January 1999
News for members of the American Academy of Family Physicians
Raymond Bargas takes a deep breath for Tillman Farley, M.D., who blends research and practice in Brighton, Colo. Farley won an AAFP research grant last year. (Photo by Jane Stoever/AAFP)
Say 'Aaah!' to research
AAFP initiative makes research stronger focus for specialty
The Academy launched its five-year, $7.72 million research initiative in 1998, and the specialty's researchers are responding with enthusiasm, energy and creativity.
The Task Force to Enhance Family Practice Research thought it might get 20-30 applications for AAFP's three up-to-$900,000 grants for research centers. Instead, 66 centers applied.
The task force figured 50-60 family physicians might request training grants for up to $100,000 to advance their research skills, but 102 applied.
"The research fires are burning," said task force chair Joseph Scherger, M.D., M.P.H., of Irvine, Calif. "We're just providing more lighter fluid."
Family practice has continually improved its patient care and education of future FPs, said Scherger.
"Our one underdeveloped area is research," he said. "We're vulnerable to health systems that want documentation of our effectiveness. We're vulnerable to our specialty colleagues who say they should take care of problems such as asthma and diabetes."
In September, the Academy held a press conference to announce its three newly designated research centers. The university-based researchers work in Ohio, Nebraska, New York, Pennsylvania, Michigan and Missouri.
"The AAFP is putting its money where all of primary care has been putting its collective mouth," said John Eisenberg, M.D., director of the Agency for Health Care Policy and Research, at the press conference.
In October, the Academy selected eight individuals for its first cycle of advanced research training grants.
"Too many doctors in private practice neglect research because the office is so hectic, and academicians neglect the practice side of things," said grant recipient Tillman Farley, M.D., of Brighton, Colo. "Actually, you can think of every practice as a lab."
Farley belongs to the Ambulatory Sentinel Practice Network, founded in 1978 as the first U.S. practice-based research network. With his grant, he'll take courses and track risk factors for mental health problems. He believes every patient visit has a psychosocial component.
"In ambulatory care, nobody goes to the doctor until their stress level is such that going is better than not going," Farley said.
His predominantly low-income, minority patients will be part of his research; he hopes to find ways to prevent mental health problems in such populations, based on his research.
Task force member Barbara Yawn, M.D., M.Sc., of Rochester, Minn., chaired a meeting on practice-based research networks in September. At the meeting, representatives of academic centers, large and small practices, managed care organizations, federal agencies and the pharmaceutical industry agreed that practices provide the best sites for studies that translate evidence into real-world patient care.
The task force found that some 6,000-8,000 FPs belong to practice-based research networks. "That's a large number of family physicians doing research as they practice," Yawn said. "We're excited about it!"
By Jane Stoever, Managing Editor
On tap in 1999, 2000
Through the research initiative, the AAFP will:
- award advanced research training grants,
- issue a request for proposals for research within managed care organizations,
- stimulate research in practice-based research networks, and
- hold a national meeting on primary care research, a gathering of family physicians and representatives of foundations and federal agencies.
"We're after research that matters, that makes a difference to how we care for patients."
-- Joseph Scherger, M.D., M.P.H.
Members give Academy high marks
Members are upbeat about the Academy, and AAFP membership is on the rise.
In the seventh annual "satisfaction" survey, members gave the Academy high marks in 1998. For example:
- 78 percent of the 495 survey respondents said the Academy is doing a good job representing family practice to the rest of organized medicine and to the public and patients,
- 69 percent said the Academy is doing a good job representing the specialty to the government,
- 84 percent gave the Academy a positive rating compared to other medical organizations and
- 93 percent of surveyed members who contacted the AAFP within the past two years were satisfied with the accuracy and thoroughness of the response.
On questions about income and regulatory hassles, however, many replies were disheartening. Four in 10 respondents did not agree with the statement, "I expect to make more money from my practice this year than last year." And 93 percent said outside regulations and rules made it difficult to practice (see E/M guidelines story).
