You've probably heard about the new model of care described in the Future of Family Medicine report. Fair warning: Patients love it!
That's because the new model of care contains what patients want and need. Check out "Patients confirm appeal of FFM project's 'new model' of care" for details on patient focus group responses to the new model. For a description of the model itself, see the FFM report at http://www.annfammed.org/cgi/content/full/2/suppl_1/s3.
The FFM new model of care provides a toolbox by which family doctors can assess their practices; learn where they have been leaders; and discover innovations that boost the quality of their patient care and, in turn, their business success.
Many FPs are already well down the road toward this new model of care. With " First in a series -- Family physicians, their patients benefit when new model of care becomes reality," FP Report launches a series of articles that visits the practices of some of these FPs -- showing what they've done, how it's worked, tips to help you implement the new model of care and ideas for easing the transition. Among the topics to be covered in the series: electronic health record systems, open access scheduling, teamwork and group visits.
BY LESLIE CHAMPLIN
When patients come first, all else will follow. In abundance. Weston Welker, M.D., knows that. He watches it happen every day in his Southside Family Practice.
Since implementing steps that have become part of the Future of Family Medicine recommendations, Welker has watched patient-centered care improve dramatically. Patient census has climbed, patient compliance for chronic disease management has skyrocketed, and serious complications from hypertension and hyperlipidemia have plummeted.
Moreover, revenues and cash flow are up, office hours are down and debt is tumbling.
Making it work
With Welker and Southside's other family physicians -- Thomas Armstrong, M.D.; Charles Mullins, D.O.; and Jenny Chapman, M.D. -- patients have a medical home that emphasizes patient convenience. The practice uses electronic medical records to ensure evidence-based protocols, comprehensive services and in-depth patient education.
In short, Southside offers many aspects of the Future of Family Medicine's new model of care. The office has a comprehensive laboratory; cardiac stress test equipment; and equipment for bone density scanning, sonograms, echocardiograms and Doppler scans.
"Nine times out of 10, we can handle any initial evaluation right here," said Welker. "And the specialists across town respect the data we send them. The specialists and the hospitals see Southside as the patients' medical home. When they admit a patient, they know they can call and ask for that patient's medication list and labs, and they'll get them."
Moreover, patients understand Southside can provide same-day appointments, no matter how serious the complaint. They walk in with everything from cut fingers or sore throat to chest pain. And Southside responds.
A patient with a history of anxiety attacks calls; he has severe chest pain and is on his way to Southside Family Practice. Fran Miller, Southside's business manager and a paramedic, moves the crash cart from the cardiac room to triage, where Annette Prestidge (also a paramedic) awaits the patient's arrival.
Triage tests indicate the patient is suffering an anxiety attack. The medical team switches from cardiac to psychiatric protocols, and the man returns home -- sans emergency room bill.
"We have a fully equipped crash cart," said Miller. "A person coming into our office with chest pain or difficulty breathing can be stabilized before we send him to the hospital."
Likewise, the team can connect the echocardiogram to a T-1 line and contact a cardiologist who sees -- in real time -- the test results on an encrypted Web site.
Ensuring smooth sailing
 A triage system that collects information on each patient's current needs and previous visits allows Weston Welker, M.D., to immediately begin examining Carolyn Guillion of Union Grove , Ala. , to determine the etiology of mild edema. |
Southside's patients expect top-of-the-line care and customer service. They get it because the office process combines attention to their needs as consumers with an evidence-based approach to their care.
Step one: Patients begin their doctor visits by checking in with a bilingual receptionist; she electronically tracks their time at each station in the office to ensure no one waits too long.
Step two: In the triage area, a nurse or paramedic electronically enters information about the patients' current complaints and checks the currency of their vaccinations or ongoing tests. If the complaints require diagnostic tests, the patients visit the phlebotomist or X-ray technician.
"We have a triage system established so when the doctor enters the exam room, he has everything he needs," said Miller.
Step three: The physicians get down to doctoring and patient education the second they greet patients. Saves time, saves money.
Welker checks Carolyn Guillion's record on his wireless computer before he enters exam room two. Guillion asks him about the swelling and stiffness in her hands and feet. Welker examines her, asking when the symptoms appeared. He explains the implications of his findings, describes his treatment plan and suggests a medication to relieve the edema.
Leaving the exam room, Welker returns to his computer, enters his notes, writes a prescription and sends it to Guillion's pharmacy. The system automatically records the new data in Guillion's record and enables the staff to prepare a bill for the insurance company.
Reaping rewards
Southside Family Practice plunged into its transformation in August 2003. Taking on $300,000 in debt, the physicians invested in state-of-the-art equipment and staff with expertise in coding, billing, and the web of government and managed care regulations. They added a phlebotomist and two paramedics. One nurse and Welker are certified in advanced cardiac life support.
