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Taking your Boards? Choose the best Board Review for family physicians. Choose AAFP Board Review Express ®.
AAFP Family Medicine Board Review Express ® Live Course in Dallas, Feb. 21 - 24
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Support the AAFP Foundation with the dues check-off campaign
When you renew your annual AAFP/TAFP membership this fall, consider supporting the AAFP Foundation by making a $50 check-off donation on your dues form. Your contribution will ensure that the important work of the Foundation continues at the state and national levels.
Go to the AAFP website to pay your dues.Your dollars will fund grants for chapter-level programs through the Family Medicine Philanthropic Consortium as well as AAFP Foundation humanitarian, educational, and research initiatives. All programs are designed to advance the values of family medicine and improve the health of all people.
The dues check-off is the easiest and fastest way to support your state and national Foundation. Your $50 gift:
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Add AAFP Virtual Care to your family medicine practice
Boost access, increase revenue with telemedicine
By Sheri Porter
The AAFP has launched a new telemedicine software platform designed specifically for family physicians working in small and medium-sized practices with fewer than 20 physicians. Called AAFP Virtual Care, the platform is powered by the virtual care technology company Zipnosis and aims to provide physicians and their patients with an easy way to connect.
This new member resource comes at a most opportune time, according to Steven Waldren, MD, director of AAFP’s Alliance for eHealth Innovation.
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Advocating for women's health in the 86th Texas Legislature
By Evelyn Delgado
Texas Women’s Healthcare Coalition Chair and Healthy Futures of Texas President/Executive DirectorThe texas women’s healthcare coalition is a nonpartisan organization dedicated to improving the health and well-being of women, babies, and families by ensuring access to preventive care — including contraception — for all Texas women. Our membership includes health care organizations, provider organizations, advocacy organizations, and faith organizations from across the state. We strive toward our mission by working with state legislators on women’s health policy issues, educating the public on the landscape of women’s health in Texas, and through building relationships with state agency leaders to improve the programs serving Texas women.
Since its formation, TWHC has advocated for priority issues during each Texas legislative session with the goal of improving access to women’s health services. The No. 1 priority is always to protect funding for the state’s women’s health programs and advocate for more funding to meet the statewide need for family planning and preventive health services.
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Our next moonshot – Apollo 13 and the state of behavioral health in Texas
By Janet Hurley, MD
If you have never seen the movie “Apollo 13,” I highly recommend it. It tells the story of a fateful NASA mission to the moon. In route to the moon, there was an explosion and the astronauts had to use the lunar lander module as a lifeboat. The movie tells the story of innovation, teamwork, and unbridled commitment toward the goal of bringing the astronauts home. The mission was called “a successful failure” because they failed to go to the moon, but they succeeded in bringing the astronauts home alive against terrible odds.
In my role as medical director of population health for my local health system, I have undertaken the task of developing a behavioral health program with the goal of having a behavioral health counselor embedded in each of our primary care clinics and psychiatrist consultants available to review behavioral health care plans, discuss cases with primary care physicians, and receive direct referrals. This is one good way to provide support to primary care while protecting a psychiatrist’s time to ensure that referrals are done for only the most difficult mental health patients. This has been my initial plan for mental health expansion in my organization.
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ABFM to pilot alternative to board exam
By Jonathan Nelson
At this year’s AAFP Congress of Delegates in New Orleans, the American Board of Family Medicine announced plans to pilot a longitudinal assessment alternative to the 10-year secure examination family physicians must take to maintain board certification. This option will be available to physicians who are current with continuous certification and are due to take the exam in 2019.
Based on ABFM’s popular Continuous Knowledge Self-Assessment platform, the new assessment option will deliver 25 questions online each quarter to diplomates who choose to participate.
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Looking for a few good family doctors to help improve a quality measure
By Shari Glickman, MSSW, PMP
The Centers for Medicare and Medicaid Services has contracted with Mathematica Policy Research to recruit provider practices to help test an electronic clinical quality measure, or eCQM. The measure title is “Documentation of a Health Care Partner for Patients with Dementia or Mild Cognitive Impairment.”