Membership figures fluctuate through the year, with the annual benchmark being the Dec. 31 total (see chart). The 1998 end-of-year total--87,852--was a record.
AAFP members* 1970 31,338 1980 50,237 1990 71,401 1995 80,147 1996 83,017 1997 85,674 1998 87,852 *Dec. 31 totals
Too many uninsured --
'Inexcusable'
-- AAFP President Lanny Copeland, M.D.
South Georgians have a name for the very ill: the "low sick."
As more Americans go without health insurance, they become the low sick, said AAFP President Lanny Copeland, M.D., of Albany, Ga.
"Family physicians are the catch-net. We're often the first to see the uninsured," said Copeland. "They have illnesses that they've just not attended to. They're much sicker than they should be. And they require more of our time."
An estimated 16.1 percent of Americans are uninsured -- about 43.4 million people, the highest number since 1992. More people are employed, don't qualify for Medicaid and have no health benefits through their work.
"It's not just the small companies that don't provide health insurance," said Copeland. "My nephew worked for a huge airline. It played the game quite nicely, keeping him under 30-35 hours of work each week so it didn't have to pay his health benefits."
At the AAFP Annual Assembly last fall, Copeland called on the Academy to champion universal coverage again, as it did in 1989-1994.
"In the past, many physicians donated their time to care for the indigent, but with market-driven changes, less time is available to serve this population," said Copeland. "Politicians do not want to take a stand as to how to fund universal coverage. This is an ethical dilemma, one that must be solved."
The AAFP is recommitting itself to universal coverage. Here's how:
- The new Task Force on Universal Coverage, chaired by Copeland, will examine AAFP's current policy on how to secure health insurance for all Americans. The task force will consult with experts and make recommendations to the AAFP Congress of Delegates this fall.
- The AAFP, AMA, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians/American Society of Internal Medicine and American College of Surgeons are studying ways to work together for universal coverage.
"It's inexcusable that we allow so many people in our country to be uninsured," said Copeland. "Too often, the ones that can't pay or aren't insured get weaned away or turned away from our health care system."
During the past two years, Copeland visited Canada and New Zealand and found that even though they insure their entire populations, the countries are urging people to buy supplemental insurance. Copeland suggested the United States might move toward universal coverage with a somewhat privatized system, allowing physician input through an oversight commission.
"In the future, there may be a blend between what we now have and what other countries have, and health systems in various countries may look much the same," said Copeland.
He added, "We've got to come to grips with one thing: We have infinite needs and finite resources."
Policy center opens soon in Washington
AAFP's Center for Policy Studies in Family Practice and Primary Care will soon be a reality.
Early last month, the Academy leased space for the policy center next door to AAFP's Washington office.
"In 1999, we've got to assemble our staff, appoint an advisory committee, and establish working relationships with the health policy community in Washington and with kindred spirits outside D.C., including practice-based research networks and AAFP's three newly designated research centers based at universities," said Larry A. Green, M.D., the policy center's director.
"By mid-1999, we should be ready to work -- to start investigating questions and responding to policy issues," Green said.
He will chair the family medicine department at the University of Colorado in Denver until June 1. Then he'll take a two-year leave from the CU faculty to direct the policy center full-time.
He's already asked several hundred family physicians and others, "What's the most important policy issue facing primary care today?"
Many replies revolved around the scope of practice. For example: In the future, will family physicians admit patients to hospitals? What's the primary care provider's role in hospice care?
The center will provide a family practice perspective to policy deliberations in the nation's capital. It will also conduct research to support the development of and advocacy for AAFP policies.
Chapters declare victory with legislative efforts
The Academy's constituent chapters play a key role in state legislative activities. Here are some "success stories" from across the country.
Georgia -- Rather than trying to reach all state legislators, the Georgia AFP targeted a group that already shares some common ground -- the Georgia Women Legislators' Caucus. The chapter formed an alliance with the caucus and holds annual meetings for caucus members and female FPs to discuss health issues, said Tanya Jones, M.D., of Atlanta, the chapter's board chair.