The transformation has paid off. Before its plunge, Southside Family Practice had average monthly collections of $70,000, about 58 percent of billings. Today, collections average $130,000, more than 85 percent of billings. Its health fair, babysitting classes, regular TV news appearances, monthly "Evening With the Doctor" lectures, and outreach to schools increase patient census, on average, by 10 families per physician per month.
The result: "In three years, we'll be completely out of debt," said Miller.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
 Using wireless technology, Weston Welker, M.D., pulls a patient's electronic health record to discuss symptoms and diagnosis and explain his treatment decision to Stephen Poteet, a third-year medical student at the University of Alabama, Birmingham. |
In addition to a full complement of in-office diagnostic and treatment capabilities, physicians at Southside Family Practice in Huntsville, Ala., offer inpatient care.
Weston Welker, M.D., and his Southside colleagues provide inpatient colonoscopies, minor surgical procedures and primary care services for patients in the ICU and on surgical floors. However, the physicians aggressively treat diabetes, hypertension, hyperlipidemia and other chronic conditions. What's that mean? "We rarely have stroke or heart attacks," said Welker.
In fact, Southside has achieved 90 percent compliance among patients who require regular monitoring for diabetes, cardiovascular conditions and respiratory ailments.
Such success challenges Southside's research activities. Participating in six studies -- on topics including diabetes, osteoporosis and asthma -- the practice has occasionally grappled with a patient census too healthy for the research protocol, said Welker.
"We treat hypertension so aggressively that it's hard for us to have patients that are out of control for our research program," he said of Southside's participation in research into hypertension treatment.
Welker's quest for new knowledge and his application of protocols have impressed the medical students who have learned at the physician's heels for the past 15 years.
"What I've learned here about family medicine is that you can do anything you want to do as along as you have the training for it," said Stephen Poteet, a third-year medical student at the University of Alabama, Birmingham. "There's no other specialty that lets you do that."
BY TONI LAPP
Geoff Clarkson has heard firsthand what patients think of family medicine and the new model of care proposed by the Future of Family Medicine project.
"The bad news is, no one knows you (family physicians) are out there," said Clarkson, managing director of the research firm Greenfield Consulting Group. "They don't know how you're differentiated from other specialists; they don't know that you have special training or receive ongoing medical education.
"The good news is that you're starting out with a clean slate. You can create a new model without first overcoming negative baggage."
Clarkson held six focus groups earlier this year, after the FFM project released its report and recommendations, and confirmed that the new model of care would appeal to the target audience -- the patients. The focus groups represented a geographic, ethnic and income cross-section of America. The patients' primary care physicians included FPs and non-FPs.
Clarkson himself describes his knowledge of family medicine going into the project as "zero," similar to what he found among lay people in the focus groups.
"Even people with family physicians did not know what (family medicine) was," Clarkson said. Patients who went to FPs often described their doctors as "generalists" or "internists," he said.
But much potential is out there. "The new model is highly appealing," said Clarkson. "No negatives were expressed."
The "personal medical home" called for in the new model of care particularly appealed to patients, he said. "It best summed up what patients want from a doctor."
Another highly ranked FFM tenet: commitment to provide family medicine's basket of services.
This will be a challenge for the diverse group of physicians who describe themselves as FPs, noted Clarkson. FPs' patients in the focus groups were often confused by which services they could expect from their physicians. "Some of the patients' FPs would see youngsters, some didn't; some delivered babies, others didn't; some performed surgical procedures. There was a wide variance in the understanding of what family physicians could do," said Clarkson.
Patients weighed in on other aspects of FFM:
• Elimination of barriers to access. This appealed to patients, though many said they already had timely access to their primary physician for urgent care. One patient stated that if he could get in for an appointment the same day, "it must mean the doctor is not very good."
• Advanced information systems. Though this was a somewhat polarizing issue, most patients liked the idea of accessible medical records. Others were concerned about privacy issues related to the accessibility of databases.
Clarkson's advice for the organizations that collaborated on FFM, including the Academy: Establish an identity and find a way to communicate it to lay people.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
BY SHERI PORTER
 Clockwise from top: David Brailer, M.D., Ph.D.; Tommy Thompson; Sen. Bill Frist, M.D., R-Tenn.; Rep Nancy Johnson, R-Conn.; and Douglas Henley, M.D. (see "Feds praise AAFP's IT role -- Academy announces physician EHR coalition at summit). All have their say at the D.C. summit. |
"We're going to get health care out of the horse and buggy days." That was the word from HHS Secretary Tommy Thompson when he spoke to a standing-room-only crowd here recently at the Secretarial Summit on Health Information Technology.
Talking to more than 1,500 technology and health leaders (including AAFP leaders), Thompson illustrated his point: You can pull out your bank card and use it anywhere in the world, he said, "but show up in an emergency room 50 miles from home and you'll have to scramble to find your medical history."
Thompson said no one paid attention when he first started talking about electronic health records four years ago. Patient care suffers as doctors wade through paperwork that is tied up in manila folders and spread over many offices, he said. "Our doctors have worked in the dark long enough. Working together, we can turn on the lights."
