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FP Report

February 1999
News for members of the American Academy of Family Physicians

Help CHIP help children get health care

A federal program enacted in 1997 provides $24 billion for states to provide health insurance to low-income children. Enrollment efforts for the Children's Health Insurance Program are now under way, but many parents -- and even many doctors -- are unaware of how to tap this resource.

CHIPS

Jeff McKinley, D.O., a second-year resident at the Family Medicine Residency Program of Topeka in Topeka, Kan., examines a 10-month-old patient. Faculty physicians at the residency are enrolled as providers in the state Children's Health Insurance Program, which is called HealthWave. They share information about the program with uninsured patients, who make up about 8 percent of the practice.

(Photo by Sharon Dickinson Dent/AAFP)

Audrey Boyd, M.D., of Columbia, S.C., a member of AAFP's Commission on Legislation and Governmental Affairs, urges physicians to enroll as providers in their state's CHIP and educate families about getting health insurance for their children.

Boyd says new federal programs often raise a red flag for physicians, which may impede efforts to get children insured. For instance, doctors may balk at the potential administrative burdens. Although such concerns aren't unwarranted, many states are making changes to alleviate the paperwork hassles, she says.

"Because the United States is trying to push insurance coverage for children, a lot of changes are being made in the system to make it easier for us to manage these children," says Boyd, volunteer medical director for Hope for Kids, an organization that works to get children insured and immunized. "Here in South Carolina, we no longer have to file on separate forms for Medicaid children, for instance."

Another barrier to getting physician providers enrolled is the belief that patients receiving federal assistance will be noncompliant.

"I think these patients really want to do the right thing and work within the system," Boyd says. "If it's a respectful system and they feel they have a family doctor who cares about them, then patients will respond differently. Create continuity and develop relationships with your patients to alleviate the stigma attached to the federal programs."

Karen Bruce, M.D., director of the Family Medicine Residency Program of Topeka in Topeka, Kan., says all of the residency's faculty doctors have enrolled as providers in the state's CHIP, which is called HealthWave. She says the FPs also treat patients at a local indigent clinic, but now HealthWave will enable many of those families to get health insurance for their children and better continuity of care at a private practice.

"I think it's excellent," Bruce says. "We provide a pretty significant amount of care to Medicaid kids, and the benefits you see longitudinally of caring for these kids beats the heck out of catching them in the emergency room."

So far, families are signing up for CHIP in much smaller numbers than anticipated. Boyd attributes the slow enrollment to a lack of information. She encourages physicians to offer CHIP flyers and applications at their practices and to teach office staff to discuss CHIP with potentially eligible families.

"Because physicians are looked upon as an authority in health care, if we tell patients about this program, they'll listen," she says. "We have to play a major role in educating the public and getting the information out."

Where can you find details on your state's program? See the box below.

What's CHIP?

The Children's Health Insurance Program gives grants to states to provide health insurance for children below age 19 living in families with incomes at or below 200 percent of the federal poverty level. Some states are using the money to expand Medicaid, while others are launching new programs to privately insure eligible youngsters.

According to the Children's Defense Fund, benefits vary by state, but children enrolled in the program generally are eligible for regular check ups, immunizations, eyeglasses, doctor visits, prescription drug coverage and hospital care.

Where can you get more details? Try these resources:

  • The Children's Defense Fund web site features extensive information about CHIP, including flyers for each state program with phone numbers of state offices. Go to http://www.childrensdefense.org/signup/index.html and download a flyer for distribution to patients.
  • Use AAFP Express to receive by fax a federal flyer that includes some information about CHIP, as well as phone numbers for regional offices. See the box on page 2 for details on ordering the flyer.

 

News from Headquarters

Request research training grants by April 2

If you'd like to increase your research skills and knowledge base and tackle research questions, let the Academy know.

You may qualify for an Advanced Research Training Grant.

The grant program is part of AAFP's five-year, $7.72 million research initiative. Eight AAFP members received training grants in 1998, and the second cycle of training grants just began. Winners may receive as much as $50,000 a year for one or two years.

Here's how to apply:

Contact Tom Stewart in the Scientific Activities Division at (800) 274-2237, Ext. 5538, for guidelines on submitting a concept paper. It should describe your plan to increase your training. The concept paper guidelines are also posted on AAFP's web site. Submit your paper by April 2

The Task Force to Enhance Family Practice Research will request full proposals from selected applicants in June and will announce the 1999 recipients in September.

The training plans of the 1998 grant recipients run the gamut from advanced degree studies in public health to courses in biostatistics, time-series analysis, epidemiology, psychology of decision making, women's health and the methodology of clinical trials.

The recipients plan to apply their new knowledge to research on topics such as the efficacy of the family practice model of care, the impact of the health care context on doctor-patient/family relationships, adult survivors of childhood cancer, cardiovascular patients' use of alternative medicines, pain management during labor and interventions with low-income families concerning domestic violence.

