Contents tagged with perspective
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Texas Family Physician - Vol. 63 No. 3, Summer 2012
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President’s letter
Member news
Perspective
CONTENTS
Primary care in Texas: Condition criticalFor the sake of Texas’ citizens and its … more
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By choosing wisely, physicians can help address the unsustainable trajectory of health care costs
By Richard Young, M.D.
“Every admitted patient should have a chest X-ray and a VDRL,” said one of my Type A personality internal medicine attending physicians during residency. The year was 1990 and this attitude was shared by a few other knowledgeable physicians at the time, though others questioned the practice and were more flexible in their medical decision-making. I would venture to guess that few family physicians or internists practice this way in 2012, but the practice is not completely dead.
A lot has changed since 1990. The total cost of U.S. health care was $724 billion and consumed 12.5 percent of the gross domestic product.1 In 2012, the total cost of U.S. health care is estimated to be $2.8 trillion and will consume 17.6 percent of GDP.2 This health care inflationary trend has continued unabated for the last 50 years.
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Texas Family Physician - Vol. 63 No. 2, Spring 2012
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President’s letter
Member news
Perspective
CONTENTS
Prepare to defend your codingFamily physicians face increased scrutiny in medical … more
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Texas Family Physician - Vol. 63 No. 1, Winter 2012
Go to the TFP archive
View the virtual issue
President’s letter
Member news
2011 Year in Review
Perspective
CONTENTS
Preserving a family traditionWith three decades of rural … more
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Patient-centered medical home: Are we or aren’t we?
By David W. Bauer, M.D.
When is a patient-centered medical home not a patient-centered medical home? In my practice, the answer is “every day.” In 2009 we received NCQA’s designation as a Level 3 PCMH. To achieve this, our physicians had to document ways in which our patients had enhanced access to our practice, provide examples of how we use evidence-based guidelines to provide quality care, demonstrate the means by which we coordinated care across time and space, and a number of other measures. We do, in fact, do those things every day. What we don’t do, is do all of them for every single patient, every single day.
Consider the analogy of a patient with diabetes whose hemoglobin A1c is 6.9. We would say that the patient’s diabetes is well controlled and congratulate the patient. But there are many ways that a patient could achieve this value. One would be to have very little fluctuation of her glucose from hour to hour. Another would be for the patient to drop into the 40s overnight, and climb to 200 immediately after meals. The hemoglobin A1c is an average, and doesn’t factor in variation. For years, decreasing variation has been the mantra of those working to improve quality, increase efficiency, and decrease medical errors in the hospital setting. As we migrate toward a new model of health care in this country—the PCMH—it would be valuable to embrace this concept in our offices as well.
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Texas can improve care and cut costs with medical home, shared savings initiatives
By Greg Sheff, M.D.
I am fortunate to be a part of a multi-year patient-centered medical home and shared savings pilot at Austin Regional Clinic. ARC is an approximately 300 physician multi-specialty group delivering care at 18 clinics and seven hospitals throughout the Austin area. Earlier this year, ARC joined a multi-year medical home pilot administered by Blue Cross and Blue Shield of Texas. The pilot was initiated in large part in response to Texas legislation requiring the Employees Retirement System, the self-funded insurer for state employees, to experiment with alternate payment and delivery models in an attempt to reduce the state’s ever-increasing health care costs. We are one of five physician groups in the state participating. Our program serves roughly 45,000 patients, including both the ERS (whose health care benefits are administered by BCBSTX) and BCBSTX fully-insured populations.
In addition to the traditional PCMH goal of comprehensive, coordinated, accessible, patient-centered care for all, ARC is also implementing processes to proactively identify high-risk patients and then deploy intensive, focused, physician-led care management interventions to these high-risk patients.
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Work to support family medicine in new health care reform environment is just beginning
By Roland Goertz, M.D., M.B.A.
AAFP President, 2010-2011Passage of the Patient Protection and Affordable Care Act—commonly known as the Affordable Care Act, or simply PPACA—was an important step toward establishing primary care as the foundation of America’s health care system. The law will have a far-reaching impact on family medicine as the nation begins to rebalance our health care system with more appropriate emphasis on primary care. Once fully implemented, it will focus more on health care and place a greater emphasis on prevention, primary care, and improved health outcomes instead of a predominately sickness care model which has focused on paying for procedures and volume.
The final vote and the signing of the PPACA was a first step. Now the task is implementation. And this is where the real work—and the real debate—begin Since its passage, the AAFP has focused on filling in the holes in the Affordable Care Act, preserving its primary care-friendly provisions, and ensuring support for primary care education that will help increase the number of future family physicians.
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Don’t let others define you
By Guy L. Culpepper, M.D.
During his recent NFL Hall of Fame induction speech, running back Emmitt Smith affirmed that refusing to let others define him was critical to his success. This simple, yet powerful advice has been a core value shared by champions throughout history. Success begins with a clear vision of one’s abilities and goals. Defining identity must not be swayed by the ever-present naysayers. This principle holds true across all spectrums of life; in faith, in business, and certainly in medicine.
Nicholas Pisacano, M.D., the founding director of the American Board of Family Practice, faced a multitude of naysayers and roadblocks when he led the efforts to have family practice recognized as the 20th medical specialty in 1969. To achieve that recognition required meticulous documentation and high standards of definition as to the training and responsibilities of the family physician. In other words, family physicians defined themselves. And Dr. Pisacano understood the importance of defining ourselves.
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My journey to family medicine
By Laci Waner, M.D.
When I was a child, there were two physicians in my small town and both were family physicians. Thus, I based my idea of a physician on these two men: a man who treats each member of an entire family, a community leader, wears boots, has a polished log with a saddle for kids to ride in the waiting room, and has a jar full of stickers and suckers for post-visit rewards. When I asked for a doctor’s kit one Christmas and set up my first clinic for my dolls and toys in my bedroom, it was this idea of a physician that I aspired to be—minus the man part.
As I grew into an adult and started my journey in medicine, I initially strayed from my lifelong interest in primary care. I was drawn to the instant gratification of surgery and the false security in the idea of limited, specific knowledge in a specialty. After exploring my interest in research, I embarked on my time in medical school much the same as any other student. I did not bargain for the expanded education I received from life while completing my school’s pre-clinical courses. The saying “sometimes life happens whether you are a student or not and whether you have a test or not” became more than just words to me. In addition to many educational experiences in medical school, I married my husband, Chris; gained a son we named Kylen; buried my father, Dudley; and gave birth to our second child, Addyx. My third-year rotations, especially the one in family medicine, greatly influenced my decision to pursue my desired specialty. However, they cannot compare to the influence that life imposed.
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Hearing voices
By Lloyd Van Winkle, M.D.
TAFP’s senior delegate to the AAFP Congress of DelegatesThis year’s AAFP annual session will mark the end of my service as chief delegate from Texas to the American Academy of Family Physicians Congress of Delegates. It is the office that affords one the special privilege of speaking from the floor and participating in debate concerning the broad spectrum of issues that come before AAFP’s legislative body.
Speaking on the floor of the Congress of Delegates is a bit of a heady experience. You rise from your seat and walk to a microphone. Once there, you make sure your thoughts are in order, pause while cultivating butterflies, and wait to be recognized by the speaker of the Congress. Once recognized, you take a deep breath, muster some spit, and identify yourself. I start with the customary statement of my name and state: “Van Winkle from Texas.” You then address your fellow delegates in a manner you hope will be clear and understandable. You would also like your comments to be eloquent enough to persuade others. If you are like me, you secretly pray that at least you won’t sound like an idiot and embarrass your state.
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