BY LESLIE CHAMPLIN
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 "Ms. Phat" (Veronica Monroe, L.V.N., of Houston) buys lunch from "Sam Wich" (FP J. Burton Banks, M.D., of Bristol, Tenn.) during a skit about obesity at the Conference on Patient Education. Role-playing produced insight into patient perspectives during doctor-patient exchanges. The participants also learned how to implement similar training to improve colleagues' communication with patients. |
America, supersized, will produce budget deficits, supersized. Worse, as obese Americans age, the nation's health care costs will explode. The financial shrapnel will gouge out not just holes but craters in health care coverage. And America's health care system will implode.
That was the scenario painted here by family physician Eduardo Sanchez, M.D., of Austin, Texas, the state's health commissioner, during the Nov. 20 - 23 Conference on Patient Education. Only strong collaboration between family physicians and public health agencies can avert disaster, he told patient educators at the meeting co-sponsored by the Society of Teachers of Family Medicine and the AAFP.
"By 2040, the cost of medical care associated with obesity, superimposed on the cost of care to the elderly, is going to break the system," said Sanchez. "You are going to be challenged with trying to take care of the elderly at the same time you're trying to care for the 40-year-old who has hypertension, diabetes and hyperuremia. Supersized burgers and supersized fries are the new weapons of mass destruction. We have more to fear from Big Macs than from anthrax."
True. According to the CDC, more than 61 percent of adults are overweight or obese; between 1980 and 1999, the prevalence of overweight adults grew from 33 percent to 35 percent and of obese adults grew from 15 percent to 27 percent. Research in the Nov. 10 Archives of Internal Medicine confirmed earlier studies tying excess weight in middle age to poorer health later in life.
Moreover, about 15 percent of 6- to 19-year-olds were overweight in 2000, says the CDC. Many already have risk factors for cardiovascular disease, according to Joanne Harrell, Ph.D., director of the Center for Research on Chronic Illness at the University of North Carolina at Chapel Hill.
Speaking at the American Heart Association Scientific Sessions Nov. 9 in Orlando, Fla., Harrell said about one in eight schoolchildren had three or more risk factors for metabolic syndrome, which heralds cardiovascular disease. She listed these risk factors: hypertension, elevated triglycerides, low levels of high-density lipoprotein, glucose intolerance, elevated insulin levels and excess body weight.
America can reverse its rush toward obesity, said Sanchez. He called for a new health care model that would intertwine medical expertise with public health agency school- and work-based programs. Physician advice motivates patients to lose weight. But prescriptions for weight control must include public health programs to help implement the treatment plan, he said.
 Eduardo Sanchez, M.D., calls for close collaboration between primary care physicians and public health agencies. |
"That motivation must be coupled with something else that continues to remind us about our goals until the next visit with the doctor," said Sanchez. "Physicians can't afford to see obese patients weekly, but patients often need it."
Such collaboration requires physician knowledge about the public health system. Clinicians should know health departments' telephone numbers and Web sites.
Without such collaboration, America faces a dim future, Sanchez warned.
"The physical health of America will determine its fiscal health," he said. "If we don't do something about obesity in tandem with public health, we won't have the resources it will take to take care of people. Sooner or later, we're going to jeopardize more than the health of our population. We're going to jeopardize the financial support for the safety net and social structures we've built to take care of ourselves."
Sanchez's call for aggressive intervention for overweight and obese patients came just days before the U.S. Preventive Services Task Force issued its guidelines, "Screening for Obesity in Adults: Recommendations and Rationale."
"It is advisable to refer obese patients to programs that offer intensive counseling and behavioral interventions for optimal weight loss," the USPSTF said. It defined intensive interventions as more than one person-to-person session per month for three months.
Though the USPSTF guidelines focused on adults, Sanchez also urged physicians to address weight problems among children.
Health care professionals often express concern "that we would stigmatize children by calling them obese," said Sanchez. " But any child who has a body mass index above the 95th percentile probably deserves at least a blood pressure check, a serum insulin, a lipid profile and a family history. And if these are abnormal, we need to move that child beyond the universal wellness intervention and into an intensive program."