"AAFP members' response to the research initiative has been overwhelmingly positive," said James Galliher, Ph.D., research affairs manager in the AAFP Scientific Activities Division. "There's a need to document what we know at a 'gut feeling' level: Family practice maintains and improves the health of the American people."

Winners receive
up to $50,000 a year
for one or two years.

Chapter grant program wants applicants

The Commission on Clinical Policies and Research is accepting applications for the next round of Matching Funds for Constituent Chapter Research. The application deadline is April 15, and the commission will announce the winners in June.

The grants are awarded on a competitive basis in the fall and spring of each year. Applications must be reviewed and approved by constituent chapter presidents or executives prior to submission to the AAFP. The funds are used by constituent chapters for research conferences, presentations and workshops.

Application information is available online at the AAFP web site -- http://www.aafp.org/research/matchapp.html -- or by contacting Bellinda Schoof at (800) 274-2237, Ext. 5560.

Meeting planners seek your assistance

Organizers of the following meetings are seeking proposals or volunteers for their programs. For applications, call the people listed below at (800) 274-2237. Information on the first two meetings also is available on AAFP Express.

Conference on Patient Education. Proposals are sought for workshops, seminars, lectures, papers, poster displays and special interest discussions at the meeting Nov. 11-14 in Austin, Texas, sponsored by the AAFP and the Society of Teachers of Family Medicine. Contact: Pamela Rodriguez, Ext. 5534. Deadline: March 15.

AAFP Scientific Assembly. The Academy has issued a call for scientific exhibits and family practice research presentations at the Sept. 15-19 meeting in Orlando, Fla. Scientific exhibits contact: Vicky Binder, Ext. 5264. Family practice research presentations contact: Carrie Vickers, Ext. 5268. Deadline: April 1.

The National Conference of Family Practice Residents and Medical Students (formerly called the National Congress of Family Practice Residents and National Congress of Student Members). Resident and medical student volunteers are needed for business sessions at this meeting July 28-Aug. 1 in Kansas City, Mo. Contact: Lyndia Flanagan, Ext. 5233. Deadline: June 1.

Draft fifth-graders into Tar Wars program now

Tar Wars, AAFP's tobacco education program for fifth-graders, will hold its national poster contest June 18-20 in Washington, D.C.

Tar Wars

What's that to you? Well, if you haven't scheduled a Tar Wars session with your local fifth-graders, now's the time.

The Tar Wars curriculum engages students in making upbeat, pro-health, anti-tobacco posters. The children enter a local poster contest, and the winners can enter their posters in state and possibly national competitions.

So, for your favorite fifth-graders to have a shot at the 1999 national poster contest, line up your Tar Wars talks now.

Other Tar Wars tidbits of info:

Awards honor contributors to public health, education

Do you know someone who deserves a pat on the back? These AAFP award programs are accepting nominations.

Resident/Student News

Attacks on affirmative action threaten medical school diversity

First came Proposition 209 in California in 1995. Then a federal court ruled on the Hopwood case, affecting Texas, Louisiana and Mississippi in 1996. Voters in Washington state continued the trend in last November's election. The result: elimination of affirmative action, creating major obstacles in the quest for diversity on medical school campuses.

Clinic photo

Kris Okumu and Viet Le, medical students at the University of California/ Davis medical school work at a clinic in an underserved community.

(Photo: University of California/Davis Medical School)

Many minorities are accepted to medical school based on standard admissions criteria without special consideration of race. But critics say the bans send a negative message to minorities considering a career in medicine and exacerbate gaps in the health care system. Since 1996, minority applications to medical schools have dropped by 19 percent in California and 22 percent in Texas, Louisiana and Mississippi. Nationwide, minority applications decreased for the second straight year in 1998.

"Even if the numbers showed nothing, the rulings are very chilling," said Herbert Nickens, M.D., vice president for community and minority programs at the Association of American Medical Colleges. "Minority students, for historical reasons, are relatively sensitive to the climate in which they're operating. I think people clearly perceive the anti-affirmative-action agitation as an anti-minority agitation."

Why should medical schools pursue diversity? Nickens said the answer is multi-pronged and includes the following:

Those who attack the use of affirmative action tend to emphasize two claims: Unqualified students are gaining admission to medical school and reverse discrimination is keeping better-qualified nonminority students out, Nickens said.

Robert Davidson, M.D., M.P.H., professor of family and community medicine at the University of California/Davis, said reverse discrimination is an issue society must weigh, but his data debunk the claim that affirmative action leads to the production of low-caliber physicians. Davidson led a 20-year retrospective study of students admitted to the UC/Davis medical school. He measured academic progress, national board examination scores, graduation rates, residency evaluations and practice characteristics and compared the results between students accepted under regular admission criteria and those accepted under affirmative action or other special consideration.

