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BY J. MICHAEL BRODIE
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Who says Californians get to have all the fun during election season? Heck, only 135 names were listed on the governor's race ballot in California at press time. Small potatoes compared with the U.S. presidential race, where about 200 have entered the fray.
According to Project Vote Smart (http://www.vote-smart.org/election_president.php), a nonpartisan citizen's election organization, there is a candidate in this year's presidential race to suit nearly every political taste: from the traditional Democrats and Republicans to representatives of such groups as the Prohibition, Anti-Hypocrisy and -- yes -- National Barking Spider Resurgence parties.
Admittedly, some parties mentioned above exist simply for the fun of it. Others represent Americans with disparate points of view exercising their right to shape political debate. The presidential election is still about a year away, but it is not too soon to initiate serious discussions on key health issues facing you and your patients.
To help you do this, the Academy has posted online the leading presidential contenders' views on health issues (http://www.aafp.org/x22202.xml) and AAFP recommendations and background information on pressing pieces of legislation (http://www.aafp.org/x623.xml).
If you would like to become more involved in the political races, you can also contact your chapter executive for updates on candidates' forums in your area. A brief summary of some health issues the Academy has prioritized follows; summaries of additional issues of interest to AAFP and its members appear in the online version of this article.
Health care coverage for all
Since 1989, the Academy has sought to reform America's health care system to include health care coverage for all. "People without coverage obviously don't get the health care they need," said AAFP President James Martin, M.D., of San Antonio. "As family physicians, we see this as unnecessary suffering, and we believe that a system guaranteeing care would result in a healthier and more productive society. Our plan would cover all people who reside within the U.S. borders and would guarantee basic services for everyone and protect against catastrophic losses. With this, we all win."
Prescription drug benefit through Medicare
The Bush administration has proposed a Medicare drug benefit along with other Medicare reforms that would cost taxpayers an estimated $400 billion over the next decade. The Congressional Budget Office has estimated that a House Medicare bill (H.R. 1) would cost $408 billion over the same period, while the Senate version (S. 1) would cost $462 billion.
"AAFP supports adding a prescription drug benefit to the Medicare program that is available for our seniors," Martin said, "but neither the House nor Senate bill meets the standards desired in the AAFP policy."
The Academy supported passage of the Patient Safety and Quality Improvement Act (H.R. 663), which passed the House of Representatives on March 13. The Academy supports similar legislation in the Senate (S. 720). Both bills would create federal confidentiality protections for reports of medical errors voluntarily submitted to patient safety organizations.
Medical liability
The House of Representatives has passed the HEALTH Act (H.R. 5), which addresses medical liability. The reforms contained in the HEALTH Act have a proven track record following their adoption in California in 1976. Since then, medical liability premiums have risen 505 percent nationwide, while California's premium increases have risen by only 167 percent.
"We support passage of medical liability legislation that contains a package of reforms such as have been effectively utilized in California for the past 27 years," said Martin. "We need to balance the need to appropriately compensate patients who have been harmed against the need for all Americans to have access to medical care."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
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BY LESLIE CHAMPLIN
Direct access to physical therapy is seeping across the nation. This year, it dribbled into Wyoming. It trickled into Oklahoma and made its way to Louisiana. It welled up in Michigan and flowed through New York.
Like a persistent stream of water, momentum for direct access has swelled to a rising tide, timed to match a surge of support in the U.S. Congress for the Medicare Patient Access to Physical Therapists Act of 2003. Physical therapists' success on the state level augments the impact of the federal Medicare legislation because it would allow PTs to bill their services independently in states with direct access laws.
The likely result: a sea change in the way patients receive physical therapy treatment and in the way that treatment is reimbursed.
Ohio experience
Generally, direct access laws expand physical therapists' scope of practice by enabling them to evaluate and treat patients without a physician's diagnosis or referral. Most states fall short of unlimited direct access. Some state laws require referral to a physician if patients show no progress within a specified period. Other laws require notification of the patient's physician within a certain time after starting therapy. However, a few laws simply remove language that requires physician involvement.
Among this year's crop of bills: Ohio's S.B. 35, which would allow patients direct access to master's-prepared physical therapists without first receiving a physician's diagnosis or referral. The bill marks the fifth attempt to expand Ohio PTs' scope of practice.