Sanchez said America's health care system could do that if physicians worked closely with health departments. Together, they could encourage school districts to incorporate physical and dietary education into the curriculum, exercise activities into the school day, and healthy food selections into the cafeteria meals.
"We need a new model," said Sanchez. "It should be school-based, where the kids spend 90 percent of their day. It should be child-centered and family-focused. It should have continuous monitoring, and we should incentivize any model to involve family physicians."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
BY J. MICHAEL BRODIE
The 2003 legislative year, a tumultuous one for family physicians, concluded with a Thanksgiving win. The House and Senate approved sweeping Medicare changes, including a new prescription drug benefit for older and disabled Americans and an increase in Medicare reimbursement for physicians. President Bush signed the bill Dec. 8.
The compromise legislation combines drug coverage for all Medicare beneficiaries -- long sought by Democrats -- with a Republican-backed plan to expand the role of private insurance companies for Medicare beneficiaries.
Physicians and Medicare patients won a reprieve protecting patients' access to care: The new law replaces what would have been a 4.5 percent Medicare physician fee cut in 2004 with increases of 1.5 percent in both 2004 and 2005.
For several years, the Academy and its members have fought for fairness in Medicare reimbursement. In October 2001, it became clear Medicare fees would plummet 5.4 percent in 2002. Between Nov. 1, 2001, and Feb. 3, 2003, FPs, patients and chapter executives sent 15,103 e-mails asking Congress to correct the Medicare fee formula. From Feb. 3 to Nov. 26 of 2003, another 2,622 family physicians sent e-mails asking Congress to fix the flawed Medicare reimbursement formula, and 323 patients sent similar e-mails.
Leaders laud new law
AAFP President Michael Fleming, M.D., of Shreveport, La., commended Congress for listening to the "thousands of family physicians who wrote, visited and called their elected officials" concerning the Medicare bill.
"Congress has taken the important first step in the right direction toward full support of seniors' access to effective medications under the Medicare program," said Fleming. "This is the first time since Medicare began 38 years ago that a general benefit has been added to the program."
Douglas Henley, M.D., the Academy's EVP, said it was correct for the Academy to support the Medicare legislation. "It contains the only legislative 'fix' to the anticipated decrease in Medicare fees and (marks) a commitment by Congress to review, and hopefully correct, the flawed formula."
Commenting on provisions to ease prescription costs for seniors, Henley said the law would "begin the slow pressure to introduce a formulary for Medicare -- that will have to occur to control costs over time."
Law addresses many issues
The new law temporarily blocks a Centers for Medicare & Medicaid Services rule that would have canceled payments to hospitals for residency training in nonhospital settings using volunteer teachers -- a block endorsed by the Academy. The law also requires HHS to develop transmission standards that will make general e-prescribing possible and then requires anyone who chooses to prescribe electronically to use those standards once they are promulgated.
Finally, chalk up two more wins for FPs and patients in rural and underserved communities. The law allocates a $1 billion increase in funding to reduce geographic payment disparities for services in rural and underserved areas. It also commits $700 million in incentives to encourage physicians to work in those areas.
Some bills still pending
At press time, House and Senate leaders had reached a tentative agreement on an omnibus appropriations bill that includes Section 747 of Title VII of the Public Health Service Act. This section calls for funds for training in family medicine, other primary care areas and dentistry. Congress was expected to complete work on the bill in January. It contains an $82.2 million allocation for 2004 under Section 747, a decrease of $10.2 million from the 2003 funding level. At one point, it had appeared the Section 747 funding would be cut entirely, an action the Academy helped prevent.
Under the guidance of Senate Majority Leader Bill Frist, R-Tenn., a patient safety bill was proceeding through the Senate in December and was expected to come up for a vote there this year. The House passed the companion bill last year. Endorsed by the Academy, the legislation incorporates voluntary, confidential reporting of medical errors as a step toward protecting patients' safety in health care.
To reach writer J. Michael Brodie, e-mail jbrodie@aafp.org.
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It just doesn't make sense, does it?
