FP Report - July 1998

FP Report -- July 1998

July 1998

Larry Green, M.D., makes a point during his Washington visit.

They HIT the HILL

WASHINGTON -- If you wanted just one word to describe this year's Academy visit to Capitol Hill, that word would be "timing."

Larry Green, M.D., head of the family medicine department at the University of Colorado at Denver, agrees.

"Congress' attention was clearly turned to tobacco during the visit, and no matter what our agenda was, people wanted to talk about tobacco legislation," Green said. "The bottom line is, the visits were uncommonly well-timed.

"Here was an issue important to the Academy that was also important to the Congress, and it was happening exactly as the visits occurred."

The visits to Congress, which have taken place annually for about the last two decades, allow the Commission on Legislation and Governmental Affairs, AAFP Board members and chapter representatives to "hit the Hill" and tell legislators what family physicians and their patients want. This year, some 40 family physicians and three chapter staff members paid visits to more than 75 congressional offices May 18-19.

"This year, we felt like we really made an impact. People are paying attention."

-- Larry Green, M.D.

AAFP Director David West, M.D., of Grand Junction, Colo., said the number of participants has doubled when compared with just two years ago. "That means twice as many legislative visits, for a bigger impact," he said.

Green said that this year, Congress was much more receptive to the Academy's push for the Agency for Health Care Policy and Research to receive a $50 million budget hike for research in family practice and other primary care areas -- a increase over AHCPR's current $149 million budget.

West welcomed the attention. "For several years, we've talked about the importance of family practice research," he said. "This year, we felt like we really made an impact. People are paying attention."

WONCA

AAFP to host 2004 meeting in Orlando

Celebrate the specialty with your international peers in 2004.

That's when the Academy will host the world conference of WONCA, the World Organization of Family Doctors.

The AAFP Scientific Assembly and the WONCA meeting will be held in tandem Oct. 13-17, 2004, in Orlando, Fla.

"The combined meeting will be an unparalleled opportunity for family physicians to take advantage of our Assembly offerings and the WONCA World Conference," said Daniel J. Ostergaard, M.D., AAFP vice president for education and scientific affairs. "We'll be able to learn from our international colleagues' research, from their experience educating their family physicians and from the ways they tackle their health care problems."

With an estimated 7,500 physicians expected to register for the AAFP meeting and 4,000 for the WONCA meeting, the event should be the largest gathering of family physicians in history.

The Academy won the bid to host the WONCA World Conference June 12, when the WONCA World Council voted in Killarney, Ireland, to head for America for its 2004 meeting.

Family Practice featured in Life

Family practice was highlighted in the cover story of the June Life magazine. The cover story, "Country Doctor," is a 10-page profile of family physician (and AAFP member) David Loxterkamp, M.D., of Belfast, Maine.

The profile includes 35 black-and-while photographs -- including the cover shot of Loxterkamp delivering a baby and another of him serving on the school board.

AAFP public relations staff provided the story's author with information about the specialty and a copy of the AAFP's 50th anniversary book, Caring for America: The Story of Family Practice.

Loxterkamp's story comes 50 years after a Life photo-essay by the same name, which spotlighted Ernest Ceriani, M.D., a general practitioner in Kremmling, Colo. Loxterkamp said he first saw that article at the age of 13, shortly after the death of his father, also a general practitioner. The pictures "gave him a window into his father's life and led him to become a country doctor himself," the 1998 story says.

News from Headquarters

See the exhibits, sights at Assembly

As you're scheduling your Sept. 16-20 Scientific Assembly courses, build in time to browse through the exhibits and see San Francisco.

Extend your learning beyond the CME classroom by talking with exhibitors. With more than 400 exhibits, the AAFP meeting boasts one of the nation's largest medical exhibit halls each year. Review your peers' research and get patient education tips at the scientific exhibits, open 8 a.m.-5 p.m. Sept. 16-19. Check out the latest in medical equipment, drugs and publications at the technical exhibits, open 8 a.m.-5 p.m. Sept. 17-19.

While you're at the Assembly, don't miss San Francisco! Take a tour with your family or guests, such as 7:30-9:30 a.m. walks and half-day tours of the city and the bay, area landmarks, Alcatraz and art museums.

The four-day youth program will take your kids cruising on the bay, exploring Marine World Africa USA, learning math and science via hands-on experiments at the University of California at Berkeley, sighting sharks at UnderWater World and studying earthquake safety at SAFEQUAKE.

You probably received the Assembly brochure and registration materials last month. See your brochure for CME opportunities, Assembly entertainment and specifics about seeing the sights in San Francisco.