FP testimony
This time, family physicians Brian Bachelder, M.D., of Mount Gilead and Steven Brezny, M.D., of Powell joined the fray. In mid-August, Bachelder, Ohio AFP president, and Brezny testified to legislators that the bill could impinge on patient safety by enabling physical therapists to treat patients for whom no diagnosis has been made.
Pointing to his hospital's current therapy referral form, Bachelder acknowledged that physicians often write "evaluate and treat" when prescribing physical therapy.
"But on the second line of the form, it also contains a space for 'Diagnosis -- Condition,'" Bachelder told legislators. "It is this diagnostic information that allows PTs to treat patients, knowing that more serious causes of a patient's symptoms have been screened out."
Brezny agreed. "Of great concern to physicians is the delivery of treatment without a diagnosis," he said in written testimony. "A diagnosis must be made before treatment may begin. If this bill passes in its current form, we are reversing the process and treating patients with a self-diagnosis or no diagnosis at all."
Passed by a 30-2 vote in the Ohio Senate last spring, S.B. 35 has gone to the House, where legislators are "a lot more receptive to our concerns," said Ann Spicer, Ohio AFP executive vice president. "I think the physical therapists realize they're going to have problems in the House. They've asked for some kind of compromise."
Action on the bill is expected when the House reconvenes this fall.
It's about the patient, not the payment
The medical community's opposition to unlimited direct access does not stem from a "turf battle between physicians and physical therapists," wrote Brezny, but focuses on patient safety and expansion in the scope of practice. Physicians have long appreciated the value that physical therapists bring to treatment, he noted. But high-quality patient care depends on accurate differential diagnoses -- something physical therapists cannot bring to their evaluations.
In legislative updates, policy statements and testimony before legislators, AAFP constituent chapters have emphasized the importance of accurate diagnosis in ensuring patient safety during treatment.
"Physical therapists are very good at what they do, developing and implementing treatments to help patients recover after severe injuries and ailments," said the Michigan AFP in a legislative alert. "Where their education is lacking is in recognizing whether the patient is suffering from a condition that is outside their scope of practice. Physical therapists are trained in therapy, not diagnosis."
Physicians don't begrudge physical therapists the right to evaluate and treat a patient "as long as it's done in concert within an appropriate professional relationship with a physician," said Vito Grasso, executive director of the New York AFP, in a recent interview. "Physical therapists are pushing for independent practice so they can have independent reimbursement. But our concern is: Who is going to coordinate care and who wants responsibility for patient outcomes?"
The American Physical Therapy Association has set its sights on independent private-sector reimbursement. Already rallying membership around the Medicare Patient Direct Access Act, the association is developing strategies to garner direct reimbursement from private insurers.
In March, the APTA Board of Directors called for a plan regarding private insurance reimbursement for services delivered without a physician referral.
"With the possibility of Medicare direct access and the increased number of state laws that allow for direct access, we should dedicate additional resources to our efforts," the board said.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
WEB EXTRA!The Academy does not have a policy on direct access to physical therapists.
However, the AAFP has addressed the scope of practice for nonphysician providers. In 1992, the Academy approved "Guidelines on the Supervision of Certified Nurse Midwives, Nurse Practitioners and Physician Assistants" (see http://www.aafp.org/x6940.xml). That policy, revised in 2002, stipulates, "these providers always function under the direction and responsible supervision of a practicing, licensed physician."
The Academy reiterated that 1992 position when it approved "Integrated Practice Arrangements" in 1996 (http://www.aafp.org/x6888.xml). Revised in 1998, that policy states, "The AAFP encourages health professionals to work together in the best interest of patients. The AAFP believes, however, that interests of patients are best served when their care is provided by a physician or through an integrated practice supervised directly by a physician."
WEB EXTRA!Ohio is one of 12 states debating direct access to physical therapists this legislative session, according to the AAFP Government Relations Division. Only Louisiana has addressed patient safety concerns by requiring close physician involvement. Legislators in both houses there approved a bill that limits direct access to those patients for whom a diagnosis has already been made. The bill also requires PTs to provide a plan of care to the diagnosing physician within 15 days of the first treatment.
Connecticut's proposal skirts the patient safety issue by allowing direct access only for wellness care.
Other states barely address physician oversight or patient safety concerns. A new law in Oklahoma allows children direct access to PTs under the Individuals with Disabilities Education Act Amendments of 1997 and the Rehabilitation Act of 1973.