The meetings have led legislators to call on the chapter for guidance on health care concerns. For example, "We got called in when they were trying to make decisions about pharmaceutical formularies for Medicaid," Jones said. "There was an effort to push through some bad choices, but we were able to quash it because we had relationships with some of the legislators."
Oklahoma -- When a patient confidentiality bill at the statehouse threatened to jeopardize medical research, the Oklahoma AFP took action. At first, the bill looked innocuous, but upon further inspection, the chapter realized the bill would significantly restrict research by preventing access to patient records, said OAFP Executive Director Sam Blackstock. The chapter convinced the authors to remove the language of concern and proceed slowly with any bill that could curb research efforts.
"Once the bill's authors talked with a few of our members, they were able to understand the issue," Blackstock said.
Illinois -- Without a political action committee, the Illinois chapter didn't have the funds or the clout to get involved in the governor's race last fall, said Gordana Krkic, the chapter's vice president for government relations. But the chapter was able to be a player in the lieutenant governor's race.
The candidate, Corinne Wood, a former state legislator, had been receptive to the chapter's input on the definition of primary care and the impact of managed care reform on rural health. Her successful run for the lieutenant governorship was the first statewide race supported by the Illinois AFP.
The chapter held a small reception/fund-raiser, and 16 FPs attended. "She was very impressed and appreciative that so many physicians showed up," Krkic said. "What family physicians say to a legislator speaks volumes more than I or another lobbyist could ever say."
Maryland -- Realizing that family practice was getting little respect from the state medical society and lawmakers, the Maryland AFP joined forces with internists and pediatricians to form the Maryland Primary Care Coalition. "We may come down on opposite sides of some issues, so on those, we go out on our own," explained William Jones, M.D., of Davidsonville, the chapter's board secretary. "But when we agree on an issue, we now have 5,000 doctors behind us."
The coalition helped defeat a direct access bill last year.
"Now the state medical society calls us whenever there's a primary care issue," said Jones.
New York -- Family physicians in New York were good at articulating issues, but didn't always have a good grasp on the political process. So the New York State AFP launched the Health Policy Conference, held in conjunction with its fall cluster meeting, said Vito Grasso, executive director. The conference -- which attracted 75 physicians last year -- educates current and emerging FP leaders on politics and lobbying.
"In order to entice people to participate in legislative activities and lobbying, you have to create a friendly environment for them," said Grasso.The conference uses family physician moderators to elevate members' comfort level.
Michigan -- Over the last three years, the Michigan AFP has made a concerted effort to increase its visibility with state lawmakers. The payoff so far includes passage of an aggressive patient rights act, advancement of an acceptable nurse practice act and a $40,000 grant to work with other agencies on a statewide tobacco control plan.
Getting physicians to testify at the statehouse, meet with newspaper editors and participate in other legislative activities is a surefire strategy for getting noticed, said Mary Elizabeth Roth, M.D., of Southfield, the chapter's immediate past president. "If we want to be heard as family physicians, we have to do the legwork, the paperwork, writing the testimony."
By Sharon Dickinson Dent,
Associate Editor
"We should do the work
ourselves. We can't depend
on others to do it for us."-- Mary Elizabeth Roth, M.D.
'98 education wrap-up
- An all-time-high number of family practice residents graduated -- 3,328.
- Some 2,814 applicants matched with family practice residencies in March 1998 (compared with 2,905 who matched in 1997). By last July 1, however, the specialty had a record 3,575 first-year residents, five more than in 1997.
- AAFP's revised recommendations for the health care workforce call for 35.1 M.D. family physicians per 100,000 Americans and 7.9 D.O. family physicians per 100,000 Americans by 2015. These recommendations are somewhat higher than AAFP's 1995 recommendations.
- New core educational guidelines for residents cover end-of-life care and care of infants and children.
- The Academy decided to increase its international activities, given the urgent need for family medicine in many underdeveloped countries.