Obesity is associated with increased mortality and morbidity. ICD-9 codes exist for the condition. But when you use those codes on reimbursement paperwork, you may not get paid.
The Academy is working hard to change that.
Board Chair James Martin, M.D. of San Antonio pounded home a clear message in letters sent to three national organizations recently: “Obesity is an illness for which prevention and reasonable and necessary diagnosis and treatment should be covered.”
The AAFP sent the letters to the American Association of Health Plans, Washington Business Group on Health, and Centers for Medicare & Medicaid Services.
Martin cited published rationale for recognizing obesity as an illness, including ICD-9 codes covering unspecified obesity and morbid obesity.
Despite that, current Medicare policy states “obesity is not considered an illness, ” said Martin in urging CMS to reassess its position.
As further ammunition to bolster the AAFP’s position, Martin cited sources from the National Heart, Lung and Blood Institute; FDA; and the Internal Revenue Service. All three recognize obesity as a disease.
In addition, strong clinical evidence shows that obesity is associated with increased mortality and morbidity and that weight loss in obese individuals can reduce risk factors for diabetes and cardiovascular disease, said Martin.
He listed additional ailments associated with obesity, including stroke, gallstones, gout, female reproductive problems, poor bladder control and psychological disorders.
“In short, the prevention and treatment of obesity can contribute positively to the prevention and treatment of many other illnesses for which health plans cover diagnosis and treatment,” he said.
The letters also made the economic case for prevention and treatment of obesity (see "Economic Implosion on Tap: Physicians, Public Health Agencies Must Curb America's Girth"). Martin said CDC resources showed the cost of obesity in the United States was more than $117 billion in 2000.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
What do some contenders for the U.S. presidency think about issues important to family physicians and their patients?
Since August 2003, the AAFP has been contacting presidential candidates to obtain their views on key health policy questions. Thus far, the respondents are: Sen. John Edwards, D-N.C.; Rep. Richard Gephardt, D-Mo.; Sen. John Kerry, D-Mass.; Rep. Dennis Kucinich, D-Ohio; and Sen. Joseph Lieberman, D-Conn. Others from whom the Academy continues to seek answers are: Ambassador Carol Moseley Braun of Chicago; President Bush; Gen. Wesley Clark of Little Rock, Ark.; Vermont Gov. Howard Dean, M.D.; and the Rev. Al Sharpton of New York City.
Simply click on each question below for a summary of all the available responses to the question. You also can click on each candidate's name, below, to go to a page reserved for the candidate's answers. As more candidates reply, the site will be updated, so check back often.
In the meantime, you can go to http://www.aafp.org/x22202.xml to read the candidates' general views on health-related topics and to link to their Web sites.
Presidential contenders
| Braun | Bush | Clark | Dean | Edwards |
| Gephardt | Kerry | Kucinich | Lieberman | Sharpton |
AAFP questions
BY TONI LAPP
Family physicians and internists can check out new guidelines on atrial fibrillation. "Management of Newly Detected Atrial Fibrillation" premiered in the Dec. 16 Annals of Internal Medicine. The guidelines are the result of work by the Joint Panel of the AAFP and the American College of Physicians on Atrial Fibrillation.
Atrial fibrillation, the most common type of arrhythmia in adults, can lead to stroke. The new recommendations are based on the evidence-based practice report released in May 2000 by the Agency for Healthcare Research and Quality, and they incorporate important new evidence that has become available since the report was published, said FP Michael LeFevre, M.D., of Columbia, Mo., a co-chair of the panel.
Perhaps the most notable recommendation deals with the fundamental question of whether to attempt rate control or rhythm control. Contrary to common practice, research has not shown rhythm control to be superior to rate control, and rhythm control may be inferior in certain subgroups, the panel found.
"The generally accepted practice has been to do everything we can to get patients back into sinus rhythm and to try to keep them there," said LeFevre. "This guideline asserts that the best approach for most patients with atrial fibrillation is to focus on control of heart rate and stroke prevention, rather than attempt to restore sinus rhythm."