Available on AAFP Express

Call the AAFP Express toll-free number -- (800) AAFP EXP [223-7397] -- and supply your AAFP ID number to have selected materials sent almost immediately to your fax machine for free. Some documents available:

Description of Document
Document #

Weekly "Washington Update" 8009

Order form for Buckle Up America! action kit 9000

Fundamentals of Management application 8000

NCFPR/NCSM information sheet 2011

Applications for scholarships and grants for the Conference on Patient Education 7003

Information and registration forms for:

ALSO (Advanced Life Support in Obstetrics) Instructor's Course

Sept. 15, San Francisco 2015

Geriatric Medicine

Oct. 15-18, Scottsdale, Ariz. 2002

Infant, Child and Adolescent Medicine

Oct. 28-Nov. 1, Portland, Ore. 2012

State Legislative Conference

Nov. 13-15, Hilton Head, S.C. 8001

Sports Medicine: An In-Depth Review

Feb. 8-14, 1999, Kansas City, Mo. 2000

Register for this year's Assembly online

Welcome to a new way of registering for the AAFP Scientific Assembly: online.

The Assembly is Sept. 16-20 in San Francisco, and the sooner you register, the better your chance for getting courses you want.

Perhaps you'd like to register your guest for courses and build your own CME schedule. Access www.aafp.org/assembly on the web, open the registration area and select items from three categories: free educational events, extra-fee educational events and family activities. You can search for sessions by topic and date, and your schedule will balk if you try to double-book yourself, a common mistake of participants who register on paper.

Use your VISA or MasterCard and submit your materials electronically. After the Academy processes your general registration form and request for extra-fee sessions, you'll receive final confirmation by mail for the courses you selected that aren't already full.

One added step for those registering a child for the youth program: Mail or fax to the Academy your signed waiver for your child's emergency medical care. The Academy will process your Assembly registration after receiving your signed waiver.

Don't wait to register. The cutoff for advance registration is Aug. 12; after that, you need to register on-site.

ACF materials are on the World Wide Web

Materials covering the AAFP's Annual Clinical Focus have been posted on the Academy's World Wide Web site.

Link to it from either the What's New page at http://www.aafp.org/whatsnew.xml or from the Clinical and Research page at http://www.aafp.org/clinical.html.

The ACF was launched at the 1997 Annual Scientific Assembly in Chicago and is designed to bring members state-of-the-art information on a specific disease state.

Get the scoop with the Congress of Delegates Handbook

To see what issues the Academy and its chapters are debating, order the 1998 Congress of Delegates Handbook.

The handbook will contain commission and committee reports to the Congress, plus resolutions from chapters, residents, students, and special constituencies such as women, minority and new physicians.

Copies of the handbook will be sent free to delegates, alternates, AAFP commission and committee members, and chapter presidents and executives about a month before the Sept. 15-17 Congress in San Francisco. Others may order the handbook for $35 by calling Phyllis Dolen in the Research and Information Services Division at (800) 274-2237, Ext. 2312.

A reminder: Whether you have the handbook or not, you're welcome to attend the Congress and speak your mind during the reference committees.

Don't hang up! That call could be from a relay user

Have you or someone on your staff received a call lately that sounded more like a telemarketer than a patient? It could have been a relay operator calling for a patient with a hearing or speech disability through your state's telephone-interpreter service.

With the system, a hearing- or speech-impaired person using a text telephone contacts a relay operator. The operator receives the strictly confidential messages typed verbatim from the caller. Then the operator tells the third party what the typist wrote. The telephone relay system is available 24 hours a day, every day.

Some users of the interpreter system, also known as relay, say 10 percent of the time the person receiving the call hangs up because he or she doesn't understand what's going on.

"I've had stories of people having to drive 30 miles to their physician to make an appointment because they couldn't get through with a telephone call," said Gary Smith, with the Better Business Bureau Consumer Education Foundation, Austin, Texas, who's working nationally to get the word out about relay systems.

Family physicians or their staffs interested in learning more about their state's relay service can call (800) 949-4232 or fax a request to (512) 445-2096. A request can also be e-mailed to gary7@ix.netcom.com.

Fit CME into your schedule

For information on these meetings, use AAFP Express (see "Available on AAFP Express").

20th Anniversary Conference on Patient Education.
Conference founder John Renner, M.D., of Independence, Mo., will keynote this Nov. 19-22 meeting in Orlando, Fla. It will offer nearly 100 CME options, including computer sessions.

State Legislative Conference.
This Nov. 13-15 meeting at Hilton Head, S.C., can help you defeat or defend bills in your state. The conference will feature a managed care forum and examine scope-of-practice issues.

Infant, Child and Adolescent Medicine for the Family Physician.
This Oct. 28-Nov. 1 meeting in Portland, Ore., will address topics ranging from common neonatal problems to date rape.

