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FP Report

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

Front Page


Help patients deal with Y2K jitters

In these last two months of 1999, patients anxious about the impending rollover to the year 2000 likely will appear in your office.

Expect your schedule to be booked solid with patients rushing to get immunizations, treatments they've postponed and prescription refills. As tension levels rise, you may also see an increase in patients with related ailments.

Y2K

Family physician Leah Raye Mabry, M.D., of Pleasanton, Texas, said FPs are uniquely qualified to help people deal with the turn of the century. "We see such a breadth of the community," she said. "They're worried not just about themselves, but also about their families, and we can address so many different concerns. We should try to reassure patients that they shouldn't get stressed out about Y2K."

Providing education about Y2K should be part of the overall preventive care program in physician offices for rest of the year, said Mabry, who serves on the AAFP Commission on Public Health.

"When you ask patients, 'Are you wearing your seat belt? Did you get a flu shot?' you also want to talk to them about what your office has done to prepare for Jan. 1," she said. "You want to tell them, 'Along with your preventive maintenance, we've done maintenance on our own office and we're ready for 2000.' Assure them that everything -- including your EKG machine, which is something they may be worried about -- has been readied."

FPs who use electronic medical records should explain how the back-up process works, emphasizing that records won't be lost, said Mabry. "Not everybody is computer-literate. They think that if the computer crashes, everything's gone. They don't know that there are floppy disks and back-ups."

Patients also may need reassurance that medical devices they use every day -- such as monitors for their children, certain diabetes monitors and pacemakers -- won't fail on New Year's Day. Mabry said FPs should explain to patients that only devices dependent on date-sensitive computer chips are at risk of malfunction. Share any information you've received from device manufacturers to help put patients' minds at ease.

Mabry said the impact of Y2K anxiety probably will vary by region. Patients in her San Antonio office have raised more concerns than those in her rural office.

"Not as many patients in rural areas are as acutely aware of the issue as those in the busy cities who have an umbilical cord to the Internet," she said. "Our rural patients know the Y2K bug exists, but many have faith that the systems won't shut down."

As patients worry about the availability of prescription drugs, FPs may be asked to write prescriptions for extra supplies of medication. This is strongly discouraged by the Pharmaceutical Alliance for Y2K Readiness, a coalition of drug manufacturers, wholesaler distributors, pharmacies, health care professionals and patient organizations.

Mark Grayson, senior director of communications at the Pharmaceutical Research and Manufacturers' Association, said the alliance is working closely with the U.S. government to ensure a continued 90-day supply of prescription medications -- including life-sustaining products such as insulin.

"You should always get your prescription filled when you have five to seven days left," Grayson said. "There's nothing more frustrating than when you go to the pharmacy to get a prescription filled, and your insurance company won't pay for it. There's no reason to overbuy and have to pay for it yourself because there is ample supply. At any time, there's a 90-day supply in the system."

The White House echoed those recommendations in a statement from the President's Council on Year 2000 Conversion, saying "Consumers should know it is clear that companies within the system are taking very seriously their responsibility to patients by testing critical computer systems and refining contingency plans."

Many organizations, including the American Red Cross, have signed on to the president's council statement.

For more information on Y2K readiness, visit the Pharmaceutical Alliance for Y2K Readiness Web site at www.y2kmedication.com. It features plenty of free information you can download for distribution to patients.

Mosques, minarets and family medicine

FPs travel halfway around world to sow seeds of family practice

Don Ellsworth, MD
Modeling family practice: Don Ellsworth, M.D., an AAFP member living in Uzbekistan, examines Timur Solier, who is hard of hearing. The boy's family prearranged the check-up with the Physicians With Heart group, including Ellsworth. Uzbekistan is considering training FPs.

TASHKENT, Uzbekistan -- A developing nation, renewing itself after years of Soviet rule: Why not try family practice there?

That's what AAFP Board Chair Lanny Copeland, M.D., of Albany, Ga., and other FPs asked in Uzbekistan Sept. 27-Oct. 3.