The summit provided the backdrop for the release of "The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care," a report prepared by HHS' national coordinator for health information technology, David Brailer, M.D., Ph.D. To read the executive summary and related materials, go to http://www.hhs.gov/onchit/framework.
Brailer compared the July 21 summit and astronaut Neil Armstrong's walk on the moon, 35 years ago to the day: "This is as big and important and bold as any goal in our society. This is not about technology; this is about the transformation of health care."
There are more questions than answers, said Brailer. "What we're trying to do is create the lines -- we want all of you to color them in." He added, "We need to do this without substantial regulation and industry upheaval."
Administrators from CMS, NIH, CDC, FDA, the Department of Veterans Affairs, and the Agency for Healthcare Research and Quality expressed their commitment to coordinating this effort from all angles.
"I'm enormously impressed by the sheer human capital in this room," said AHRQ Director Carolyn Clancy, M.D. She reiterated AHRQ's mission to improve quality and safety. "From the prospect of AHRQ, we think this framework rocks," she said.
Rep. Nancy Johnson, R-Conn., agreed: "When we get technology in place so that physicians and their staff love it, it's going to change everyone's world." She challenged the audience to share the health IT vision with their rotary clubs, chambers of commerce and "all those folks who make our economy work."
"If we don't succeed in doing this right, we'll fail the American people," she said.
Senate Majority Leader Bill Frist, M.D., R-Tenn., also made an appearance to show his support. "I speak as a policy-maker, as a physician and as one who cares about the future of health care delivery," said Frist.
In 10 years, America's population will be older, better educated, more affluent, more wired and more mobile, he said. They'll be living longer and living with chronic illnesses. "What isn't working today certainly won't work if we project that onto tomorrow," said Frist. "We've got to transform our health care system into one that is patient-centered, consumer-driven and provider-friendly."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
"The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care," recently released by HHS' national coordinator for health information technology, outlines a broad 10-year initiative that includes four major goals and strategic action plans to reach each of those goals. Those goals are to:
Fourteen medical organizations have formed the Physicians Electronic Health Record Coalition, and the Academy announced the new alliance at the recent health information technology summit in Washington, D.C.
AAFP Executive Vice President Douglas Henley, M.D., shared news about PEHRC while participating in a “reactor panel” on clinical leadership. He said the groups in the coalition represent more than 500,000 physicians.
Henley explained that one of PEHRC's objectives is to help develop a certification process for health IT products that will give physicians the confidence to invest in EHR systems. (Read more about PEHRC at http://www.aafp.org/x28539.xml.)
Earlier in the summit, both David Brailer, M.D., Ph.D., HHS' national coordinator for health information technology, and HHS Secretary Tommy Thompson spoke of the need for just such a certification process. They said it should come from the private sector rather than the federal government.
Introducing Henley at the summit, Brailer said, "One of the most entrepreneurial associations that I know of is the American Academy of Family Physicians. Their Center for Health Information Technology is innovative, experimental and sets the pace." The AAFP has taken a leadership role that is constructive to all, Brailer said.
Stepping to the podium, Henley said, "Now the fun really begins as we transform a vision into reality." Addressing Brailer, he added, "We stand with you to do just that, sir."
Henley also spoke about the AAFP's passion for electronic health records, saying it is driven by the reality that physicians "need this technology to help us do our jobs better."
"The amount of data that a single physician or any clinician needs today to provide the best care simply exceeds individual human cognition,' he said.
•Resident & Student News•
 "There's no other profession like ours," FP Regina Benjamin, M.D., tells family medicine residents and medical students at the 2004 National Conference. |
BY SHERI PORTER
Regina Benjamin, M.D., believes passionately in providing health care to the underserved. That's why, in 1990, she founded the Bayou La Batre Rural Health Clinic on Alabama's Gulf Coast in what she calls "a community of working poor."
That's also why she gave a clear directive to her young audience here during the National Conference of Family Medicine Residents and Medical Students July 28 - 31. "I believe you and I need to be lighthouses, to stand for what we believe in," said Benjamin. One way to provoke change "is to let the world know it's on the wrong course," she said.
Benjamin, a family physician, presented the Stephen J. Jackson, M.D., Memorial Lecture, and she came to the podium with a strong résumé. Benjamin was the first black woman elected to the AMA Board of Trustees and the first woman president of the Alabama Medical Association. She received the Nelson Mandela Award for Health and Human Rights in 1997 and has been featured in major U.S. news outlets, including The New York Times and World News Tonight With Peter Jennings.
"Health care is not simply (ensuring) the absence of disease," said Benjamin. Physicians can undertake community projects to help their patients. For instance, she said she worked through the Alabama health department to help clean up the water in the bayou by providing containers fishermen could use to dispose of their boat oil. "It was just a simple thing -- putting containers there," said Benjamin, but it made a difference.