The authors reviewed almost 200 studies to identify the benefits of using blood thinners to prevent stroke, of slowing heart rate versus converting to normal rhythm and of using electrical versus pharmacologic cardioversion to convert to normal rhythm.
Other guideline recommendations address stroke prevention and anticoagulation, electrical cardioversion versus pharmacologic cardioversion, the role of transesophageal echocardiography in guiding therapy, and maintenance therapy.
ACP and AAFP have collaborated previously on a guideline on the prevention and management of migraines, published in the Nov. 19, 2002, Annals of Internal Medicine. Those guidelines were derived from the migraine headache guidelines developed by the Headache Consortium, in which the AAFP was a partner. Two more clinical practice guidelines -- on deep venous thrombosis and pulmonary embolism -- are in the works.
The long-awaited conclusions and recommendations of the Future of Family Medicine project are expected to be finalized this month and published as a supplement to the March/April Annals of Family Medicine. But for those wanting a sneak preview, the project's Web site summarizes the findings and proposed recommendations.
As part of the project, begun in 2001, the specialty asked the public, family physicians and other physicians questions designed to help family medicine transform and renew itself. Project leaders retained a research firm to analyze the findings for an objective look at perceptions of the specialty. The six organizations in the project, including the AAFP, have considered the analysis and helped shape directions the specialty might take.
The proposed recommendations reflect the specialty's priorities, such as creating a new model for family medicine, developing a research agenda, providing patient-centered care and achieving health care coverage for all. For more information, go to http://www.futurefamilymed.org, click on "Project Update," accept the terms for viewing, and click on "Recommendations" on the left. Because feedback is vital to the Future of Family Medicine project, you may make comments or request more information via e-mail to ffm@aafp.org.
BY CINDY BORGMEYER
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AAFP delegates and others at the interim meeting of the AMA House of Delegates Dec. 6 - 9 in Honolulu spoke out strongly against recommendations in an AMA council report. It said the AMA should call for the medical care provided under Medicaid to be funded through federal tax credits.
Concerned that the report, as written, did not reflect a pluralistic strategy for Medicaid reform, opponents succeeded in getting an amendment passed. Introduced by the AAFP, the amendment leaves the door open to pursuing alternative funding mechanisms.
The AMA Council on Medical Service report asked the AMA delegates to adopt policy stating "the medical care portion of the Medicaid program should be financed with federally issued tax credits that are refundable, advanceable, inversely related to income and administratively simple for patients."
"We believe one of the problems with the Medicaid program has been its inadequate financing," AAFP President Michael Fleming, M.D., of Shreveport, La., said in an interview after the meeting. "The amendment specifically notes, 'All financing mechanisms should be sufficient to adequately fund the overall costs of caring for this patient population,'" said Fleming. The amendment, which also calls for "adequate reimbursement to physicians caring for such persons," was overwhelmingly passed.
In an unprecedented effort to consolidate support for the amendment, a letter developed by the American College of Physicians with input from the Academy and other groups was distributed to all AAFP members -- some 70 FPs -- at the meeting. The letter noted, "While Medicaid is in need of reforms, it is imperative that we strengthen and not undermine the health care safety net. Although the goals of the CMS report are commendable, we believe it does not propose policy in the best interests of patients, physicians or the AMA."
The letter was signed by the ACP, AAFP, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, National Medical Association and National Hispanic Medical Association. Delegates from all those groups spoke in favor of the amendment on the floor of the AMA house.
"The report was well thought out and represents a very in-depth effort. Our concern is that it limits what we're going to look at as a possible funding mechanism for the Medicaid program," Fleming said.
"One of the things we believe very strongly is that everyone should have access to quality care. Anything that limits access to quality care is not good for patients," he said.
Advocating tax credits as a funding mechanism for health care services isn't new to the AMA. The organization first championed the concept in a 1999 publication, Rethinking Health Insurance: The AMA's Proposal for Reforming the Private Health Insurance System. In May 2003, the AMA published a fine-tuned version of its reform proposal, Expanding Health Insurance: The AMA Proposal for Reform, on which the CMS report was based.