The former Soviet republic became independent in 1991. It adopted a new flag, printed Uzbek money, threw out history books lauding Vladimir Lenin and Josef Stalin, and rediscovered its Uzbek heroes and poets. Beautification is in; the KGB is out.

Family physicians preached family practice in this land of mosques and minarets during the seventh annual Physicians With Heart airlift.

Uzbekistan received $5.2 million worth of medicine and medical supplies in the airlift, cosponsored by the Academy, the AAFP Foundation and the humanitarian aid organization Heart to Heart International. Two preliminary shipments were worth $2.9 million in U.S. wholesale dollars, for a total value of $8.1 million.

Uzbek officials are restructuring the country's health care system, trying to orient it to generalists instead of subspecialists and to retrain the generalists. The process requires massive change.

"GPs serve as traffic cops at the polyclinics (multispecialty clinics)," said AAFP member Don Ellsworth, M.D., who has worked in Andijon, Uzbekistan, for five years. "If you've got a sore throat, the GP tells you to see the ENT specialist. If you've got chest pain, you see the cardiologist." Even the GPs at rural clinics send pregnant women to hospitals for deliveries by OB-Gyns.

Next airlift goes to Azerbaijan

Next year's Physicians With Heart airlift will benefit the former Soviet republic of Azerbaijan, on the Caspian Sea between Russia and Iran.

Family physicians interested in introducing Azerbaijan to family practice and monitoring the delivery of airlifted products should contact Maya Singh of Heart to Heart International at msingh@hearttoheart.org or (405) 787-5200.

This year, financial contributions for Uzbekistan from pharmaceutical companies and AAFP members totaled about $10,000. The donations covered the cost of antibiotics and hepatitis A vaccine, selected because hepatitis A is widespread in Uzbekistan, said AAFP Foundation President Gerald Keller, M.D., of Mandeville, La.

If you'd like to contribute to the AAFP Foundation International Fund and help support the Azerbaijan airlift, call (800) 274-2237, Ext. 4452.

Copeland was visiting an Uzbek rural clinic when he spied an exam table with stirrups. Moving to the foot of the table, he asked the staff, "Why couldn't you deliver babies here? You could!" They disagreed, but Copeland, who delivered about 1,500 babies when he worked in rural Moultrie, Ga., had made his point.

Even though health professionals' education and most health care is free in Uzbekistan, doctors' wages reflect the typical Third World devaluation of the profession of medicine. GPs' salaries may be $15 a month, anesthesiologists' salaries may be $20 a month, and restaurant owners and street cleaners may earn more.

During seminars in five Uzbek regions receiving the donated products, family physicians in the airlift delegation led sessions on how to use the medicine and why family practice would fit Uzbeks' needs. Accustomed to pediatricians and internists, audiences learned about doctors who can care for people "from cradle to grave" or, as one translator said, "from crystallization to cremation."

More than 400 medical students, educators, administrators and health providers attended the symposium in Tashkent, Uzbekistan's capital. Audience members asked whether the FPs were content with what they made.

"I'm happy with what I earn," said Copeland. "But I do get frustrated that some subspecialists, such as gastroenterologists, cardiologists and cardiothoracic surgeons, make two to three times as much as I do." The audience applauded. Copeland had struck a chord common to U.S. and Uzbek generalists.

Physicians with Heart
These health professionals and educators in Uzbekistan are among 900 who heard about a concept new to them -- family practice -- in seminars by Physicians With Heart delegation members. The health professionals also received advice about using medicines airlifted to their areas.

When a teacher said her students wouldn't have the resources to set up a family practice office, Copeland replied, "It wouldn't take a lot of money. You can be a family physician with your brain and your heart and your stethoscope."

Ellsworth discussed clinical decision-making at the seminar. "In America, decisions we make on how to treat a patient are determined more by our knowledge and what we read in the latest clinical journals, not mandated by the government," he said. "There are advantages both ways. If the decisions are mandated by the health ministry, you have uniformity. In America, it's easier to implement the latest clinical practices because you don't have to wait for legislative changes."