Survey results: ACF works
Two years ago, the Academy decided to shower its members with CME on a different topic each year.
The campaign, the Annual Clinical Focus, aims to give members state-of-the-art skills and provides patient handouts.
The first ACF, in 1998, zeroed in on preventing, diagnosing and treating cardiovascular disease. Supported by more than $2 million from pharmaceutical companies, the ACF sprouted videos, monographs, lectures and patient education handouts.
On the question of whether family physicians are updating their skills because of the ACF, the jury's now in.
The verdict: The ACF works.
Members listed their confidence levels on 10 items related to cardiovascular disease, before the ACF and toward its completion. About 1,100 members returned the October 1997 survey before receiving ACF materials; 277 members completed the survey in November 1998. The 1998 survey showed improvement on all 10 items (see chart).
Members also noted changes they'll make thanks to their ACF CME, such as treating hyperlipidemia more aggressively; regularly encouraging smoking cessation, daily exercise and proper diet; and using more ACE inhibitors and beta blockers.
The 1999 ACF, aimed at preventing and treating complications of diabetes, debuted at the 1998 AAFP Scientific Assembly.
Check out the ACF web page at http://www.aafp.org/acf for information on ACF offerings.
New products, services support your practice
Electronic CME options, an E/M documentation guide and patient education brochures -- these are some of AAFP's resources developed in 1998 that can help you and your practice.
A fee for shipping and handling may be added to the member prices listed below, and Missouri residents pay 6.6 percent sales tax.
1998 ACF. The 1998 Annual Clinical Focus on the Prevention and Management of Cardiovascular Disease featured condition-specific learning tools. An information sheet listing the products is available, item #R583, free. The latest offering is a CD-ROM reproducing key elements of the program, item #R585, free.
HIV monograph. The AAFP Home Study Self-Assessment program is offering the monograph HIV Infection for $25 to all who request it. The monograph provides treatment information and may be used to obtain five hours of Prescribed credit, item #R291.
E/M documentation pocket guide. A handy pocket guide will help you follow Medicare's documentation guidelines for evaluation and management services. The pocket guide (item #R557), developed by Family Practice Management, costs $5.
Physician-sponsored networks guide. Are you thinking about developing or entering a physician-sponsored network? If so, request the AAFP's "Preamble and Guiding Principles for Physician-Sponsored Networks." It covers topics such as optimal health outcome for patients, family physicians' expertise in managing care and their focus on preventive health, clinical autonomy for network physicians, and the need for PSNs to demonstrate their value in order to obtain contracts with health plans, item #R737, free.
Colposcopy privileges. A new AAFP position paper, "Colposcopy by Family Physicians," is geared to helping FPs gain privileges. The paper reviews scope of practice, notes indications for colposcopy, and discusses training, proof of proficiency and privileges, item #R732, free.
Hospitalists. An informational statement prepared by the AAFP outlines the major issues of concern about the hospitalist issue and steps to address them, item #R718, free.
Assembly CD-ROM. You can obtain CME via a CD-ROM presenting some of the top main-stage lectures from last year's Assembly. "Lecture Highlights of the 1998 AAFP Scientific Assembly" is approved for up to 10 hours of Prescribed credit, item #R028, $99.
Greeting cards. The AAFP Foundation is selling holiday and all-occasion cards featuring paintings by A. Earl Mgebroff, M.D., of Yoakum, Texas. Cards can include messages or be purchased blank. Funds from the sale of the cards will go toward foundation programs. "Church" holiday cards, item #R650; "morning" holiday cards, item #R653; "all occasion" cards, item #R656, each box $20.
Academy Collection reference books. Primary care reference works, written by and for practicing FPs, are available for $24.95 each. The 10-volume set can be purchased as a unit for $199. Books already published are: Office Procedures (item #R590), Office Procedure Forms (#R591), Challenging Diagnoses (#R592) and Conditions of Aging (#R593). Over the next two years, six more titles will be added: Musculoskeletal Pain, Occupational/Environmental Medicine, Endocrine Disorders, GI Problems, Children's Health and Skin Disorders.