At the interim meeting, the dissenting groups' concern centered on the report's -- and the proposal's -- sole reliance on tax credits. "While tax credits can facilitate expanded coverage, the report is overly optimistic that the federal government will establish tax credits at high enough levels to allow Medicaid recipients to receive comprehensive benefits with nominal cost-sharing," said the groups' letter.
The bottom line, according to Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities, is that such a system would most likely leave too many people vulnerable. "We do not believe that the future of health care financing in this country -- the financing of Medicaid, in this case -- lies solely with tax credits," Ostergaard said in an interview during the meeting. "Although such an approach might work for upper- and middle-income people, we don't believe it offers an adequate safety net for either the working poor or the unemployed."
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AAFP to retain its 16 delegates to AMA in 2004 Delegates at the interim meeting of the AMA House of Delegates adopted an AMA Bylaws amendment freezing the current number of delegates allotted to each constituent association in the AMA house throughout 2004. Thus, the AAFP delegation will retain its 16 delegates and remain the largest delegation in the AMA house through Dec. 31. Delegates at the meeting acted in response to difficulties in accurately assessing both overall AMA membership and specific constituent association affiliations. |
Not too many docs after all
A few pleasant surprises came out of the meeting, said AAFP delegation chair Dale Moquist, M.D., of Wichita Falls, Texas. Delegates adopted several recommendations on physician workforce reform. The action came in response to a report from the AMA Council on Medical Education that called on the AMA to abandon its policy stating a physician oversupply exists or is imminent.
Specifically, said Moquist, delegates adopted a new AMA policy stating there should be no decrease in the number of funded graduate medical education positions. Any proposed increase in GME positions -- overall or in a given specialty -- and in the number of U.S. medical students should be based on a demonstrated regional or national need, said delegates.
Similarly, delegates called for the AMA to collaborate with the public and private sectors to ensure an adequate supply of physicians in all specialties and to develop strategies to mitigate the current geographic maldistribution of physicians.
The delegates modified existing AMA policy by calling for "a sufficient supply of primary care physicians -- family physicians, general internists, general pediatricians, and obstetricians/gynecologists." The delegates also directed the AMA to work with representatives of primary care specialty groups and the academic community to "develop recommendations for adequate reimbursement of primary care physicians and improved recruitment of medical school graduates in primary care specialties."
The AMA is also to collect and disseminate information on market demands and workforce needs to assist medical students and residents in selecting a specialty and choosing a career path. In addition, said delegates, "there is a need to enhance underrepresented minority representation in medical schools and in the physician workforce, as a means to ultimately improve access to care for minority and underserved groups."
Finally, delegates directed the AMA to work collaboratively with state and specialty societies to develop a national consensus on physician workforce policy.
First-time support for Title VII
Perhaps the biggest surprise was the delegates' resounding support for Section 747 of Title VII of the Public Health Service Act. Delegates unanimously adopted a resolution that called for continued funding of Section 747, the only federal program that supports family medicine training programs at both undergraduate and graduate levels. It is specifically designed to increase the number of primary care physicians and other health professionals who care for the nation's underserved.
Delegates also directed the AMA to encourage its members to contact their federal lawmakers and urge them to support legislation including funds for Section 747.
The House recently passed, and the Senate is expected soon to consider, a compromise appropriations bill containing an $82.2 million Section 747 allocation for 2004. That would be a decrease of $10.2 million from the 2003 funding level.
"This is the first time the AMA House of Delegates has supported Title VII, which is so important for funding family practice residencies and departments of family medicine," said Moquist.
The delegates' vote is indeed a milestone, agreed Fleming. "The AMA has now said unanimously that Title VII funding should be increased and that primary care professions are very important."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
It's become an annual tradition, a celebration of the cooperation between the AAFP, CDC Advisory Committee on Immunization Practices and American Academy of Pediatrics: They have released the 2004 Recommended Childhood & Adolescent Immunization Schedule. It is available online and in the Jan. 1 American Family Physician.