Ellsworth also conveyed the joy of offering primary care. "The longer you stay in an area and practice medicine, the more your day is filled by people who are your friends," he said. "So getting up and going to work in the morning is always exciting, because you're sharing your life with your friends."

Products/Services


Scan this area for AAFP products, services and meetings that might help you and your patients. Order these items from the AAFP order department at (800) 944-0000 unless otherwise noted; a shipping and handling fee might apply.

Letters


Genetic risk factors, universal coverage

To the editor:

Three reports in the July 1999 FP Report compelled me to write. Let me first explain that I am retired from clinical practice, and my only gainful employment is doing life insurance exams on and collecting specimens from applicants.

In the July issue's section on medical genetics, concern was expressed that the results of genetic tests could be used to deny or rate life insurance policies. How does this information differ in principle from all other information that is used to assess actuarial risk? Why is it unfair to charge higher premiums to those who are at greater risk of early demise and charge lower premiums to those eligible for "preferred" rates? Whether or not there is effective treatment or prevention for "risk factors" may have a bearing on rating but I think not on the basic concept.

Another July issue article, "Medical Groups Seek Universal Coverage," deals with health insurance. Please excuse me for being a dinosaur, but I have never thought it was a good idea to pay a large, faceless bureaucracy to pay my bills in the cloak of an insurance policy. I would not have health insurance (except for catastrophic coverage) were it not that one without coverage is charged more than the insurance companies are charged. I know the rationale is that most uncovered people can't or won't pay anything, so the charges are made higher to the uncovered who can pay. I really don't think this strategy motivates the financially irresponsible or the impoverished to get insurance.

Arguably, there are other intangible benefits to health insurance for the insured, e.g., "peace of mind," relief from budgeting and cost control provided by the insurance company. But these (and possibly other) benefits are not free. They raise the real cost of medical care, and the consumer should have a choice. If consumers were getting the rebates they deserved by paying their medical bills directly and promptly, the number of people with full coverage would probably drop even more.

Universal coverage can only come by increasing government intrusion of the kind detailed in a third July FP Report article, "Idaho FPs Speak Out Against HCFA Audits." Aren't we getting carried away by the liberal element in our midst? Normal, routine medical care should not require insurance. If people can't afford to pay for routine care, they can't afford the insurance premiums either.

To its credit, American medicine (AMA) opposed health insurance in the early days, but they lost the battle. Yet, it appears to have been a financial boon for the profession. To me, therefore, this push for universal coverage looks too self-serving.

By the way, I like FP Report's change from "house organ" to news.

FRANK LEITNAKER, M.D.
Miesau, Germany


Use national center to help children with disabilities and their families

To the editor:

I'm writing to let family physicians know more about resources for children with disabilities.

Families typically first consult their child's physician if they are concerned about development or possible disability. They turn to physicians for help -- for the child and for the family -- so they can best meet their child's needs.

If a child exhibits developmental problems or has a disability, there are many resources in the community. There are early intervention services for infants, preschool programs for toddlers, and school services for youngsters of all ages and all abilities. Each state has disability organizations and state agencies available to provide assistance to schools, homes and communities.

What's needed is someone to make the referral, to initiate the connection between families and all the possible resources. The National Information Center for Children and Youth with Disabilities -- also known as NICHCY -- has information for professionals and families and provides these connections. The center is funded by the U.S. Department of Education; we serve all inquirers and cover all disabilities. Physicians can use the center's materials and the Web site or refer families directly. All services and most materials are available free of charge.

We invite you to call the center at (800) 695-0285 to request our catalog, or you can go directly to the Web site at www.nichcy.org.

SUZANNE RIPLEY
NICHCY -- Washington, D.C.

Other News


House-Senate panels to dictate shape of high-priority health bills

House-Senate conference committees will forge agreements within the next few months affecting three areas of high priority to FPs and the Academy: managed care reform, Title VII funding, and the Agency for Health Care Policy and Research.