The measure requires that a patient’s health care surrogate or partner’s contact information (email address and/or phone number) be documented in structured fields of the electronic health record or electronic medical record. Testing activities include practice staff — clinicians and practice managers — speaking with the Mathematica team about the practices’ workflows and the data elements they capture in their EHRs. We also ask practices to submit an extract of de-identified patient-level data from the EHR for analysis, including the data elements required for the eCQM, such as a health care surrogate or partner’s contact information. Finally, we ask practices to permit trained chart abstractors to review the data elements in a sample of patient charts.
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Why MIPS-eligible clinicians need an EIDM account
TMF Health Quality Institute
The Enterprise Identity Management system enables health care providers to establish a single user ID to use across multiple CMS applications. Clinicians and applicable practice staff should have an EIDM account. This article will explain why clinicians who are eligible for the Merit-based Incentive Payment System should have an account and how to open and maintain an account.
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An emphatic plea for psychiatry support in our communities
By Janet L. Hurley, MD
It’s taken a while for me to be ready to write about this. It is challenging as a physician to have things go wrong with a patient—badly wrong. Such situations are a major cause of physician burnout and job dissatisfaction. Some years ago I had such an event, and the effect was harrowing.
Suffice it to say we need more mental health resources in many Texas communities to provide needed services to patients and support to primary care physicians. As I speak to family physicians across the state, I learn the challenges my region experiences with insufficient mental health access are not unique. I am tired of patients being dismissed from mental health institutions back into the care of their primary care physician because there is no psychiatrist to see them for follow-up. I am tired of the insufficient payment structure that makes psychiatrists move to cash-only arrangements, limiting a patient’s ability to afford their care. I’m tired of having to treat refractory depression, advanced bipolar, and psychosis, simply because there are limited psychiatrists to do it. This simply needs to change.
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Atlantic Health Partners offers low costs vaccines and support to TAFP members
By Perdita Henry
TAFP often engages, supports, and partners with organizations whose missions and values align with our own. Atlantic Health Partners is one of those organizations, and they are dedicated to making sure busy practicing physicians have access to the vaccines needed to keep their patients healthy.
They offer low prices on a comprehensive portfolio of immunizations and provide exemplary customer service.
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Preparing for the business side of running a practice
By Perdita Henry
TAFP recently launched the brand-new educational platform, Practice MEd, specifically designed to help residents learn the business side of running a practice.
This new educational tool incorporates user-friendly, interactive multimedia learning, and allows users to learn at their own pace. Practice MEd can be used as a standalone learning tool for practice management education or as a supplement to current training. These modules also count toward the 100 hours of health system management training required by the Accreditation Council for Graduate Medical Education.
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The Texas Council on Family Violence needs your help
By Perdita Henry
The Texas Council on Family Violence and associated researchers throughout the state are in the process of updating the Access to Safety, Justice, and Opportunity: A Blueprint for Domestic Violence Interventions in Texas, also known as the State Plan. The blueprint “serves as the core guidance document for determining and assessing underserved areas or populations as well as identifying and outlining any unmet needs for survivors of family violence.” It also serves as a funding map for both the Health and Human Service Commission Family Violence Program and the Family Violence Prevention and Services Act fund and contains a detailed inventory of family violence programs across the state.
Rachel Voth Schrag, PhD, LCSW, Assistant Professor of Social Work at the University of Texas at Arlington and lead researcher working on the State Plan, reached out to TAFP to talk about the challenges her team faces when it comes to identifying family violence survivors and the crucial role survivor interviews play in their research.
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Resident Voice: Why physician advocacy is important
By Leo Lopez, III, MD
During the 2017 Texas legislative session, I spent time at the State Capitol in Austin as a recipient of the TAFP Foundation James C. Martin, MD, Scholarship, appreciating the depth, scope, and importance of physician advocacy. In my time as a medical student and resident, I’ve watched health policy debates evolve. I’ve watched them triumph from inception to implementation. I’ve watched them fall in committee at the behest of a deluge of lobbying efforts and special interests.
As these important issues revolving around clinical practice, graduate medical education, and access to health care are debated, the relative silence of the physician voice is impressive. While many outstanding physician leaders make selfless sacrifices to protect patient and physician interests, the gross physician influence in advocacy and health policy is severely impoverished.