The Michigan House Committee on Health Policy is mulling over a bill that would eliminate the requirement for a physician's prescription for physical therapy. The New York Assembly has approved a bill that stipulates PTs must practice for three years before treating without referral. It would also limit the therapy to 30 days or 10 visits, whichever came first.
The most liberal of the direct access proposals passed in the Oregon Senate but died in the state's House of Representatives. Had it succeeded there and received a gubernatorial thumbs-up, the bill would have amended existing law by giving patients indefinite direct access to PTs as long as neither patient nor therapist submitted a bill for treatment to an insurer.
By providing information on other states' initiatives, the AAFP has assisted constituent chapters in combating direct access to PTs. Questions? Contact David Reynolds in the AAFP Government Relations Division by calling (888) 794-7481, Ext. 2550, or by e-mailing dreynold@aafp.org.
BY SHERI PORTER
"We were simply the spark that started the fire," said family physician Mark Goedken, M.D., of Cedar Rapids, Iowa, referring to AAFP's efforts to equip members with tools to fight colonoscopy privileging battles.
Goedken and
FP David Kresnicka, M.D., of Marion, Iowa, became entangled in a colonoscopy
controversy in March 2000 when both completed the National Procedures Institute
colonoscopy training course -- but were subsequently excluded from performing
the procedure by their local hospitals.
The pair turned to the Iowa AFP for help. Eventually, the 2001 AAFP Congress of Delegates passed Substitute Resolution No. 604 that led to the AAFP's Colonoscopy Pilot Project.
The project churned into motion in fall 2002 when the Academy surveyed members who have been granted colonoscopy privileges in U.S. hospitals. Survey data indicate that hospitals have granted privileges to FPs whose experience with the procedure ranges from having performed five colonoscopies to having performed more than 150. Of those surveyed, 61 percent had received hospital privileges after performing fewer than 55 colonoscopies.
Go to http://www.aafp.org/x23483.xml to read three documents related to this topic, including a position paper and the colonoscopy privileging statement that refers to data from the Colonoscopy Pilot Project.
"We believe that these new data will improve the ability of family physicians to obtain privileges in colonoscopy at their local medical centers," said Goedken. "Family physicians should be encouraged by AAFP's strong position." He suggested FPs can use the AAFP materials to gain support from their credentials committees and general medical staffs.
Goedken gave credit to the Iowa AFP; Iowa AFP EVP Janet Wee; and AAFP EVP Douglas Henley, M.D., calling their support and assistance the "fuel" that kept the issue front and center.
Kresnicka, who lives in an urban area but has his patients come to a nearby rural hospital for the procedure, said he was happy to see momentum for the issue building. "I plan to reapply for colonoscopy privileges at both of our local hospitals again in the near future," he said. "I will use the new AAFP data on colonoscopy along with my record of more than 300 completed cases without complications to convince the credentials committees to allow qualified family physicians to perform this procedure in their hospitals."
Family physicians have always been responsive to the needs of their patients and their communities, said Norman Kahn, M.D., AAFP vice president for science and education. He said the Academy has been keeping FPs current on the appropriate screening guidelines for colorectal cancer and how to reduce morbidity and mortality related to the disease.
"One way to do this is to get more patients screened, and one screening tool is colonoscopy," said Kahn, who added the Academy wanted to recognize the small but growing number of members incorporating colonoscopy into their practices.
"Most physicians involved with endoscopy believe that as more FPs decide to incorporate colonoscopy into their practices, fewer hospitals will be able to deny (colonoscopy) privileges to FPs as a whole," said Goedken. "There is power in numbers."
According to the AAFP's 2003 Practice Profile Survey, colonoscopy is the second most contested privilege in the specialty (3.2 percent of respondents said their request for the privilege was denied). However, according to the same survey, more than 82 percent of members said they don't want to perform the procedure.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
WEB EXTRA!
In Connecticut, colonoscopy training, not privileging, is the roadblock family physicians face in one rural community hospital.
The administration of Day Kimball Hospital in Putnam recently ruled that physicians must obtain additional procedural training at teaching institutions to be credentialed.
At the request of one of its members, the Connecticut AFP jumped into the fray, sending a letter to the hospital "strongly objecting to the hospital's requirement," said Joseph Cremé, M.D., of Putnam, president-elect of the CAFP.