Keep tabs on the community's economic condition, she told residents and students, because patients will come in with upset stomachs and high blood pressure -- but "the real problem is they don't have a job. They can't think of their health when they can't put food on the table."
Understand the trust that patients place in you. "There's no other profession like ours," said Benjamin. "A perfect stranger will walk up to you and put her baby's life in your hands simply because she trusts you." A woman will divulge her deepest, darkest secrets -- particularly about domestic violence -- because of that trust. But with that trust comes a tremendous amount of responsibility, Benjamin said.
"We are the leaders in our communities," Benjamin said. "Remember, you never know who's watching you." She recalled an elderly black gentleman who, several years ago, stopped her as he was cleaning a room after an AMA meeting. "I just want you to know that we're proud of you," he said. "I told my granddaughter about you."
Lastly, Benjamin urged audience members to keep their lives in balance. Get enough sleep, eat right and take vacations, she advised. "Put on your own (oxygen) mask before you help others," she said, referencing the message airline passengers hear before takeoff.
Physicians balance many balls, said Benjamin. "Some of those balls are rubber and some are precious crystal. Some balls you can drop and some (like family) you just can't. You have to decide which balls to keep in the air."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
 Medical students and residents revel in networking opportunities at the minority forum. |
Four family medicine leaders spoke their minds at the Minority Special Interest Forum and Reception July 29.
Jeannette South-Paul, M.D., of Pittsburgh; Peter Nalin, M.D., of Indianapolis; Harry Strothers, M.D., of Atlanta; and Regina Benjamin, M.D., of Bayou La Batre, Ala., touched on a variety of topics, including these.
Minority recruitment
The numbers just don't make sense: Minorities make up about 30 percent of the nation's population, but minority physicians make up just 6 percent of the health care workforce. The latter figure has been consistent since the 1950s, said Benjamin. "It hasn't changed, and I don't know why." What she did know, she said, is that if students don't get fired up about science in junior high, they probably won't be on a path to a medical career.
Add to that this statistic: Only 6 percent to 10 percent of minority students graduate from college, said South-Paul. "If these young people do not graduate with a bachelor's degree, they're not going to medical school."
Mentoring
"What matters in mentoring is relationships, consistency and unconditional positive regard," said Strothers. You don't have to reinvent the wheel, he added. Look for existing community organizations such as boys' and girls' clubs.
A major problem has been getting male mentors, said South-Paul, because they think they have to be perfect to mentor. She tells the guys, "You just need to be there. You just need to be an ear at the end of the phone."
When mentoring young people, tell them they need to do some kind of "service learning" if they want to be in a health profession, said Nalin. Say to them, "If you have a choice between scooping ice cream and working in a nursing home, work in the nursing home," he advised.
Admissions testing
"Be on that admissions committee," said Strothers. Committee members can make a big difference in who enters medical school.
"The standardized tests are just that -- standardized," Benjamin said, adding that the goal of the exams is to ensure that the physician's skill level meets a basic minimum. "You don't want people to think that because you're a minority, you'll be given a break. You will meet that standard and meet it well," she said.
 FMIG leaders discuss how their interest groups can help define the specialty of family medicine within the academic environment. |
Family medicine interest group leaders, if you're excited about the future of family medicine and want to convey that fervor at your next FMIG event, the AAFP has resources for you to use.
That was the message Norman Kahn, M.D., AAFP vice president for science and education, delivered July 28 during an interactive workshop at the National Conference.
Using selected slides from a comprehensive slide library the AAFP has developed, Kahn gave FMIG leaders, coordinators, faculty advisers and others a close-up look at the Future of Family Medicine project's report and recommendations. He also challenged them to "pay it forward" by telling others about the FFM results.
For starters, Kahn pared the new model of family medicine down to a basic definition: "a personal medical home in which a patient establishes a continuous relationship with a physician and a defined basket of services is delivered." (See related stories for more on the new model.)
"Now as an individual family physician, I may not provide every one of those services," Kahn said, citing prenatal care, labor and delivery, and managing hospital inpatients as examples. "But even if I don't provide the service myself, I will make sure that the personal medical home my patients are part of provides that defined basket of services."
One upshot of the FFM project -- a process that literally began and ended with patient input -- was the identification of six areas on which the specialty's future depends, said Kahn. Namely:
To keep those findings fresh in the minds of everyone involved in the specialty, Kahn explained, the AAFP is sending every medical school, every family medicine department and residency, and every constituent chapter a poster -- suitable for framing -- displaying the six key points.
But that's only one way the AAFP is trying to help FMIGs get the word out about the FFM findings.
"You can have this slide show," said Kahn. "If you're a student, if you're a family medicine interest group leader, if you're a faculty member or faculty adviser, you can have it."