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Harris County Academy of Family Physicians hosts roundtable for medical students
By Jean Klewitz
HCAFP met for their third annual medical student roundtable on Tuesday, March 6, to host an open discussion on family medicine. The mission of the discussion is to dispel myths about family medicine often heard by students in academia. Members welcomed 28 medical students for dinner at Houston’s Baba Yega restaurant. It was an evening of frank questions and enlightening conversation in which even salary amounts were openly discussed.
HCAFP President, Lindsay Botsford, MD, MBA, kicked off the presentation by telling the students that the goal was to break down barriers and “meet people who are actually doing family medicine.” Botsford moderated the nine-physician panel, which included physicians in academics, solo practice, and group practice. With the variety of careers represented on the panel, Botsford encouraged students to reach out after the discussion if they wanted a personal connection with someone who is practicing in a way they envision for themselves. Unable to represent the whole gamut of family medicine on the panel, Botsford said, “That’s the beauty of family medicine… we have so much diversity in what we do that we just couldn’t even represent it all here tonight.”
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The supportive infrastructure primary care needs to combat the opioid crisis
By Janet L. Hurley, MD
Earlier this year, I had the privilege of representing Texas family physicians at a conference sponsored by Superior Health Plan called “Changing the Paradigm in the Treatment of Chronic Pain and Substance Use Disorder in Texas.” As a middle-aged primary care physician who grew up in the era of “pain is the fifth vital sign,” I was frustrated by some comments made by legislators and health care policymakers, many of whom are not primary care physicians and have no idea what it is like trying to apply new pain guidelines to patients who are suffering. It is time to empower primary care physicians with the tools needed to manage these patients humanely and safely.
The patients we worry the most about, who have had childhood traumas and diffuse pain syndromes, often take combination drugs like benzodiazepines and opiates, and are some of the hardest to treat. We are told by new CDC guidelines that we should try to minimize treatment with these drugs, yet these patients often have intense psychosocial needs that our medical communities are not equipped to address. Experiments done in other areas where physicians made a firm stance against ongoing prescribing have sometimes led to higher overdose deaths from illicit drug use.
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Courage on display at Community First Village
By Larry Kravitz, MD
Why write about courage in medicine now? Simply because we are witnessing an erosion of ethics, truth, science, and altruism in our society. Not that the world has become a vast Sodom and Gomorrah, but we are seeing more amplified abandonment of idealism in front of us daily, and I have found myself more and more challenged to find public leaders embracing selflessness. It is more tempting to abandon ideals when society doesn’t seem to value them anymore. So let us look back on an era where Washington, D.C. was once referred to as “Camelot” and idealism was the dream of the entire American realm, and let us decide together to still be courageous.
The idea for John Kennedy’s 1955 Pulitzer Prize winning collection of essays, “Profiles in Courage,” was perfect. The young Senator Kennedy prepares for a future of statesmanship and service by delving back to find beacons that could light his way forward in government.
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Eight minutes to set the course for your Academy
By Perdita Henry
You may have noticed a few emails encouraging you to complete the 2018 Member Survey. This isn’t just any survey. Your responses will guide TAFP leadership and staff during the upcoming strategic planning meeting.
Every few years, TAFP begins the process of preparing for what’s next and asks its members to share in-depth information about themselves and the future as they see it. Those answers drive an immersive meeting where TAFP leadership will begin charting the course for the Academy’s next few years. The last time we sent out a survey of this nature was a few years ago and so much has changed since then.
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Lessons of Life
By Tasaduq Hussain Mir, MD, FAAFP
It has been almost a year now since I read the powerful book, “When Breath Becomes Air,” a neurosurgical scholar’s account of his losing battle with cancer. Dr. Paul Kalanithi died at a very young age of 36 due to lung cancer that had spread from his lungs to his brain.
“When Breath Becomes Air” is about a journey toward an imminent death. This book is a doctor’s account as a patient and the reciprocal relationship between him and his doctor. It is about an uncomfortable sense of vulnerability when it comes to physicians being on the other side of the table as patients. It is also about our gratitude for what we have in our hands and how to reconcile with what is beyond our reach. It is about our appreciation for each and every blessing that comes our way without us realizing it.