"Where do practicing FPs get the hands-on experience they need to do this procedure if they can't be trained at their community hospital by physician colleagues?" asked Cremé.
The training situation effectively locks some FPs out of performing colonoscopies because Cremé practices in a rural community where access to teaching facilities is difficult.
"In our area of New England -- the dark side of the moon as far as family practice goes -- the Connecticut residency programs I've spoken to have said, ‘Hey, we're having a hard time just getting our residents trained to do colonoscopies.
We can't take docs already out in practice and plug them into a residency program to learn this.' They simply don't have enough preceptors," said Cremé.
"I'll tell you one thing -- no GI guy around here is going to credential an FP to do colonoscopies and then have the FP take some of his business away."
At a staff meeting Sept. 9, the community hospital's board chair explained the hospital's stand on the issue. "He cited mainly malpractice insurance concerns that were brought up by attorneys," said Cremé. After a number of staff physicians spoke against the training requirement decision -- and chided the board for its lack of understanding of medical training -- the board chair agreed to form a committee for further discussion.
"The hospital is saying we can't learn from our colleagues who've been doing this procedure for 10 to 15 years. That's our stumbling block right now," said Cremé.
WEB EXTRA!
BY TONI LAPP
CHICAGO
Campaign materials availableFor more information about the "Get Smart: Know When Antibiotics Work" campaign, including background materials on antibiotic resistance in the community and educational tools available to fight this problem, go to http://www.cdc.gov/drugresistance/community/. |
When it comes to prescribing antibiotics, the customer is not always right. That was the message sent by CDC and AAFP leaders Sept. 17 in Chicago.
Emphasizing the seriousness of the growing problem of antibiotic resistance, the leaders spoke during the launch of the "Get Smart: Know When Antibiotics Work" campaign. Representatives from the FDA and American Academy of Pediatrics, also partners in the public education campaign, participated as well.
Richard Besser, M.D., CDC medical director for the campaign, explained the CDC's primary goal in spearheading the campaign: "We would like to see the day when instead of requesting an antibiotic, patients ask for the best care for their illness."
 Michael Fleming, M.D., chats with a reporter at the CDC press conference Sept. 17. |
To this end, the campaign will largely be directed at parents of young children, Besser said, because antimicrobial drug overuse is highest among children. Of particular concern to parents is otitis media in children; the AAFP and AAP are currently collaborating to develop treatment guidelines for this ailment, he noted.
AAFP President-elect Michael Fleming, M.D., of Shreveport, La., was on hand to offer the Academy's perspective and stressed that one out of every four children is treated by a family physician. "Symptoms like runny nose, cough, fever, headache and muscle aches may be bothersome, but antibiotics will not make them go away any faster," he said.
Fleming also addressed the issue of patient expectations: "Family physicians are under a great deal of pressure to prescribe unnecessary antibiotics by patients and worried parents who mistakenly think that while the antibiotics may not help, they can't hurt. But they can hurt. Antibiotics taken inappropriately can harm patients, especially those with chronic or multiple illnesses. And they harm us all in the long run as we create antibiotic-resistant bacteria that will become harder and harder to combat."
The press event drew a diverse group of journalists, including representatives from the Associated Press, Bloomberg News, The (London) Times, Nature, Science News, Scripps Howard News Service, United Press International and The Wall Street Journal.
During the turbulent 1960s and 1970s, calls to "change the system" in the United States weren't soon heeded -- or even welcome. Yet those calls persisted. Eventually, they changed the nation's course.
Sometimes changing the system is what it takes. The AAFP has now thrown its support behind a Senate bill proposing to do just that. Change the system for trying medical malpractice cases, that is.
Introduced by Sen. Michael Enzi, R-Wyo., the Reliable Medical Justice Act (S. 1518) would create as many as seven demonstration projects in states wishing to replace their current judicial systems for trying medical malpractice suits with other types of systems.
"Medical liability insurance premiums have increased across the nation, threatening patient access to medical services in some areas. A new vision for addressing this medical crisis is urgently needed," AAFP Board Chair Warren Jones, M.D., of Ridgeland, Miss., wrote in a Sept. 5 letter to Enzi.