And there are plenty more slides to choose from, Kahn noted. "Understand that we have a thousand more slides," he said, "so whatever you want -- we can find it." Mix and match them to suit what you're trying to accomplish, Kahn invited. Create a presentation that answers the question, "What do people want from primary care?" or "What is the new model of family medicine?"
"My hope is that every one of you will show this slide show at least once during the coming year. I want to impact the attitudes of medical students before they submit their rank lists in early 2005."
To view and download various FFM slide presentations as PowerPoint files, go to http://www.futurefamilymed.org/x19624.html. You also can download a free copy of Microsoft's PowerPoint viewer at the site.
 In a role-playing exercise, workshop facilitator Brenda O'Hara, M.D., waves an ammonia ampule under the nose of a "patient" who has lost consciousness in the waiting room. |
BY CINDY BORGMEYER
All images of the popular TV show ER aside, the concept of triaging patients originated on the battlefields of the Civil War. It grew out of a need to conserve resources by assessing which wounded soldiers could benefit from treatment and which would likely perish despite the most valiant medical efforts.
In a primary care setting, triage determines who can be safely treated in the office and who should be transported to an emergency care facility. That's what Brenda O'Hara, M.D., told participants during a July 29 National Conference workshop.
O'Hara directs the Fort Wayne (Indiana) Medical Education Program, which offers family medicine precepting opportunities for medical students at Indiana University, Fort Wayne. She laid out the basics of making in-office triage decisions:
"A lot of things people get very excited about aren't true emergencies," O'Hara cautioned. "A person with a laceration -- particularly a head wound -- may be the bloodiest, most ghastly thing on earth. Yet nine times out of 10, if you put a little pressure on it, it's not an emergency, and you can sew it up right in your office.
"On the other hand, there are some things that may not look at first blush like a true emergency, but if you keep those people in your office, they could begin to deteriorate very quickly."
O'Hara cited a cardinal rule when dealing with others' emergencies: First, check your own pulse.
"It's hard not to get excited," she said, "but one of the best things you learn as a physician is that despite how scared you are and how bad it looks, you're the one in charge, and you have to keep calm."
Other emergency dos and don'ts O'Hara recounted:
"Someone who's vomiting, for instance," O'Hara said. "If I can't get it under control quickly, it's best to get them out of the office -- otherwise, you'll have two or three more people who'll start vomiting, too."
If an ambulance is called, notify family members about the situation and give the emergency room a heads-up.
As for what to do in the meantime, there's no substitute for having the right equipment on hand, O'Hara advised. Here's a partial list of what the well-dressed FP's office is wearing this season:
Finally, think creatively, O'Hara said. She recalled one instance involving an elderly woman who walked into the office in obvious distress. "I knew she was having an allergic reaction," O'Hara said. "She was real hypotonic; she had a lot of rigid spasms." The woman also had absolutely no veins, O'Hara added.
"They (nursing staff) drew up some epi, and I pulled up her tongue, stuck the needle under there and injected it," she said. "I thought, 'Sublingual -- it works for nitro..' Well, it worked for her, I'm happy to say."
 King |
 Dickson |
 Patterson |
 Flagg |
On July 31, delegates to the National Congress of Family Medicine Residents and National Congress of Student Members elected representatives for the coming year:
Of the 2,631 registrants at the 2004 National Conference, 541 residents and 651 medical students attended, voicing their opinions on issues affecting family medicine, visiting with exhibitors and learning alongside colleagues. Link to information on resolutions considered by the National Congress of Family Medicine Residents and National Congress of Student Members at http://www.aafp.org/conference.xml. The site also lists the names of winners of a laptop computer and three personal digital assistants chosen from among conference registrants.
 A hands-on demo in the exhibit hall gives this attendee an opportunity to try his hand at colonoscopy. |
 The National Conference closing party gives attendees a chance to kick back and relax with newfound friends. |
 Fun and festivity are the order of the evening at the party celebrating the closure of the 2004 resident and student conference. |
 Patricia Paul, M.D., of Newport News, Va., testifies at the National Congress of Family Medicine Residents about problems residents can face when their residency closes. |
 The "patient" watches every move the "physician" makes during a hands-on procedural skills course on casting and splinting. |
 AAFP President Michael Fleming, M.D., chats with a student about where the specialty of family medicine is headed during an open forum, "Visioning Family Medicine's Future," Thursday morning. |
 This medical student, taking time out from her busy conference schedule to donate blood, watches with interest as the technician prepares for the blood draw. |
 Samuel LeBaron, M.D., takes time to visit with two women from the audience after his guest lecture appearance Saturday afternoon. |
 There's nothing like a good yoga stretch to start the day out right. |
 This volunteer for the treadmill-testing workshop took the challenge of peak exertion seriously. |
Here's some news physicians need to note: CMS has eliminated the 90-day grace period formerly allowed after new ICD-9, CPT and Healthcare Common Procedure Coding System codes take effect.
Physicians must use 2005 ICD-9 codes beginning Oct. 1 or face the hassle of denied or delayed claims.