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Family physicians can improve access to women’s health services by providing LARCs
By Melissa Benavides, MD
There is tremendous need across the state of Texas for increased access to women’s health services. As a physician representing the TAFP on the Texas Women’s Healthcare Coalition, I would like to remind my colleagues that family physicians are well positioned to fill this void. Even some of the smaller, more remote towns throughout our state are served by dedicated family physicians who have equipped themselves to provide convenient, wide-ranging women’s health services. As many patients prefer and trust their family physician, we are well-positioned to make positive impacts on the health status of women and children throughout Texas.
I would like to address two major steps we can take as family physicians to improve the availability and convenience of women’s health services in our state.
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TAFP residents and students elect 2018 officers
The 2018 C. Frank Webber Lectureship and Interim Session Family Medicine Resident and Student Track drew students and residents from all over the state. Participants received a warm welcome from TAFP President, Janet Hurley, MD, explored the frontier of telemedicine, got an in-depth lesson on family medicine finances from past president of TAFP and president-elect of TMA, Doug Curran, MD, and much more.
In addition to timely discussions and presentations, the Section on Resident Physicians and the Section on Medical Students held elections for various officer positions. Officer candidates had the chance to talk to their colleagues about their professional passions and how they would represent resident and student TAFP members within the Academy.
TAFP Resident Section Officers
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Family medicine’s best gather in the capital city.
By Perdita Henry
Texas’ best and brightest family physicians gathered in Austin, April 13-14, to learn the latest in CME, determine the direction of the Academy, and reconnect with colleagues from across the state during the annual C. Frank Webber Lectureship and Interim Session.
More than 400 physicians, residents, medical students, and other health care professionals took part in the yearly event, featuring an energetic exhibit hall, vibrant committee meetings, and special learning opportunities and activities beyond the CME lecture hall. CME attendees had the opportunity to earn up 17 AMA PRA Category 1 Credits™ and AAFP Prescribed Credits.
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Learn the benefits of ImmTrac2
Your patients have a lifetime of vaccines ahead of them. The easiest way to keep them organized is ImmTrac2, the Texas Immunization Registry. The Texas Department of State Health Services provides this registry. It is secure and confidential, and safely consolidates and stores Texans’ immunization records in one place.
ImmTrac2 replaces the ImmTrac system launched in 1996, and now offers expanded capabilities including immunization history, forecasts, reminders, instant reports, easy edit/delete functions, and resettable passwords.
With more than 164 million vaccine records, the registry is a major component of DSHS’s initiative to increase immunization coverage across Texas.
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ABFM invites board-certified family physicians to enroll in PRIME Registry free for the first three years
By ABFM staff
PRIME Registry is a practice and population data tool developed by the ABFM that safely extracts patient data* from your electronic health records and turns it into actionable measures, presented in an easy-to-use, personalized dashboard, maintaining its full confidentiality. PRIME not only simplifies quality reporting for payment programs such as MIPS and CPC+, but also allows you to better evaluate aspects of your practice, patient groups, and individual patients, illuminating gaps or successes in patient care.
Another bonus for ABFM Diplomates is the integrated Performance Improvement activity tool. This allows Diplomates to easily use EHR data to complete PI activities and earn points toward the ABFM continuous certification requirements.
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Transitioning from resident to new physician
By Alyssa Molina, MD
When it comes to residents transitioning into practice, there are a few things I would stress. Know where you would like to be on the job continuum between autonomy and security. You could have a completely autonomous position. You own your own practice, you decide when you’re opened, when you are closed, and what you do. While you’ll have complete autonomy, you won’t have security. If you are sick and you don’t come to work, you don’t get paid. At the other end of the spectrum, you have the security of being employed by a practice. In that practice, they decide how many patients you see, how many vacation days you get, and so on. There’s very little autonomy, but you have job security. You always get a paycheck, and it doesn’t matter how many patients you see. Most jobs are somewhere in the middle so, it’s important that you figure out for yourself, and your family, where you are comfortable on the spectrum.
Where I’m currently employed, I have a lot of autonomy. If I choose to take off, I just make sure I’m not on call and that someone’s covering the clinic. I’m paid based on my productivity so there isn’t a certain number of days I have off each year. If I’m willing to take a smaller paycheck, I could take off more days and still have a job when I get back. Where I am on the continuum provides me with a base. They do all the billing for me, so I don’t have to worry about that.