After the House-Senate panels juggle the differences between bills from the two chambers, Congress will vote on the final bills.

Managed care reform. The House voted 275-151 on Oct. 7 to pass a bill the Academy supports, the Bipartisan Consensus Managed Care Improvement Act. The bill would apply patient protections to all health plans, unlike the limited Senate bill the AAFP has criticized.

In a procedural move, the House tacked onto its bill some provisions from a recently vetoed tax bill. They include deductions for caretakers of elderly family members, an expansion of medical savings accounts, and tax breaks for self-employed and uninsured employees to help them buy private health insurance.

"As for the tax provisions passed to help the uninsured, they may help some, but they are not enough," said AAFP Board Chair Lanny Copeland, M.D., of Albany, Ga. "Right now, 44 million Americans have no health insurance. One out of six of our citizens has to choose between putting food on the table and seeing a doctor for preventive health care. This is unacceptable."

If the conference committee on the reform bills retains the tax measures or approves legislation much like the Senate bill, and if Congress adopts the committee's bill, President Bill Clinton reportedly may veto it.

Title VII. The House called for Title VII funding for family medicine training programs similar to the 1999 level of $51 million. The Senate, however, called for an across-the-board Title VII cut of 25 percent.

"The Academy is lobbying the conference committee to maintain the current funding," said Jeffrey Human, director of AAFP's Washington office. "We hope there'll be no compromise, no decrease, and the committee will follow the House's recommendation."

AHCPR funding. Both Senate and House bills call for something the Academy has long sought: more funding for AHCPR (soon to be renamed the Agency for Health Research and Quality).

Similarly, both the Senate and House gave legislative approval to the agency's already existing Center for Primary Care Research. The legislation defines primary care research and spells out what kind of research the center should conduct. The Academy helped draft the legislation.

Congress considers end-of-life bills

Congress is considering several bills on end-of-life care, and the Academy has commented on them:

However, the Conquering Pain Act also asks federal agencies to develop performance measures for pain management and palliative care. The Academy calls that provision an "inappropriate intrusion into medical care" and suggests any such guidelines should be advisory, not mandatory.

"There is a lack of consensus in the medical community about what constitutes medically futile care even when the patient's condition is irreversibly terminal," says the Academy in an Oct. 13 statement to a Senate panel. "The culture of medicine is weighted toward hospital-based, high-technology, acute care interventions."

AAFP's statement accents the need to incorporate patients' and families' wishes into care plans and encourages more research into therapies for end-of-life pain.

At press time, the House was expected to vote on its bills in October, and it was not known when the Senate would act on the companion bills.

AAFP seeks next EVP

Robert Graham, M.D., the Academy's current EVP, recently announced that he would leave the staff next year, after a new EVP is selected.

Individuals interested in applying for the position should go to the Academy's Web site at www.aafp.org/aafpjobs/evp.html for more information.

The application deadline is Nov. 19.


Financial Summary

This financial summary has been prepared to present an overall picture of AAFP's financial condition and operations.

Consolidated Statements of Financial Position

Assets
 May 31, 1999
 May 31, 1998
Cash and cash equivalents $ 11,249,567 $ 11,363,479
Receivables 6,989,824 5,909,966
Income tax refund receivable 1,895,547 1,895,547
Inventory of publication materials 100,739 96,251
Prepaid expenses and other assets 2,529,569 1,405,757
Marketable securities at fair value 47,490,180 39,138,830
Property and equipment:
Land 495,000 495,000
Office buildings, improvements 4,558,589 2,793,757
Office equipment, furniture, fixtures 9,076,357 8,250,236
Less allowances for depreciation 14,129,946 11,538,993
(6,774,910) ( 5,953,357)
7,355,036 5,585,636
Investments in deferred compensation plan at fair value 2,155,379 1,807,594
Total assets $ 79,765,841 $ 67,203,060
Liabilities and Net Assets
Liabilities and deferred revenue:
Accounts payable $ 4,327,313 $ 3,153,472
Accrued expenses and other liabilities 4,069,737 3,573,728
Unearned revenue 17,297,976 15,109,824
Liability for deferred compensation plan 2,155,379 1,807,594
Income taxes payable 2,037,619 2,051,358
Deferred rent concessions 283,387 933,788
Total liabilities 30,171,411 26,629,764
Net assets: unrestricted 49,594,430 40,573,296
Total liabilities and net assets $ 79,765,841 $ 67,203,060