To avoid similar billing hassles with other coding systems, use the 2005 CPT and HCPCS codes beginning Jan. 1.
"This is a change from the way CMS has done business in the past," said Kent Moore, AAFP manager of health care financing and delivery systems. "Historically, physicians have had a 90-day transition period to make the switch; that's not going to happen now."
Moore said physicians should act soon to have the new codes in hand to avoid interference with their cash flows in the future.
Go to http://www.cms.hhs.gov/medlearn/icd9code.asp and click on information in the box titled "Effective Oct. 1, 2004" for a listing of the 2005 ICD-9 codes.
The revised HCPCS codes should be available at http://www.cms.hhs.gov/medicare/hcpcs/update.asp in the near future.
Contact your usual supplier for the 2005 CPT code book.
|
COCME MEMO TO BOARD: |
Evidence-based CME activities just gained even more appeal. At its Aug. 3 - 8 meeting in Napa, Calif., the AAFP Board of Directors approved a recommendation from the Commission on Continuing Medical Education doubling the credit awarded for educational activities designated for AAFP EB CME credit.
Activities approved for partial EB CME credit would receive double credit only for the portion that was evidence-based. For example, in a CME course eligible for a total of 20 CME credits, of which 12 were evidence-based, the 12 could be doubled. Thus, participants who completed the course would be eligible to receive up to 32 credits, rather than the 20 currently awarded.
"Awarding double credit for EB CME," said the COCME memo to the Board, "would convey the value of EB CME to family physicians and CME providers."
The board also considered, but did not approve, a COCME recommendation that would have required AAFP members to complete at least a minimum number of EB CME credits per three-year membership cycle. Although Board members acknowledged the ample opportunities for EB CME the AAFP offers its members -- such as through American Family Physician and AAFP Home Study -- it stopped short of mandating that members include such activities in their CME portfolio.
No timeline for implementing the credit change -- which will require modification of the Academy's computerized CME record-keeping system -- has yet been established.
BY J. MICHAEL BRODIE
Want to know the biggest difference between the two leading candidates vying for the White House? Take a look at their health care plans and the price of implementing them. The proposals could not be further apart when it comes to how they would decrease the number of uninsured Americans and how they would set a federal price tag for doing so, according to Kenneth Thorpe, Ph.D., chair of the health policy and management department at Emory University, Atlanta.
"As you look at what they are proposing for health care, what you are seeing is the biggest area of difference between the candidates," said Thorpe in a recent FP Report interview. "Health care is, by far, a clear area where there are fundamental policy differences."
Thorpe has studied the federal costs of health care proposals by President George W. Bush and Sen. John Kerry, D-Mass., and how the proposals might affect the uninsured. Thorpe's analysis is available on the AAFP Web site at http://www.aafp.org/x22202.xml.
Thorpe's analysis notes that, in the administration's fiscal year 2005 budget proposal, Bush promises to reduce the price of health insurance. His plan would trim insurance premiums, for example, through encouraging the use of association health plans that enable small businesses and associations to buy insurance through large purchasing pools. It also would provide refundable tax credits for people who buy individual (not employer-sponsored) policies. Thorpe's report says Bush's plan to cover the uninsured would cost about $90 billion from 2005 to 2014 and would insure up to 2.4 million otherwise uninsured people.
Kerry's plan aims to make health insurance more affordable and expand coverage to 27 million otherwise uninsured Americans, according to Thorpe's analysis. The Kerry plan would cost taxpayers about $653 billion from 2005 to 2014. Much of the cost of the plan would come from providing tax cut initiatives to encourage small businesses, people 55 to 64 years old and workers in between jobs to buy health insurance. The plan also calls for the federal government to fund the expansion of the number of children and adults qualified for Medicaid and the State Children's Health Insurance Program.
During the interview, Thorpe said he regarded this election as critical because the road voters choose to travel will determine whether an already overburdened health care system will be further stretched or greatly eased.
"Half the battle is to make sure that what is being proposed here (by Bush and Kerry) is being discussed," said Thorpe, who hopes his work will add to the national health care debate. "These are radical policies on how to spend federal dollars."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
|
"We have had asthma guidelines for over 12
years but few tools to figure out how to implement them into practice." |
To offer high-quality care to your patients with asthma and allergies, your practice needs systems in place for treating these chronic conditions. The AAFP is offering resources to help you launch those systems.
AAFP has posted the following tools at http://www.aafp.org/asthmaallergyguide.xml:
These tools are part of the Asthma and Allergy Resources for Family Physicians program, which began in 2000 and is funded by an educational grant from Schering-Plough.
A pair of ongoing practice-based research projects are also part of the program. One seeks to assess the performing of spirometry and evaluate the value of those tests in the primary care setting. The other involves development of patient-oriented tools for assessing asthma control.