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Chewing on a big fat wad of gum
By Janet Hurley, MD
Changes in health care have been fast and furious in the last several years. The advent of MACRA created the need to prepare for MIPS and APMs, and more robustly report on quality and cost. There is an ongoing desire for interoperability and EMR modifications requiring more “clicks” than we would like. Many physicians have added new types of team members to their practices, such as social workers, nurse navigators, or care coordinators to reach out to patients in new creative ways.
Some of this has been good for patients, and some of it possibly not. Some days it feels like physicians are chewing a big fat wad of gum, and feeling choked.
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Looking for a few good family doctors to help improve a quality measure
By Jonathan Nelson
Want some extra cash and a chance to help refine and validate a Medicare quality measure? Check out this email we recently received from Shari Glickman, a program analyst with Mathematica Policy Research, Inc.
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MIPS 2018 update: Revised claims codes for quality measure reporting
By TMF Health Quality Institute
Eligible clinicians participating in the Merit-based Incentive Payment System who plan to report MIPS quality measures using claims should be aware that some claims codes have changed for the 2018 performance period. Following are answers to common questions about the claims-based reporting.
Question: We noticed some of the 2018 Quality Data Codes for claims submissions have changed. If my practice submits claims using the previous codes, will they count toward our MIPS quality measure submission for the 2018 period?
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The Primary Care Leadership Collaboration empowers the next generation
By Perdita Henry
Leaders aren’t born, they are made. Good leaders know how to listen, they know how to communicate, they practice what they preach, and they know how to encourage their team members to utilize their unique talents. They also know how sharing their values through storytelling can inspire others to join their mission. The American Academy of Family Physicians, Family Medicine for America’s Health, and Primary Care Progress recognize the importance of leadership training, which is why they joined forces to create the Primary Care Leadership Collaborative.
“Building on the unique strengths of each of the partner organizations, this yearlong learning collaborative will provide structured teaching, coaching and support to enable teams of Family Medicine Interest Group participants to have significant impact on the state of primary care delivery and education at their local institutions and in their communities,” the PCLC stated in a frequently asked questions document distributed to participants.
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Q&A: MIPS Reporting for 2017
By TMF Health Quality Institute
Clinicians participating in the Merit-based Incentive Payment System (MIPS) path of the Quality Payment Program (QPP) must report their 2017 data to the Centers for Medicare & Medicaid Services (CMS) between Jan. 2 and March 31, 2018. (The data submission window for clinicians using the CMS Web Interface is Jan. 22 to March 16.) Following are answers to common questions about the reporting process.
Question: How many MIPS measures and activities do I need to report for the 2017 performance year?
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Answer: For the 2017 transition year, clinicians may report using the test, partial-year or full-year option. Those who go beyond the test option can earn a positive payment adjustment. Minimum reporting requirements for each are: -
What happened to Tar Wars?
By Perdita Henry
In 1988, Jeff Cain, MD, and Glenna Pember, of the Hall of Life and Doctors Ought to Care, had an idea about keeping kids away from tobacco products. They would go on to create Tar Wars, an educational program for fourth- and fifth-grade students. In the 30 years since the first class, Tar Wars has reached more than 10 million children across the globe. The program was eventually bought by AAFP and it became an opportunity for local family physicians, residents, and students to visit classrooms and discuss the health risks associated with smoking, the financial costs of the habit, and the sneaky ways advertisers market their product to young people. In the last few years, the program hasn’t seemed to bring the passion and excitement that it once did. The TAFP Commission on Public Health, Clinical Affairs, and Research wants to see that change.
At a number of commission meetings, members have reminisced about visiting children in their community and teaching them the importance of remaining tobacco free. Visiting schools with the Tar Wars message, by all accounts, seemed to bring joy to students and participating physicians alike. “I loved those mornings at school,” says John Carroll, MD. “I had five classrooms to visit and I spent 35 to 40 minutes with each. We flew through the discovery of being targeted by the second largest public advertising campaign.” After spending time with their local physician, the kids had the opportunity to create their own posters featuring their personal brand of tobacco-free messaging. Those posters were then submitted to state chapters and one would be chosen as the state winner. The Texas winner would receive the prize of hotel and airfare to present at the Tar Wars National Poster competition.
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