Consolidated Statements of Activities

Year Ended May 31
Revenues 1999
 1998
Membership dues and fees $ 13,492,260 $ 13,462,957
Publications 18,959,783 18,912,931
Programs and miscellaneous 23,749,399 22,767,506
Investment income 4,384,218 5,252,020
60,585,660 60,395,414
Expenses
Membership services and programs 31,332,513 28,643,208
Publications 11,127,888 10,985,565
General and administrative 11,282,495 10,311,372
Income taxes 2,389,132 1,902,182
56,132,028 51,842,327
Revenues in excess of expenses 4,453,632 8,553,087
Other income:
Income tax refunds 60,663 --
Net unrealized gains on marketable securities 1,458,914 989,360
Gain on sale of partnership interest -- 2,397,004
Insurance refund 3,047,925 --

Change in net assets 9,021,134 11,939,451
Net assets at beginning of year 40,573,296 28,633,845
Net assets at end of year
 $ 49,594,430
 $ 40,573,296

The above data are only a part of the complete financial statements examined by PricewaterhouseCoopers LLP, certified public accountants.


You haven't even started on Y2K?

If you haven't even started with Y2K preparation, better develop a patient care "contingency plan" that isn't dependent on anything using embedded computer chips -- which could fail in a big way when 1999 becomes 2000.

Such a contingency plan is the "absolute minimum" that should be done if you can't fully correct Y2K problems in your facility or practice, according to the Health Care Financing Administration.

For HCFA's step-by-step guide to Y2K preparedness, go to www.hcfa.gov/y2k/y2kpreps.htm; you also can call HCFA at (800) 958-4232. Or visit the AAFP Web site at www.aafp.org/fpnet/y2k.

Robert Berenson, M.D., director of HCFA's Center for Health Plans and Providers, says that those who submit Y2K- compliant electronic bills will get paid in a timely manner because Medicare is required by law to do so. But for those who encounter Y2K computer problems and are forced to submit old-fashioned paper claims, it likely will be a different story.

Reassure patients about Y2K

Patients likely are concerned about how to prepare for Jan. 1, 2000, when some computers may malfunction because of confusion caused by the two-digit year code 00. You can help put their minds at ease.

New E/M guidelines fall victim to Y2K

Implementation of new evaluation and management documentation guidelines have hit a roadblock: Y2K. Health Care Financing Administra-tion staff have indicated that concerns about the transition to 2000 might delay pilot testing of the Medicare E/M guidelines, says Kent Moore, AAFP reimbursement issues manager. The result: The new guidelines might not be implemented until 2001.

Below are answers to some commonly asked questions:

Q. Will I be able to get my medicines during the Y2K transition?

A. Yes. As the year 2000 approaches, drug stores and other retailers are planning with consumers' needs in mind. For months, leaders in the pharmaceutical supply system have been working together to prepare for an orderly transition. Government agencies and organizations within the system are taking the necessary steps to make sure there is a usual flow of medications. Pharmacies will have access to a substantial supply of medicines in January.

Q. Should I stock up on prescription drugs?

A. No. Do what you usually do: Get a refill of your medication when you have a five- to seven-day supply left. The pharmaceutical supply system maintains a normal 90-day supply of drugs, and many companies are manufacturing extra medication to reassure doctors and patients.

Q. What should my family do to prepare?

A. Take these simple steps to prepare for any medical situation, regardless of Y2K.

Source: The Pharmaceutical Alliance for Y2K Readiness

FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.


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