Family physicians presented the program and tools as a model for implementing evidence-based knowledge in everyday family practice at the July 12 Translating Research Into Practice conference in Washington. The conference -- co-sponsored by the Agency for Healthcare Research and Quality, National Cancer Institute, and Department of Veterans Affairs -- provided a forum for health care professionals to share experiences and collaborations for moving research into sustained behavior change.
The AAFP resources program began with the yearlong "Learning and Improvement Collaborative on Healthcare for Children with Asthma," co-sponsored by the AAFP and the National Initiative for Children's Healthcare Quality. Thirteen family medicine practices across the United States took part in the effort, which concluded last year.
"This resources program combines state-of-the-art clinical knowledge on these two conditions with proven, practical tools for providing excellent care. Much of the guide is based on what we learned from practicing family physicians in the AAFP collaborative," said Kurt Elward, M.D., of Charlottesville, Va., after the TRIP conference. He is the lead author of the guide and was a presenter at the meeting.
"We have had asthma guidelines for over 12 years but few tools to figure out how to implement them into practice," said FP Barbara Yawn, M.D., a TRIP conference presenter; director of research at Olmsted Medical Center in Rochester, Minn.; and a faculty member for the AAFP program. "Guidelines don't tell you how to care for the individual asthma patient or how to change your practice to make quality care efficient or convenient.
"Caring for people who have asthma without telling them when to increase medications, call for an appointment or come for emergency care -- all elements of an action plan -- is like sending someone home with a new glucose monitoring (system) but not telling them when and how to use it. We just won't do that."
Find your HIPAA hat and put it back on -- the one you wear to tackle complying with the Health Insurance Portability and Accountability Act. There's another HIPAA deadline coming down the pike.
Unless CMS decides otherwise, covered entities -- and that most likely means your practice -- must be fully compliant with the HIPAA security rule by April 21, 2005. This portion of HIPAA focuses on safeguarding patients' protected health information that is created, maintained or transmitted electronically.
If you need help, consider purchasing an Academy resource that aims to ease your trek along the latest compliance trail.
The HIPAA Security Rule Manual: A How-To Guide for Your Medical Practice was developed specifically for small medical practices and offers a 22-step guide to compliance.
"For now, I'd advise physicians to read the manual and be familiar with the security rule," said David C. Kibbe, M.D., director of the AAFP's Center for Health Information Technology.
Physicians would do well to conduct a risk analysis for their practices soon, a task made easier by using a comprehensive checklist available in the exhibits section of the manual, advised Kibbe. "It's important to identify the security risks in your information systems early on and learn how to eliminate those risks to become compliant with the security regulations in the future," he said.
You can download the 138-page security manual at http://members.aafp.org/members/cgi-bin/hipaa_security.pl in either a PDF or text format (the text format allows the user to customize the sample forms). The cost is $50.
 Source: National Ambulatory Medical Care Survey |
BY TONI LAPP
If it seems like you've been seeing fewer children in your office in recent years, it might be because you have: Children's visits to FPs numbered 32.5 million in 2000, down from 41.5 million in 1990, according to data from the National Ambulatory Medical Care Survey.
Meanwhile, pediatricians have seen a jump in visits by patients younger than 18.
Disturbed by this trend, the AAFP Board of Directors in August approved the establishment of the Task Force on the Care of Children by Family Physicians. The panel will include members of the commissions on Education, Health Care Services, and Quality and Scope of Practice. The Robert Graham Center in Washington will conduct an evidence-based study and analysis for the task force to use in its work.
Mark Johnson, M.D., of Newark, N.J., president of the Association of Departments of Family Medicine, in 2003 became aware of the drop in children's visits and brought it to the AAFP's attention.
"We were looking at this in relation to the Future of Family Medicine project and how we want the new model of care to look," he said. "I believe we want children in that model."
He learned that in the mid-1990s, 22 percent of children's medical visits were handled by FPs, which seemed apt. But then he learned that the percentage was declining. By the year 2002, the most recent for which National Ambulatory Medical Care Survey data are available, FPs/GPs recorded 16.6 percent of office visits by patients younger than 18.
What disturbs Johnson most is that he suspects some FPs are voluntarily choosing not to treat children, particularly in geographical areas where the ratio of subspecialists to primary care doctors is very high. "We are giving up parts of our practice that are normally within our purview," he said.
From an educational standpoint, it is becoming more difficult to give students interested in family medicine a complete education when more and more practices are treating only adults, he said.
In addition, patients' choices are narrowing. Johnson recalls the experience of a friend who became guardian of two nieces, 16 and 10, and tried to schedule their health visits.
"She went to an FP because she wanted total family care, but the office manager said they could take care of one, the 16-year-old, but not the other, the 10-year-old," Johnson said.
Why should patients care? Because studies show that FPs provide more efficient care -- requiring fewer visits and charging less money -- than pediatricians, and FPs' patients have better outcomes, says Norman Kahn, M.D., AAFP vice president for science and education.