Patient education handouts. The revised CD-ROM "AAFP Patient Education Handouts" contains about 300 brochures, the Tar Wars coloring sheets and curriculum, teen-oriented brochures and "Let's Eat" nutrition sheets, with all material in English and Spanish, item #R1598, $175.
Colposcopy self-study. The new self-study CD-ROM program "Colposcopy for the Family Physician" includes a syllabus, video and audio instruction, a photo atlas, searchable text documents and an interactive test. It is approved for up to 11 hours of Prescribed credit, item #R293, $110.
Video CME. New video programs cover the following areas, with each program approved for one Prescribed hour and costing $17.95: Alzheimer's disease, item #R1800; chronic viral hepatitis, item #R1806; seasonal allergic rhinitis, item #R1809; macrovascular complications of type 2 diabetes, item #R1812; treatment of type 2 diabetes, item #R1815; and prevention of complications of type 2 diabetes, item #R1818.
Audio CME. Packages from recent AAFP courses cover the following content areas (also listed are the Prescribed hours you may earn, order numbers and prices): family-centered maternity care, 20.75 hours, item #R182, $295; and women's health, 25.5 hours, item #R294, $295.
Community presentations. Do you plan on telling elementary school children what it's like to be a family physician? The AAFP's elementary activity packet can help. It contains fun and educational games as well as a box of crayons, item #R204, free. You can also explain family medicine to students bound for college or medical school with the "Take Another Look at Family Practice" brochure, item #R184, free.
FMIGs. Want to help a medical student leader start a family medicine interest group? There's some step-by-step assistance in the Family Medicine Interest Group Manual, item #R103, free.
HIV Consultation. A free telephone consultation service offers a wealth of HIV information to FPs and other health care providers at (800) 933-3413.
Kit on breastfeeding. The Physician's Breastfeeding Support Kit contains guides and patient education information, item #R926, free. Resource packets. Resource packets will help you prepare for exams to earn certificates of added qualifications. Both the geriatric resource packet (item #R179, $35) and the sports medicine packet (item #R221, free) contain information about AAFP-sponsored and approved courses and materials along with bibliographies.
Computers. If you're planning to purchase or update your computer system, AAFP publications can help you make your decision. The Directory of Software Vendors for Group Practice lists and reviews software from hundreds of vendors, item #R9546, $84. The monograph How to Select a Computer System for a Family Physician's Office provides a step-by-step approach to going digital, item #R603, $10. The monograph comes with a free supplement, "Family Physicians and the Year 2000: Preventive Medicine for the Millennium Bug."
You can request these resources -- unless otherwise noted -- by calling the AAFP order department at (800) 944-0000.
Assembly sets record; Fellowship rules change
The AAFP celebrated its 50th Scientific Assembly in 1998, and a record number of physicians attended the party.
More than 7,000 physicians -- 7,323 to be exact -- took advantage of the CME and exhibits available at the Assembly in San Francisco in September.
Total registration in San Francisco also set a new record: 20,646 attendees, including physicians, vendors and presenters.
Also during the 1998 Assembly, the largest number of family physicians in 15 years received the AAFP degree of Fellow during the Fellowship Convocation.
Requirements for earning the degree changed Jan. 1. Now, applicants need a total of 100 points representing accomplishments in areas such as academic training and CME, publishing and research, volunteer teaching, public service, practice experience and/or service to the specialty.
Initiatives aim to curb youth violence, smoking
The media violence program educates parents and children about the feelings generated by violent television, movies and video games -- and how those feelings can translate into unruly behavior. For information on presenting the program, call Joyce Haas at (800) 274-2237, Ext. 5540.
Tar Wars, the AAFP's tobacco-free education program, reached an estimated 325,000 youngsters in 48 states and six foreign countries during the 1997-98 school year. The program emphasizes the short-term effects of tobacco use and teaches children to identify tobacco marketing strategies.