Geriatric Medicine for the Family Physician.
Attend this Oct. 15-18 meeting in Scottsdale, Ariz., for an update on assessment, pharmacology, ethical dilemmas, depression and other geriatric issues.

Sports Medicine: An In-Depth Review.
To expand your skills and perhaps prepare for an exam for a certificate of added qualifications in sports medicine, attend this meeting Feb. 8-14 in Kansas City, Mo. 1999 is the last year you can qualify for the CAQ exam via the practice category route (later, a fellowship is required). Call the American Board of Family Practice at (888) 995-5700 for the exam application, which is due Nov. 1. The submission deadline for CME credit is March 1; the exam is April 16.

Tobacco control bills

AAFP lobbies vs. Senate amendments, in favor of House bill

At press time, senators were siphoning off funds for public health as they tacked amendments onto S. 1415, the National Tobacco Policy and Youth Smoking Reduction Act.

AAFP Board Chair Patrick Harr, M.D., of Maryville, Mo., objected. "Recent passage by the Senate of amendments offered by Sen. Paul Coverdell, R-Ga., to increase funding for drug interdiction efforts and Sen. Phil Gramm, R-Texas, to reduce the 'marriage penalty' (in income taxes) has greatly reduced funding going to public health programs," Harr said in a mid-June letter to all senators. "The Academy urges you to restore funding in S. 1415 for public health programs before final passage on the Senate floor."

Harr's letter reflected the Board's unanimous vote during its April 28-30 meeting that revenues from tobacco legislation should be used for public health programs, specifically tobacco-related programs, and for primary care research at the Agency for Health Care Policy and Research.

Last month the Academy also wrote all members of the House of Representatives, asking them to support H.R. 3868, the Bipartisan NO Tobacco for Kids Act. It was introduced by Reps. James Hansen, R-Utah; Martin Meehan, D-Mass.; and Henry Waxman, D-Calif.

H.R. 3868 contains virtually all of AAFP's five criteria for comprehensive tobacco legislation: strong steps to end tobacco use by children and reduce tobacco use by adults, with real timetables and penalties; full disclosure of all documents related to the harmful effects of nicotine; no immunity for tobacco companies from individual or class action lawsuits; and unrestricted authority for the Food and Drug Administration over all tobacco products.

Wanted: community preceptors!

The future of the specialty depends on medical students who decide to follow today's family physicians into family practice. And currently, there's an urgent need for more community family physicians to serve as preceptors, to teach students "real-world" knowledge that can't be learned at medical school.

As a preceptor, you can help students ranging from newcomers learning basic history-taking and exam skills, to senior students planning to enter family practice residencies and needing more hands-on clinical experience.

What's in it for you?

Take AAFP President Neil Brooks' word for it:

"You can share the incredible rewards that come from being a mentor and role model, and give back to the medical profession by shaping the attitudes and the knowledge base of those who will care for your patients in the future."

AAFP President Neil Brooks, M.D.

MYTH:
I don't have enough worthwhile information to teach.

FACT:
Students desperately want and need the information that only you may be able to provide. They need to see all aspects of patient care, from your rapport with patients, to your management of common problems, to your use of referrals and community services, to your running of an office practice.

Call your local family medicine department, family practice residency or constituent chapter office for more information about preceptor opportunities in your area.

American Academy of Family Physicians
The doctors who specialize you

News from Washington

Call to action

Tell HCFA: Practice expense payments need to be truly resource-based

Last year, the Health Care Financing Administration proposed a way to pay physicians for their resource-based practice expenses. Unfortunately, last month HCFA dropped its 1997 Medicare proposal and issued a poor substitute.

Shifting sands of HCFA proposals

How changes in practice expense payments may affect overall Medicare payments

Specialty
June 1997 proposal*
June 1998 proposal*

Family practice
General practice
Obstetrics/gynecology
Internal medicine
Emergency medicine
Neurosurgery
Thoracic surgery
Cardiac surgery

12%
9%
4%
3%
-2%
-21%
-28%
-32%

6%
3%
5%
1%
-13%
-10%
-13%
-14%

* Percentage changes from 1997 payments, using the "bottom-up" approach.

** Percentage changes from 1998 payments, using the "top-down" approach. These changes incorporate the "down payment" whereby primary care providers are receiving an advance on gains expected under full implementation of changes related to resource-based practice expenses.

The Academy is concerned and asks you to take action.

First, some background. In 1994, Congress asked HCFA to develop a way to pay physicians for their resource-based practice expenses -- real costs for equipment, administrative overhead, staff -- instead of paying for practice expenses based on physicians' traditional charges for services.