The recommendations for children and adolescents through age 18, available at http://www.aafp.org/x7666.xml, include a catch-up chart for patients whose immunizations were delayed. The immunization schedule extends only through June because it is expected that a schedule for the latter half of 2004 will include routine influenza vaccination for children 6 months through 23 months old.
Also available at the AAFP Web site is the Adult Immunization Schedule. Online at http://www.aafp.org/x14956.xml, it indicates the recommended age groups for routine administration of currently licensed vaccinations for persons 19 and older. The AAFP, ACIP, and American College of Obstetricians and Gynecologists released this schedule in November, and it was published in the Dec. 15 AFP. This is the second year for the schedule for adults. It will be updated annually.
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| The New Mexico AFP announces the candidacy of Arlene Brown, M.D., of Ruidoso for AAFP president-elect. | The Kentucky AFP announces the candidacy of Larry Fields, M.D., of Ashland for AAFP president-elect. | The South Dakota AFP announces the candidacy of Daniel Heinemann, M.D., of Canton for AAFP president-elect. | The Illinois AFP announces the candidacy of Carolyn Lopez, M.D., of Chicago for AAFP president-elect. | The Pennsylvania AFP announces the candidacy of Thomas Weida, M.D., of Hershey for AAFP speaker. | |
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| The Wisconsin AFP announces the candidacy of Bradley Fedderly, M.D., of Milwaukee for AAFP vice speaker. | The Texas AFP announces the candidacy of Leah Raye Mabry, M.D., of San Antonio for AAFP vice speaker. | The South Carolina AFP announces the candidacy of Audrey Boyd, M.D., of Columbia for AAFP director. | The Maine AFP announces the candidacy of Judith Chamberlain, M.D., of Brunswick for AAFP director. | The Uniformed Services AFP announces the candidacy of Lori Heim, M.D., of Southern Pines, N.C., for AAFP director. | The Colorado AFP announces the candidacy of Virgilio Licona, M.D., of Fort Lupton for AAFP director. |
You can now easily identify the most recently created or revised Academy policies using a new resource on the AAFP Congress of Delegates Web page at http://www.aafp.org/congress.xml. You'll need to enter your member ID number to get to the site.
The "Policy Statements -- New and Revised" document, available as a PDF file at http://www.aafp.org/PreBuilt/Summary.pdf, presents an alphabetical list of nonclinical policies created or revised by the 2003 Congress. (Click on "More information on using PDF files" for help accessing the file.) Nonclinical policy statements are those describing the Academy's views on public health issues and delivery of medical care.
Each policy is listed by title; some also include a brief descriptor. Members can click on the appropriate title to link to the policy on the "AAFP Policies on Health Issues" Web page at http://www.aafp.org/policies.xml.
Stay tuned ... you should soon be able to access new and revised clinical policies at the "AAFP Clinical Recommendations" Web page (http://www.aafp.org/clinicalrecs.xml) through a similar process.
WEB EXTRA!
Chiropractors will not become veterans' primary care professionals, but they will play a role in veterans' health care, according to recommendations sent to the Department of Veterans Affairs by its Chiropractic Advisory Committee.
On Nov. 3, the committee offered 38 recommendations to Secretary of Veterans Affairs Anthony Principi. He had appointed the committee -- six chiropractors, four other health care professionals and one public adviser -- in August 2002. Their mission: Report to Principi on the Veterans Health Administration's definitions of service to be provided and protocols governing referrals to chiropractors, direct access to chiropractic care and the scope of practice of chiropractors.
"The key here is that the VHA system is going to a primary care model system where everyone has a primary care physician and the care of the veterans is coordinated by the primary care physicians," said AAFP Past President Warren Jones, M.D., of Ridgeland, Miss., who serves on the committee.
The committee's recommendations include these:
If Principi accepts the recommendations, Jones said, it would be "a win-win situation for the veterans."
In 2002, nearly 7,800 AAFP members sent letters to lawmakers in Congress opposing a provision that would have allowed veterans to designate chiropractors as their primary care providers. The letters helped trounce that provision.
Jones said the law is clear about chiropractors working within the VHA . They can provide services, he said, but they are not to replace primary care physicians.