Tar Wars pencils, pens and book covers, as well as information on presenting the program, are available by calling (800) TAR-WARS. The curriculum, mousepad and clothing items are offered in the AAFP catalog, accessible at https://secure.aafp.org/cgi-bin/catalog.pl online.
AAFP/Chapter Relations Initiative shines at one year
The first year of the AAFP/Chapter Relations Initiative isn't quite summed up yet, but preliminary results are telling.
The initiative -- which features leadership development, peer-based assistance, revenue sharing and teamwork -- distributed $96,385 to constituent chapters in 1998. Every chapter received some amount of money (based on attendance and participation in certain Academy meetings and programs).
But that's not all.
The initiative also made computers available to the 25 constituent chapters requesting computers and set up a "template" for a chapter World Wide Web page. Forty-three chapters now participate in the chapter executives listserv, and 48 have a web page.
The initiative has also scheduled nine leadership training "road shows" for 1999 and has completed the first section of the new AAFP Directory of Resources for Chapters. The rest of the directory was being finalized at press time.
In addition, the Chapter Assistance Program brought 11 chapter executives to a December meeting where they were trained to serve as consultants to other chapters.
The Academy's Chapter Affairs Committee guides the initiative, with the intent to enhance AAFP/chapter communication and teamwork.
AAFP web site booms
Activity on the Academy's World Wide Web site grew significantly in 1998.
An all-time-high monthly usage record was set in November, when about 135,000 users visited the site. A single-day record was set on Nov. 10, when 6,244 users accessed www.aafp.org for one reason or another.
Among the possible reasons: A slew of new offerings, such as clinical quizzes from American Family Physician. Those who visit http://www.aafp.org/afp/afpquiz.html can take the online clinical quiz, check their answers electronically, review the related article and then report the quiz for CME credit. (CME quizzes from Family Practice Management can be found at http://www.aafp.org/fpm/fpmquiz.html on the Academy's web site.)
Another draw to the web site: AFP and FPM are online in entirety, including patient handouts.
In addition, CME hours can be reported online. About 1,700 members used that feature in November.
For the latest in AAFP news, you can read FP Report and Directors' Newsletter on the web site.
FPM turns five, adopts new look
Family Practice Management is five years old and, with the January issue, is sporting a new look. "The new FPM will have more to offer to all family physicians," says Robert Edsall, FPM's editor-in-chief.
The new design, geared to easier reading, includes a greater variety of shorter articles, highlighted key points, a new logo and cover, and new departments, with excerpts from a solo physician's journal and information on computers and patient care.
Academy plays active role at AMA interim meeting
AAFP seeks coverage of people with diseases since childhood and requests reconsideration of ethical stance
Here are highlights from the Dec. 6-9 interim meeting of the AMA House of Delegates in Honolulu:
The AAFP joined 16 other medical societies in asking the AMA to work for affordable health insurance coverage for adults with congenital illnesses and/or diseases they've had from childhood. Coverage for this group, while an incremental change, is wholly consistent with AAFP's strategy for universal access. The resolution was referred to the AMA Board of Trustees.
The AAFP asked AMA to reconsider its stance allowing use of data from unethical, egregious experiments if no other data exist and human lives would otherwise be lost. The house had received for information the AMA Council on Ethical and Judicial Affairs opinion on such data, which was based on CEJA recommendations approved by the house last June.
At AAFP's request, the opinion was referred to a reference committee at the interim meeting, and AAFP Board Chair Neil Brooks, M.D., of Rockville, Conn., spoke about the Academy's concern. He testified that last September, the AAFP Congress of Delegates voted for the first time to have AAFP differ from AMA on a principle of medical ethics. The Congress voted to not support the use of data from unethical experiments and directed AAFP to ask CEJA to reconsider its stance.
"We believe the basis of our interaction with our patients is our ethical stance," Brooks testified, "and anything that could be interpreted as saying we would condone unethical actions would erode that stance."