For instance, even though FPs recorded 16.6 percent of children's visits as cited in the NAMCS data, 31.7 percent of children saw an FP/GP in 2002, according to the National Health Interview Survey. In other words, FPs/GPs tended to see more than one child in a single visit.
Such numbers will be taken into consideration by the task force, which will craft recommendations for the Board of Directors to consider in March 2005.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
The 2004 Congress of Delegates will act on two proposed amendments to the AAFP Bylaws when it meets Oct. 11 - 13 in Orlando, Fla. These amendments implement changes called for by the 2003 Congress:
• The first amendment proposes to change how certain constituency groups are represented in the Congress. Specifically, two delegates and two alternates would be seated in the Congress to represent the new physicians constituency, with no sunset date. Six delegates and six alternates would be seated to represent the other constituencies (not including new physicians) represented at the National Conference of Special Constituencies. Of these latter seats, no more than two delegates and two alternates could be elected from a single special constituency. These seats would sunset at the close of the 2010 Congress.
All special constituency representatives would be elected for two-year terms, with those elected serving their first year as alternate delegates and their second year as delegates. Special constituency representatives could serve a second two-year term, but no individual could serve more than four years total as a special constituency alternate and delegate.
• The second proposed amendment calls for changes to current Bylaws language pertaining to the specialty's name. In one instance, the term family practice of medicine and surgery would be changed to practice of family medicine; in all remaining instances, the words family practice would be replaced with family medicine.
According to the Bylaws Workgroup, which developed the proposed amendments, it should be noted that deleting the words and surgery from the first of these terms should help avoid misperceptions that the specialty of family medicine does not include surgery within its scope.
To view the proposed amendments, go to http://www.aafp.org/congress.xml and click on "Proposed Amendments to Bylaws of the 2004 Congress of Delegates." You'll need to log in using your member ID to access them.
And if you really want to get a jump on what delegates at this year's Congress will be considering, visit http://members.aafp.org/members/x10518.xml to check out resolutions submitted to date for consideration at the annual meeting. The Congress also will act on reports and recommendations from the Board of Directors, commissions and committees.
National Tar Wars winner announcedEthan Osborne, a fifth-grader from Sparta, N.C., was named the 2004 Tar Wars® national poster contest winner on July 22. As the national poster contest winner, Osborne receives a family trip to Disney World worth up to $3,000. The tobacco-free education program, which discourages tobacco use among the country's youth, is administered by the American Academy of Family Physicians. |
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Join Academy and chapter leaders at the annual State Legislative Conference Nov. 5 - 6 in Savannah, Ga. to discuss how state government actions affect family medicine. This year's conference will provide family medicine leaders with insights into post-election politics at the federal and state level. In addition, family physicians and chapter staff will exchange information about this year's legislative advocacy efforts. For quick online registration, go to the AAFP's state advocacy page at http://www.aafp.org/slc.xml. Questions? Call the AAFP's Washington office at (888) 794-7481. |
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Review your skills and update your knowledge regarding the care of your youngest patients when you attend AAFP's Infant, Child and Adolescent Medicine course Nov. 16 - 21 in San Francisco. Hear about the newest treatments and latest technological advances in topic areas including infant nutrition, obesity, disruptive behavior disorders, anemias, headaches, sleep problems and autism. Break out sessions include pediatric infectious disease, sports medicine, substance abuse, and asthma and allergies. This course may assist physicians who are planning to sit for the examination leading to a certificate of added qualifications in adolescent medicine and even offers an informal breakout session featuring physician tips on how to prepare for the CAQ exam. Go to http://www.aafp.org/x14363.xml to learn more and click on "Register" for easy online registration. Register by Oct. 17 for the discounted rate. |
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Take advantage of AAFP's customized personal digital assistant program offered by PDA Verticals. This company offers a variety of hardware devices as well as software that is built to order for family physicians. Visit with representatives from PDA Verticals during the Academy's 2004 Scientific Assembly Oct. 13 - 17 in Orlando, Fla. Representatives will be available Oct. 12 - 13 in the registration area and will be exhibiting Oct. 14 - 16 in booth 2067 in the Orange County Convention Center Exposition Hall. Questions? Call (800) 462-0388 or visit the Academy's PDA Web page at http://aafp.pdaorder.com. |
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Attention members in solo and small-group practice. The AAFP Practice Overhead Insurance Plan, underwritten by New York Life Insurance Co., can provide the cash necessary to keep your office up and running should you become totally disabled. It can pay staff salaries, rent, utilities, malpractice premiums and other expenses. This protection might make the difference between being able to return to work in your own practice and becoming an employee in another practice setting. Visit http://www.aafpins.com and scroll down to "Disability Income" for policy features, costs, eligibility, renewability, limitations and exclusions. |
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A shipping fee may apply; Kansas residents pay a 7.275 percent tax. |
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FP Report is published by the
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Copyright © 2004 by
American Academy of Family Physicians.