The Enzi proposal offers three models for consideration as alternatives to current tort litigation:
"States could also apply for grants to implement a tort reform model other than these, if they could demonstrate how the model would make the medical liability system more reliable, enhance patient safety and maintain access to liability insurance," Jones noted.
A copy of his letter appears at http://www.aafp.org/x23999.xml.
BY CINDY BORGMEYER
Family physicians know that delivering high-quality patient care requires far more than a "paint-by-numbers" approach. You'd expect that view to be supported in an assessment of how family physicians connect with and care for their patients with cancer.
Well, now that view has won support.
The results of pre- and post-intervention surveys -- in which family physicians ranked their knowledge and skills levels before and after the 2002 Annual Clinical Focus on care of cancer patients -- show many areas in which FPs improved and a few in which they said they'd like more training.
ACF is the Academy's yearlong initiative designed to bring members state-of-the-art information on a specific medical topic.
Survey respondents answered questions about cancer prevention, detection and treatment, as well as queries regarding their ability to support patients with cancer and to manage health and psychosocial issues faced by cancer survivors.
Perhaps not surprisingly, areas in which respondents thought their knowledge and performance had improved were primarily those involving their clinical and analytical skills. Areas in which they desired more education tended to be those in which they perceived their performance to be tied to patients' behaviors and sometimes to the efforts of others on the cancer care team.
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Prevention Treatment
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"That tends to be the more difficult part of any of this: It's not writing a prescription for chemo -- it's how you change behaviors," says Stephen Spann, M.D., of Houston, ACF medical director.
Further confounding the issue is the constant flux and growing volume of clinical screening recommendations as new research evidence is generated, he adds. "Every time we turn around, there's something new. There's no way to get through all of this information; it would take hours out of every day."
Overall, survey respondents reported increased confidence in knowing lifestyle and environmental risk factors for the five most common cancers -- lung, prostate, breast, colon and skin -- after completing the ACF year. They were less confident, however, when it came to knowing which primary and secondary preventive interventions to use for risk reduction or detection of those cancers.
Respondents also reported greater confidence in their ability to manage the care of patients with cancer, including treating side effects of commonly used cancer therapies. They expressed less confidence, however, in their ability to provide overall psychological support to their patients with cancer. "Again," says Spann, "this is something you can't learn from reading a book."
Although respondents said they were more confident in their ability to work with oncologists in managing cancer patients' care after the ACF, they were less confident about working within a multidisciplinary, team approach to cancer management that included such services as home health and hospice care.
What may be most helpful in reviewing these data, says Spann, is to look at the big picture -- consider the long-term effects of the ACF program.
"I think the long-term potential benefits of the ACF program include the fact that there is a careful and systematic review of new evidence in topical areas of great importance to family physicians," he says. "Each year we cover a new area, and often there are linkages to topics covered in previous years, as well as ongoing updates to those earlier topics."
To reach writer Cindy Borgmeyer, e-mail
cborgmey@aafp.org.
WEB EXTRA!
Even though the U.S. Senate and House of Representatives passed bills this summer proposing various Medicare reforms, the conference committee negotiating differences in the bills may not reach a solution that will be approved by both chambers.
Because the legislation would affect the Medicare fee schedule, the Academy encourages members to e-mail their lawmakers and seek support for fair reimbursement as a way to protect patients' access to care (see end of story).
The legislation would initiate prescription drug coverage for seniors. Some observers suggest the tide is turning against the drug benefit, once thought to be too popular to oppose. Two dozen groups have called for defeat of the legislation likely to come from the conference committee, saying that the benefit will not be enough, especially with Medicare costs already rising rapidly.
On Sept. 16, Senate Minority Leader Tom Daschle, D-S.D., said he was "becoming increasingly concerned" about whether negotiators working to reconcile the bills (H.R. 1 and S. 1) would be able to reach a compromise, the New Orleans Times-Picayune reported.
The AAFP supports adding a prescription drug benefit to the Medicare program that is available for all seniors, though there are also reservations about the proposed bills, said AAFP President-elect Michael Fleming, M.D., of Shreveport, La.
"The idea of the legislation is extremely important. That Medicare patients should have coverage to be able to get the prescription drugs they need is absolutely vital," Fleming said. "That said, I don't think either the House or Senate bill meets all of our (AAFP) criteria. But in Washington, you get the best that you can. We are very anxious about what is going to come out of the conference committee."