The reference committee recommended that CEJA reconsider its opinion, but the house disagreed. The opinion will appear in the next revision of the AMA's Code of Medical Ethics.
- The AMA house also adopted 38 amended recommendations that aim to help AMA overcome serious flaws in its structure, governance and operations. The original recommendations came from a committee the house created in response to the AMA's 1997 Sunbeam crisis. The committee was assisted by an outside management consulting firm. The committee report noted "a disturbing element of distrust" among the house of delegates, councils, board of trustees and staff.
- AMA should "express outrage that the practice of medicine is characterized as abusive and fraudulent and vigorously oppose the harassment of honest physicians," says a substitute resolution delegates adopted on Medicare evaluation and management documentation guidelines. The resolution also asks AMA to continue advancing alternatives to numerical guidelines.
HCFA listens up on E/M guidelines
The guidelines for using evaluation and management codes for Medicare reimbursement were "too flawed to be fixed," said (then) AAFP President Neil Brooks, M.D., of Rockville, Conn., in March.
The federal government listened.
The (then) American College of Physicians, as well as the AAFP, called for an overhaul of the E/M guidelines.
By now, HCFA has worked with the medical community to propose a new framework for the guidelines. Ninety-one percent of 80 AAFP members who reviewed the new document in November found it better than the 1997 guidelines. Seventy-one percent had a favorable impression of the revised guidelines. But concerns continued that the guidelines were still too intrusive and insufficiently related to patient care.
This month, a Current Procedural Terminology Editorial Panel work group, including AAFP Past President Douglas Henley, M.D., of Fayetteville, N.C., will meet with HCFA staff to study specialty society comments. The work group will propose revisions to the full CPT Editorial Panel in February. Its recommendations will form the basis for HCFA's pilot testing later this year.
The new guidelines are expected to be implemented no earlier than a year from now, after education of physicians and Medicare carriers.
AAFP, others oppose legal assault on RBPE
Hospital-based specialties are claiming primary care's Medicare increases for 1999-2001.
The AAFP and other office-based groups are fighting back.
Here's the play-by-play.
On Nov. 2, the Health Care Financing Administration proposed a method for the 1999-2001 transition to a fee schedule using resource-based practice expenses.
The base year for the transition, said HCFA, should be 1998, the year primary care received a $330 million "down payment" on the RBPE.
However, on Nov. 4, 11 hospital-based groups filed a suit against HCFA, saying the base year should be 1991. The groups represent ophthalmologists, neurosurgeons, cardiologists, orthopedists, gastroenterologists, and cataract and refractive surgeons.
Their strategy would transfer to hospital-based groups many gains for primary care since 1991.
At issue: several hundred million dollars in 1999-2001 payments, including the 1998 down payment.
By 2002, the fee schedule will use the full RBPE. According to HCFA, the typical family physician providing mainly office-based services will receive a 9 percent increase in total Medicare payments compared with 1997 payments. Those funds are not in jeopardy, but the 1999-2001 increases are.
Therefore, office-based specialties, including the American College of Physicians/American Society of Internal Medicine and the AAFP, will soon submit an amicus brief to the federal district court in Chicago, concurring with HCFA.
Good news in '98 includes family physicians in high places
Several family physicians advanced to high offices. Leaders include Surgeon General David Satcher, M.D., Ph.D., of Washington; AMA President Nancy Dickey, M.D., of College Station, Texas; World Organization of Family Doctors (WONCA) President Robert Higgins, M.D., of Anacortes, Wash.; and Medical Women's International Association President Lila Stein Kroser, M.D., of Philadelphia.
In addition, four of the nine physicians in Congress are family physicians.
The government reported in 1998 that about 186 million office visits were made to physicians in general or family practice in 1996. Visits to FPs/GPs exceeded those to any other physicians' group by more than 83 million.
1998 research began to document the value, effectiveness and satisfaction quotient of FPs.