Offering a retrospective, Michele Johnson, legislative representative in the AAFP Government Relations Division, said, "Family physicians fought legislation a few years ago that would have classified chiropractors as primary care providers in the VHA system. Congress listened. The legislative compromise we won was the appointment of this committee. Now these recommendations include the primary care physician's referral of a patient to a chiropractor -- a successful resolution of what had threatened to be a major problem."
WEB EXTRA!
To the editor:
The recent announcement of AAFP's negotiating with major electronic health record distributors greatly excited me for two reasons. First of all, I might now be able to afford an EHR system for a new office my group is opening in June. But secondly, and most importantly, the AAFP has shown that it does truly care about its members, knows what its members are up against in their offices and will work for us in helping us overcome obstacles. Thank you.
Christopher Ciccone, M.D.
Yorktown, Va.
To the editor:
Six years ago, my ex-partner and I squandered $50,000 on a dysfunctional electronic medical record system. I have been waiting for the market to "mature." To my disappointment, last year there were over 400 vendors peddling EMR. AAFP has taken a tremendous step in narrowing the field, lowering prices for the small practice and establishing some kind of industry standards for EMR. Keep up the good work. I'll be waiting!
John Koella, M.D.
Saratoga Springs, N.Y.
To the editor:
My thanks to the AAFP for its efforts at helping promote EHR use to us little guys (one doc and one advanced registered nurse practitioner). I am so ready to get on board the EHR bandwagon, but I've been limited by issues of cost and vendor choice. I am proud to be a member of such a forward-thinking organization.
Charlie Booras, M.D.
Jacksonville, Fla.
To the editor:
I found the AAFP EMR price reductions laughable. I and other struggling FPs in the solo market need a "basic" no-whistles-or-bells EMR at rock-bottom cost.
Bruce Bailey, M.D.
Canterbury, Conn.
To the editor:
Just a comment from Britain: The government is so involved here in doctors' practices that each doctor's office would get a sizable or at least reasonable "adopt the new format" grant for new laws such as the Health Insurance Portability and Accountability Act and for more expensive modernizations. So my colleagues here were quite surprised that so few U.S. doctors use EHR until I pointed out that the Americans all have to cover the expense of EHR on their own. Here, almost all have EHR, and not all the same one, either, as it is not dictated by the government.
Jennifer S Marsden, MD, FAAFP
Andover, United
Kingdom
Editor's Note: To learn more about AAFP's EHR initiative, visit the Academy's Center for Health Information Technology Web page at http://www.aafp.org/centerforhit.xml. Click on "Current Projects," then on "Principled Group Purchasing Agreements -- Partners for Patients."
WEB EXTRA!
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Would you like help creating professional, evidence-based CME materials for your next presentation? The Academy has developed PowerPoint presentations on sinusitis, urticaria and rhinitis to assist physicians, faculty and speakers. Take advantage of these ready-to-use resources. Utilize the entire PowerPoint package, or incorporate only what you need for your presentation. Go to ( http://www.aafp.org/x24675.xml ) to view the programs; contact rjones@aafp.org if you’d like to receive these free CME tools. |
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Proven value: Check out the new look at AAFP’s award-winning patient education Web site, familydoctor.org. The site has been redesigned, and it’s a snap to navigate. Not that folks weren’t using it already, including 933,908 visitors in October 2003 alone. Send your patients to a reliable source where they can read up on 475 different medical conditions and print out more than 550 patient education handouts (25 percent of which are now available in Spanish). |
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Proven value: Has the steady media coverage of obesity got your patients asking for help? Look no further than the AAFP’s “Physician’s Guide to Outpatient Nutrition,” a resource designed to help physicians educate patients about nutrition. Topics include patient behavior change, nutrition and physical activity, and weight loss. You’ll also find sections on nutrition’s role in the aging process, in the prevention of heart disease and in risk reduction for certain cancers. The guide is available for $34.95 and can be ordered online at ( http://www.aafp.org/shop/939 ). |
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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
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Copyright © 2004 by
American Academy of Family Physicians.