Fleming said the Academy would study what the conference committee recommends. "We may decide that the conference bill is too flawed to be fixed and we are going to oppose it, or we may make a decision that it is OK but it would better if we added some things to it later that would help our patients more."
If the conference committee produces a watered-down bill that the House or Senate rejects, "everybody loses," warned Fleming. "From a political standpoint, I think both parties lose. And most important of all, our patients lose."
The House version of the legislation would prevent a 4.2 percent cut in Medicare reimbursement next year and instead ensure a 1.5 percent increase in 2004 and again in 2005. The two-year period would allow time for Congress to revamp the formula for reimbursement.
By mid-September, the conference committee had not resolved issues related to the Medicare fee schedule. The committee, however, did vote Sept. 9 to set up a temporary discount drug card program to fill the gap in health care coverage until Congress could come up with a more comprehensive plan.
The Academy asks you to e-mail your lawmakers -- via http://capitol.aafp.org -- about the legislation's possible impact on the Medicare fee schedule and therefore on seniors' ability to obtain health care. At the Web site, click on the Medicare item for physicians under "ACTION ALERT!"
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
This financial summary has been prepared to present an overall picture of AAFPs financial condition and operations.
CONSOLIDATED STATEMENTS OF FINANCIAL POSITION
| May 31, 2003 | May 31, 2002 | |
| Assets | ||
| Cash and cash equivalents | $13,522,129 | $12,150,890 |
| Receivables, net of allowance for doubtful accounts of $745,112 in 2003 and $621,218 in 2002 | 8,393,638 | 8,909,201 |
| Inventories | 50,108 | 55,893 |
| Prepaid expenses and other assets | 2,178,124 | 2,747,485 |
| Marketable securities | 44,317,171 | 44,495,124 |
| Deferred tax assets | -- | 111,815 |
| Property and equipment, at cost | ||
| Land | 5,781,848 | 5,781,848 |
| Office buildings | 30,638,272 | 30,626,918 |
| Office equipment, furniture and fixtures | 11,203,942 | 10,609,451 |
| 47,624,062 | 47,018,217 | |
| Less accumulated depreciation | (10,857,609) | (8,794,777) |
| 36,766,453 | 38,223,440 | |
| Investments in deferred compensation plan, at fair value | 1,367,957 | 1,544,838 |
| $106,595,580 |
$108,238,686 |
|
| Liabilities and net assets | ||
| Liabilities | ||
| Accounts payable | 2,322,822 | 1,911,628 |
| Accrued expenses | 6,365,230 | 5,895,956 |
| Unearned revenue | 21,894,759 | 20,450,182 |
| Income taxes payable | 2,217,508 | 2,873,320 |
| Mortgage note payable | 20,461,654 | 21,547,537 |
| Liability for deferred compensation plan | 1,367,957 | 1,544,838 |
| 54,629,930 | 54,223,461 | |
| Net assets | ||
| Unrestricted | 51,965,650 | 54,015,225 |
| $106,595,580 |
$108,238,686 |
|
| CONSOLIDATED STATEMENTS OF ACTIVITIES | ||
| Revenue | ||
| Membership dues and fees | $15,344,100 | $14,654,995 |
| Publishing activities | 20,548,867 | 18,892,455 |
| Programs and miscellaneous | 28,297,161 | 25,352,817 |
| Investment income | 223,207 | 1,461,352 |
| 64,413,335 | 60,361,619 | |
| Expenses | ||
| Membership services and programs | 36,735,860 | 36,331,685 |
| Publishing activities | 12,041,957 | 11,527,843 |
| Organizational business services | 15,602,427 | 15,374,138 |
| Income taxes | 1,830,994 | 1,520,186 |
| 66,211,238 | 64,753,852 | |
| Other income (expense) | ||
| Interest on income tax refunds | 248 | 335,246 |
| Income from insurance company demutualization | -- | 6,778,308 |
| Net unrealized gains (losses) on marketable securities | (251,920) | (1,549,345) |
| (251,672) | 5,564,209 | |
| Change in net assets | (2,049,575) | 1,171,976 |
| Net assets, beginning of year | 54,015,225 | 52,843,249 |
| Net assets, end of year | $51,965,650 |
$54,015,225 |
The above data are only a part of the complete financial statements examined by Grant Thornton LLP, certified public accountants.