His findings, published in the Oct. 8, 1997, Journal of the American Medical Association, included graduation rates of 97 percent for regular admissions and 94 percent for affirmative action admissions and no differences in the residency experiences. "We also found that of our graduates, a much higher percentage of minority students were likely to go into primary care," Davidson said. "There is an implication in much of the anti-affirmative action rhetoric that somehow we are producing inferior products. At least at this school over the last 20 years, that proves absolutely false."

Unable to ask medical school applicants to reveal their race, admissions committees in states with affirmative action bans have devised much more complicated ways to ensure a diverse student population.

"What most schools have done and what we've done here is develop a very broad set of criteria that we're using for our admissions," Davidson said. "Certainly GPAs and MCATs are part of that, but a whole series of other issues are now included in a very lengthy secondary application."

Applicants receive preferential points for criteria such as having parents who didn't graduate from high school, growing up in an underserved community, overcoming barriers to graduate from college and working a certain number of hours while in school.

"The charge to the admissions committee is to select individuals who will produce a broad diversity among the student body, who are capable of meeting the rigorous academic demands of the school, and who are likely to produce the types of physicians we want with good communications skills and a commitment to service," Davidson said.

"I think people clearly perceive
the anti-affirmative-action agitation as
an anti-minority agitation."

-- Herbert Nickens, M.D.

Help minority children say, 'I want to be a doctor when I grow up'

Many schools, organizations and specialty societies are working to address lagging minority applications to medical school, and you can, too.

What's going on? The Association of American Medical Colleges has made a crusade of working for medical school diversity. "We've been trying to speak out as much as possible and make the case that it's important," said Herbert Nickens, M.D., vice president for community and minority programs.

The AAMC works to diffuse affirmative action battles while promoting various programs in its Project 3000 by 2000, an education reform effort with the goal of graduating 3,000 underrepresented minorities annually by the year 2000. A major component of the project aims to intervene early in the educational process, provide exposure to the health professions, improve student achievement and ultimately boost test scores. "Addressing the dramatic educational disparities is the real target," Nickens said. "Test scores are what allow folks attacking affirmative action to have something very tangible they can point to."

According to official AAFP policy, the Academy is "highly supportive" of programs that work to increase minority applications and admissions to medical school. In addition, the AAFP's Committee on Special Constituencies is exploring opportunities to encourage member participation in outreach programs designed to increase minority involvement in the medical professions. It's also developing alliances with minority health organizations to collaborate on mentoring initiatives targeting minority high school students.

"It's imperative that medical school classes reflect the diversity of the community to meet all the public health needs," said committee member Donnie Batie, M.D., of Baton Rouge, La.

What can you do? The AAMC's Nickens said medical students historically have led the charge for changes in the educational system. Speak up about the need for diversity on campus, make sure your admissions committee is addressing the decline in minority enrollment and get informed about the issues so you can counter attacks on affirmative action.

Nickens also encouraged students and residents to participate in programs that work with schoolchildren. "Students and residents have a particularly important role," he said. "Because of their age and numbers, they're well positioned to be mentors and buddies to the kids in these programs. Whether the students and residents are minorities isn't important. I think it's criticial for these kids to have somebody who pays attention to them and listens to them and talks to them about what they can grow up to become."

Other News

What's it take to get C-section privileges?!

Family physician Eric Runte, M.D., of Sonora, Calif., and his county are appealing a judge's decision not to hear their Caesarean section privileges case.

Runte, the primary surgeon for 70 C-sections during his 1990-93 family practice residency, applied for C-section privileges at Sonora Community Hospital in November 1994.

"That unleashed a cascade of events that culminated in this lawsuit," said Runte.

He directs the Primary Care Clinic at Tuolumne General Hospital in Sonora, and the County of Tuolumne joined the lawsuit as Runte's employer. The hospital has no birth center, so Runte delivers babies at Sonora Community Hospital.

After he applied for C-section privileges, SCH adopted a policy that effectively precluded anyone but OB-Gyns from obtaining the privileges.

Federal District Judge Robert Coyle ruled last July 24 in Fresno, Calif., that Runte and the county had not presented sufficient evidence of antitrust activity by SCH and three OB-Gyns at SCH. However, Coyle peppered his 69-page opinion with statements in Runte's defense (see box).

Barbara Hensleigh, J.D., Runte's lawyer, submitted the notice of appeal Dec. 22 to the federal appellate court in San Francisco, which may rule on the case this year. If the court finds in Runte's favor, it will probably remand the case to Coyle for trial.

Coyle said July 24 the SCH policy allowing only OB-Gyns to perform C-sections was "a business decision which, on balance, this court cannot say was unreasonable."

"We feel the opposite," said Runte. "The judge's line of reasoning could restrict an entire class of physicians from performing C-sections in this county."

