Conference on Patient Education, a one-of-a-kind national meeting that gives FPs the tools they need to provide quality patient education. Mark your calendar for Nov. 20 - 23, destination San Antonio. Participate in top-notch plenary sessions and choose from nearly 100 CME workshops, seminars, computer sessions and more. Need more information? Go to http://www.aafp.org/pec.xml, where registration is a breeze. |
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Proven value: Join the next Fundamentals of Management course! Take advantage of a unique opportunity to enhance your leadership and management skills. This proven CME program can help you take your organization to a higher level of success. Note these important dates: Sept. 30, early-bird application deadline; Oct. 31, final application deadline. Check out http://www.aafp.org/fom.xml for program curriculum and application information. |
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Proven value: Act now -- don't miss the Aug. 27 preregistration deadline for the 2003 Scientific Assembly Oct. 1 - 5 in New Orleans. Enjoy these early-registration benefits: Avoid standing in line in New Orleans and get the best selection of courses and other events offered in 2003. Online registration is a snap -- just go to http://www.aafp.org/assembly.xml, select "2003 New Orleans," then click on "Register." |
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A shipping fee may apply; Kansas residents pay an 8.05 percent tax. |
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FP Report is published by the
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Copyright © 2003 by
American Academy of Family Physicians.