HCFA's 1997 proposal appropriately went "from the bottom, up" in estimating actual costs. It projected substantial increases for primary care services and sizable cuts for other services (see the chart). By law, the changes must maintain budget neutrality.

To moderate the increases and decreases, on June 5 HCFA published a new proposal in the Federal Register. It operates "from the top, down" in setting practice expenses based on total current practice costs. The new proposal extends inequities in traditional fees and is similar to one proposed by subspecialty groups fighting the 1997 proposal.

Here's an example of the imbalance in the 1998 proposal: A family physician would have to conduct 40 mid-level, established-patient office visits to generate the same practice expense payments as a cardiac surgeon performing one coronary bypass surgery with three venous grafts. The surgeon's payment is high, even though the hospital bears most practice expenses associated with the surgery.

Time to act: The new proposal ignores Congress' directive for covering resource-based practice expenses. The Academy asks you to join it in calling HCFA to task. Here's how:

If you wish, read the new proposal at www.access.gpo.gov online or in the June 5 Federal Register in your local library.

Read sample letters the Academy has drafted, available at www.aafp.org/gov online.

Write your own letter to HCFA, Department of Health and Human Services, Att.: HCFA-1006-P, P.O. Box 26688, Baltimore, Md. 21207-0488. Note that resource costs for evaluating and managing many types of illnesses may well exceed costs for subspecialty care.

Send your members of Congress a copy of your letter.

OIG finds most physicians' Medicare coding OK

The Office of the Inspector General gave the Academy some welcome news last month: The vast majority of physicians are correctly coding for Medicare reimbursement.

When there's a coding problem, it's almost always because the physician has given little or no explanation for the coding. For example, the physician may simply note that a patient is "stable" while coding the visit as very complex.

Several AAFP and OIG staff members met June 10 to discuss the OIG chief financial officer's audit of the Health Care Financing Admin- istration's finances and how Medicare carriers process claims. The audit did not aim to detect fraud but to identify problems in the processing system.

One result of the audit: The OIG will keep urging carriers to interpret HCFA's instructions uniformly, instead of having variation in how carriers implement rules.

If you know examples of wide variations in how carriers follow HCFA's instructions, contact Michele Johnson in the Academy's Washington Office at (888) 794-7481.

Reader's Forum

Why legislate laws for social responsibility?

To the editor:

I am very concerned where our country and the AAFP organization are heading. Why must we legislate laws for social responsibility? This current trend against the tobacco companies is just the beginning! What's next? (Legislation holding) auto makers responsible for "gas guzzlers" or SUVs as they are too dangerous on the road, and in accidents they cause more damage to little cars.

Our country was founded on the belief of rugged individualism, that people can think independently and have the ability to make decisions and be responsible for them. This attack on legitimate businesses in this country is un-American. It's very disingenuous and dishonest that President Clinton and most of the legislators say they are doing it for the children, when in fact this current anti-tobacco legislation is just a ruse to collect money from a legitimate industry to pay for social programs. The intent is not to get children or adults to quit smoking but to collect more taxes for more spending programs. If one wants to end smoking, then ban tobacco from U.S. markets like it was tried with alcohol during the Prohibition Era.

As with alcohol then, people would still find a way to smoke as they would do now, even with increased taxation.

There are already laws on the books not being enforced against minors purchasing, possessing and using tobacco products. What good does it do to pass more laws when society doesn't obey the existing ones? Our nation needs to return to the idea that made this country -- that people are responsible for their own actions. As I teach my children, you make choices all through life and then you have to live with the consequences. I have stood in grocery store lines watching parents buy cigarettes and then handing them to their child right in front of the clerk. What good does it do when the parent supports teenage smoking? You are told to mind your own business if you talk to them. As a physician, I tell every patient who smokes about the dangers of smoking and that they should quit, but I leave it up to them to make that choice. It's their responsibility, not ours, to quit smoking. Legislation through taxation is not going to make a difference, nor do I believe that was ever the intent anyway.

RICHARD OLSON, M.D.
Bemidji, Minn.

'I hope this special section encourages residents to do OB'

To the editor:

Thanks so much for the special section, "Family-Centered Maternity Care," in the March edition of FP Report.

I hope it will encourage residents to include obstetrics in their practice. When I started practice in a rural area in 1988, there was one obstetrician in town. In my second year of practice, that obstetrician died suddenly. I became the only doctor delivering babies in a three-county area. In 1992, I was able to receive training and privileges to perform Caesarean sections.

The word family is derived from the Latin word famulus, which means servant. As family physicians, I hope that we can continue to be servants for those who need us the most.

OSCAR F. LOVELACE JR., M.D.
Prosperity, S.C.

FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.