A strategy to secure media coverage of AAFP leaders and members resulted in an increasing number of interviews on television and in national newspapers and popular magazines.
AAFP's net assets escalated by about $12 million in the fiscal year ending May 31, reaching $40,573,296. Ventures such as the new headquarters, the research initiative and the D.C. policy center mean the 1998-99 net assets will not begin to match the rise of the prior year.
Academy's new headquarters heads toward completion
From the ground up: The AAFP will move into its new headquarters in Leawood, Kan., in the fall.
Conferences
Constituencies gear up for 10th meeting
As AAFP's special constituencies -- women, minority and new physicians -- plan their 10th annual meeting, they're celebrating.
"We've made so much progress," said Maggie Black-burn, M.D., of Harpersfield, N.Y., convener of the 1999 National Conference of Women, Minority and New Physicians.
"Formerly, women and minorities were underrepresented," she said. "Now, we have a lot more women in leadership, and more minorities. The conference feeds leaders into the AAFP and chapters."
NCWMNP provides a forum for policy-making, sending resolutions to the AAFP Board and Congress of Delegates. At NCWMNP's urging, the Congress has seated delegates representing women, minority and new physicians since 1993.
The Committee on Special Constituencies addresses the concerns of the three groups, plus issues relating to international medical graduates and to gay, lesbian, bisexual and transgender populations.
"Many of our issues overlap," said Blackburn. For example, many new physicians work in rural areas, and many minorities practice in inner cities, with both sets of patients often underserved.
The 10th NCWMNP will be April 29-May 1 in Kansas City, Mo.
Think ahead: Mark your calendar to 2004
- July 28-Aug. 1, National Conference of Family Practice Residents and Medical Students, Kansas City, Mo.
- Nov. 11-14, Conference on Patient Education, Austin, Texas.
- Nov. 12-14, State Legislative Conference, La Jolla, Calif.
- Sept. 15-19, 1999, Scientific Assembly, Orlando, Fla.
- Sept. 20-24, 2000, Scientific Assembly, Dallas, Texas.
- Oct. 24 - 28, 2001, Scientific Assembly, Atlanta, Ga.
- Oct. 16-20, 2002, Scientific Assembly, San Diego, Calif.
- Oct. 1-5, 2003, Scientific Assembly, New Orleans.
- Oct. 13-17, 2004, AAFP Scientific Assembly-WONCA World Conference, Orlando, Fla., to be cosponsored by the Academy and the World Organization of Family Doctors.
A long look ahead: The last meeting in the prior list is really two meetings for the price of one. Attendees can learn both from AAFP's scientific program and WONCA's international presentations.
A short look ahead: If you're considering attending the sports medicine meeting this February, you may want to register early. 1999 is the last year for practice eligibility for an exam to obtain a certificate of added qualification in sports medicine, so AAFP's sports medicine course may be sold out early. In later years, you'll need to complete a fellowship to be eligible to take the CAQ test.
A look backward: More than 500 family physicians and others -- a record -- attended the 20th Anniversary Conference on Patient Education last year, an indication of the explosion of health information for consumers and of health professionals' commitment to teaching patients the right stuff.
FP Report * January 1999 * Volume 5 / Number 1
The official news publication of the American Academy of Family Physicians. Published monthly by the News Department, Communications Division, for distribution to all AAFP members. Opinions expressed in the FP Report do not necessarily reflect the policies of the AAFP.
Paula Haas Binder, Editor, News Department
Jane Stoever, Managing Editor
Leigh Anne Bathke, Associate Editor
Sharon Dickinson Dent, Associate Editor
Todd Simchuk, Associate Editor
Renee Campbell, Production/CirculationAddress comments and inquiries to FP Report, 8880 Ward Parkway, Kansas City, MO 64114-2797; fax them to (816) 822-8857; call (800) 274-2237, Ext. 4230; or send them to pbinder@aafp.org via electronic mail.
Copyright © 1999 American Academy of Family Physicians. All rights reserved.
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