The California AFP, other chapters, the AAFP, the County of Tuolumne, residency programs and many individual FPs have helped fund the case.

"If we can bring this lawsuit to a successful conclusion," said Runte, "it will benefit family practice across the country because it will establish case law that could be used in other cases."

Excerpts from judge's order rejecting Runte case

Judge Robert Coyle decided July 24 not to hear a case concerning the right of Eric Runte, M.D., to apply for Caesarean section privileges at Sonora Community Hospital (see story above). Coyle, however, stated points in Runte's favor:

  • "There is evidence Dr. Runte is qualified to perform C-sections. ... Dr. Robert B. Lefkowitz, Dr. Runte's evaluating physician, ... an obstetrician, ranked Dr. Runte in the top 10 percent of residents he has seen perform C-sections."
  • "Dr. Runte's exclusion from the C-section market harms competition in that market."
  • "Dr. (Donovan) Teel (a defendant OB-Gyn) ... apparently made certain notable statements. For example, Dr. Teel, upon learning that Dr. Runte wanted to perform C-sections, informed him that he would never do so in Sonora. When asked why, according to Dr. Runte, Dr. Teel said something similar to 'It's a money issue' or 'There isn't enough of the pie to go around.'"
  • "Dr. (Louis) Erich (a defendant OB-Gyn) ... made certain notable statements. ... Dr. Erich stated something similar to 'If there weren't enough obstetricians, Dr. Runte would be welcome to do C-sections.'"


HCFA offers tips to tackle Y2K problem

The Health Care Financing Administration has named the Y2K bug as its top priority, working to ensure computer systems will keep processing claims for 70 million Medicare and Medicaid beneficiaries.

Y2K refers to the impending problem of some computers mistaking the year 2000 for 1900 because they only read the last two digits. If the problem isn't addressed, health care providers could experience delayed payments or disruptions in receiving data.

HCFA encourages physicians to develop a Y2K readiness plan. One suggested plan includes five steps: (1) Become aware of how the year 2000 can affect your system. Identify entities that you depend on and that depend on you, inventory both hardware and software programs, and identify items you can't live without. (2) Assess the readiness of everything on your list by contacting vendors or checking appropriate web sites. (3) Update or replace systems and software programs that you decide are important for your office to function. (4) Test your existing and newly purchased systems and software; don't assume they're Y2K-ready. (5) Develop business continuity plans to take effect if problems arise. Focus on issues that would be most problematic for you and your patients. For example, what will you do if claims can't be sent in the right format to an insurer or the payroll system doesn't function appropriately?

HCFA has released additional information on its plans for dealing with Y2K and tips to help providers tackle the problem at their own offices. The Academy will compile the information into an appendix to the AAFP monograph, Family Physicians and the Year 2000: Preventive Medicine for the Millennium Bug, by March 1. You can order the free monograph and appendix (item #R710) or just the appendix (item #R709) by calling the AAFP order department at (800) 944-0000.

Enjoy TV-free week

You and your patients can participate in the fifth National TV-Turnoff Week April 22-28. The week is sponsored by TV-Free America and endorsed by more than 50 national organizations, including the AAFP.

To learn how to organize TV turnoffs in your community, contact TV-Free America by mail at 1611 Connecticut Ave. N.W., Suite 3A, Washington, D.C. 20009; by phone at (202) 887-0436; by e-mail at tvfa@essential.org or by fax at (202) 518-5560. Check out the web site at http://www.tvfa.org .

A $10 donation will get you an "organizer's kit" with a guidebook, posters, bumper stickers, pledge cards, activities, articles and more.

Put Patch in your Assembly

The real Patch Adams will clown around and offer his pitch on health care possibilities during the Sept. 15-19 AAFP Scientific Assembly in Orlando, Fla.

What's his message? "I want family doctors to design and create their ideal medical delivery system and have fun doing it," said Hunter "Patch" Adams, M.D., a family doctor in Arlington, Va.

The real-life inspiration for the movie "Patch Adams" operated a pilot health care site for 12 years, providing free care that blended traditional and alternative therapies with artwork, nature and good humor. For the last 13 years, he has raised funds for a hospital complex that's slowly being built in Hillsboro, W.Va.

Adams will present two CME sessions at the Assembly -- an evening lecture, "Laughter and Medicine," from 5 to 6:30 p.m. on Wednesday, Sept. 15, and a three-hour course, "Living a Life of Joy," at 8 a.m. on Thursday, Sept. 16.


FP Report * February 1999 * Volume 5/Number 2

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, C.A.E., Editor, News Department
Sharon Dickinson Dent, Managing Editor
Jane Stoever, Associate Editor
Leigh Anne Bathke, Associate Editor
Todd Simchuk, Associate Editor
Renee Campbell, Production/Circulation

Address 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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