BY LESLIE CHAMPLIN
The more things change, the more
they stay the same, and the October Family Practice Management certainly
demonstrates the truth of that saying.
Why? Because October marks the journal's 10th anniversary and 100th issue, and to celebrate, FPM has reprinted classic articles from the past decade.
The special issue isn't a trip down memory lane so much as a reminder that today's issues -- adequate reimbursement, government paperwork, managed care requirements, emerging technology -- are yesterday's challenges in "new and improved" versions.
"Every one of the articles we have included is as useful to family physicians today as it was when it first appeared," said FPM Editor-in-Chief Robert Edsall. "These are classics, not just because they were important or influential or popular when they were published, but because their value endures."
The issue also will include a ready-made practice resource: several pages of FPM's most popular coding tools.
Introduced during the Clinton health care reform effort, FPM has met a growing demand from physicians for advice and tools to build better practices and improve patient care. During the past decade, the journal has helped physicians successfully navigate the changing landscape of health care, keeping readers abreast of issues related to managed care, Medicare, Medicaid and the Health Insurance Portability and Accountability Act, as well as practice integration, disintegration and computerization.
Today, 104,000 family physicians, other physicians and nonphysician health professionals read FPM. In its inaugural year, the journal received the Award for General Excellence from the Society of National Association Publications.
In a departure from the many medical journals that hit physicians' desks, FPM presents pragmatic advice based on the experience of family physicians and practice management consultants. FPM covers all areas of practice except the strictly clinical, which is the purview of American Family Physician.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
WEB EXTRA!
To the editor:
I am writing in response to the July FP Report article on pluses for the privacy regulations for the Health Insurance Portability and Accountability Act -- that removing nosy neighbors, nosy in-laws, nosy reporters, extended family, etc. (from knowing about a patient's condition) is somewhat beneficial. I have to disagree heartily.
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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. |
What happened to the family in family practice? There is your local family, plus your extended family. When I popped in the June AAFP Home Study disk on coronary artery disease, (I found) it has been shown that people in small communities that have community help from neighbors and family and have local support do much better pre- and post-coronary event than people that are more isolated.
It seems we are taking a step backward in our care of the individual. Family can be a very important supportive aid to people in times of trial and tribulation.
HIPAA seems to be isolating people more and more, taking the family out of medicine, taking the care away also.
Larry Lovall, M.D.
Brownsburg, Ind.
WEB EXTRA!
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Would you like to identify and address under- and overcoding
issues in your practice? A new affiliation between AAFP and Physcape Inc. will
give Academy members access to Web-based benchmarking information.
Physicians can assess practice performance, receive reports and analyze data
through comparison with Physcape's database of more than 90 million procedural
records. Go to http://www.aafp.org/physcape.xml to
subscribe to a free 30-day trial. If you sign on, you'll enjoy an AAFP
member discount. |
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"Helping Your Patients Who Have Hepatitis C," an element of the 2003 Annual Clinical Focus on Prevention, is a free packet of information for you and your patients. The packet, mailed to all AAFP active and resident members, includes a fact sheet about preventing transmission of hepatitis C, a patient education handout and a summary of the NIH consensus statement on management of this disease. If you haven’t received your packet by the end of October, call the AAFP at the number noted above and request item #593. |
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Proven value: If you are preparing to sit for the American Board of Family Practice certification or recertification examination, consider purchasing a self-study tool: the Family Practice Board Review Self-Study Packet. The packet of taped lectures and workshops comes in three audio formats: audiocassette (#275), audio CD (#1275), or MP3 (#1276). Each costs $695. Choose the format you desire and also receive a 100-question test and a bound syllabus of the handouts to accompany the talks. Go to http://www.aafp.org/x18301.xml to order online. |
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| Proven value: Thinking about stepping up to the plate for Tar Wars®, the AAFP’s tobacco-free education program? Go to http://www.tarwars.org/x1886.xml to download the free 2003 - 2004 program guide, and learn how to present the program to your community’s fourth- and fifth-grade students. All materials -- including updated statistics, classroom activities and poster contest information -- are available in English and Spanish. To see the top four 2003 Tar Wars National Poster Contest winning posters, go to http://www.tarwars.org/x2041.xml. |  |
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A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
WEB EXTRA!
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FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
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