Archives
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Independent physicians are disappearing and communities suffer for it
By Christopher Crow, MD, MBA
Every six months, leaders and physicians in the Catalyst Health Network—independent physicians all—get together to talk over what’s going on in our network and in health care generally. They’re great meetings. I always leave fired up about our work and I think my fellow physicians do, too.
These convenings are especially encouraging at this time when there is so much pressure on physicians to join big hospital systems and affiliated medical groups. Such mergers are driving health care economics in Texas and across the country — and they’re creating big problems for patients, physicians, and communities.
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Looking ahead to 2020—Seeking clarity in a cloud of change and disruption
By Tom Banning
TAFP CEOMomentum continues to grow for value-based payment initiatives and other alternative payment models to fee for service. According to a report from the Health Care Payment Learning and Action Network, 34% of all U.S. health care payments in 2017 were tied to the value of care delivered, up from 23% in 2015.
The Centers for Medicare and Medicaid Services has led the charge toward value-based payment models, through various programs that design, pilot, and reward providers’ participation in them–pay for performance, Medicare Shared Savings ACOs, bundled payments, etc. Additionally, Medicare Advantage participation continues to grow and flourish. Commercial insurers are also beginning to aggressively drive payment models away from fee for service toward total cost of care, capitation, and value-based payments through exclusive provider or narrow networks.
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President's Letter
Private practice: Are we approaching the end of the road?
By Rebecca Hart, MD
TAFP PresidentIs private practice obsolete? Can it be saved, and if so, who will save it?
Such questions dog many of our colleagues in family medicine. We struggle to keep small businesses thriving amid ever-increasing administrative hassles and expenses. All the while, disruptive new market entrants threaten to upend the mores and norms we’ve always known.
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Funded delegate spots and scholarships available for NCCL and ACLF
Each year, AAFP holds the National Conference of Constituency Leaders and Annual Chapter Leader Forum together in Kansas City, Missouri. NCCL representatives and ACLF attendees from across the nation gather to discuss various issues, suggest policies and programs to AAFP, and receive leadership training. In 2020, the conferences will be held April 23-25 and TAFP is looking for members to serve on the delegation or apply for scholarships to attend.
TAFP opportunities for NCCL
Spots are available for 10 TAFP members to represent each of the five constituencies: new physicians (physicians who have been out of residency for seven years or fewer), women, minorities, international medical graduates, and LGBT physicians. TAFP reimburses up to $1,200 for expenses for each of the five delegate and five alternate delegates. In addition, TAFP offers two other opportunities to attend NCCL with funding. These scholarships will be awarded to one third-year resident and one minority physician.Interested? Please send a current curriculum vitae and a statement of intent to Jonathan Nelson at jnelson@tafp.org by Friday, Dec. 20, 2019. Be sure to let him know which constituency or constituencies you would like to represent.
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TAFP announces innovators competition prize winners
Academy launches Behavioral Health Integration Toolkit
The judges’ tallies are in and we have three winners in TAFP’s first-ever Behavioral Health Integration Innovators Competition. In May, the Academy put out a call to primary care practices asking them to submit their unique models of behavioral health integration for the chance to win $10,000. Entries were judged by the TAFP Behavioral Health Task Force, which was appointed after the Academy identified the need for greater integration of behavioral health services in primary care as a top priority in its strategic plan.
The judges selected winners in each of three care settings: academic health centers, integrated health systems, and solo and small group practices. The winners are the Memorial Family Medicine Residency Program of Sugar Land in the academic setting category, the Heart of Texas Community Health Center of Waco in the integrated health systems category, and the Hope Clinic of McKinney in the small group and solo practice category.
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Plan now for Hard Hats for Little Heads month
By TMA Staff
Like the Panhandle community of Perryton, you, too, can help ensure that kids in your community have helmets as TMA celebrates the 25th birthday of the Hard Hats for Little Heads program in October.
A hit-and-run accident in Perryton earlier this summer sent a 10-year-old bicyclist to the hospital and prompted the community to host a local bike safety workshop. TMA member Rex L. Mann, MD, a Perryton family physician, got busy to make sure the event featured a TMA helmet giveaway, a first for the community. These local family physicians, along with Dr. Mann, helped provide helmets for the event: Manon E. Childers, MD, Blake A. DeWitt, MD; Jennifer T. McGaughy, DO; and Rick A. Siewert, DO.
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The health care zombie apocalypse
By Janet Hurley, MD
There was once a time when I believed that organized medicine would play a major role in creating a sustainable health care product for our nation. Admittedly our organized medicine leaders have a lot of great ideas, many excellent skills, good relationships with lawmakers, and brilliant expertise. However I learned with sadness as time progressed that the dysfunctions in Washington, D.C., and Austin are unlikely to lead to substantive health care changes. While our organized medical societies give wise advice, our lawmakers are not always listening.
I then turned my energies to the private sector and focused my leadership on a large integrated health care system that emphasized and respected high-value primary care. I had hoped that these kinds of systems could leverage their medical homes, medical neighborhoods, and IT systems to more optimally coordinate care and reduce waste. Yet once I entered that world, I became aware of the massive regulatory burden facing our hospitals today. The relentless push to become a Joint Commission-accredited, “high reliability organization” with “zero harm” is commendable, yet requires the hiring of multiple levels of safety officers, nursing leaders, and administrative leaders, and the development of many more “clicks” in the electronic medical record that leads to massive nurse burnout rates in our country.
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President's Letter
Accomplishments and challenges in a busy year
By Rebecca Hart, MD
TAFP PresidentGreetings colleagues. As I reflect on this year so far, it’s been a whirlwind! We have seen major accomplishments, but huge challenges lie ahead. Let’s recap where we are on several issues.
Accomplishments: The 86th Texas legislative session ended with a few significant wins for family medicine. We retained our funding for the Family Medicine Preceptorship Program and Physician Education Loan Repayment Program. We successfully protected funding levels for existing residency training programs while the Legislature increased graduate medical education expansion funding by $60 million. And once again, we defeated challenges to our scope of practice and turned back efforts by nurse practitioners to practice medicine independently.
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Join us in San Antonio or stream live from home: Emergency and Urgent Care live course
Attend the AAFP’s Emergency and Urgent Care live course from your home or join your peers in San Antonio, Texas, October 9-12.
Know the latest treatment options in emergency and urgent care settings, gain
hands-on skills, and recognize when to treat and when to refer. At the end of this course, you will be able to:- Prepare treatment plans for patients who present to emergency departments and/or urgent care clinics.
- Evaluate, diagnose, and treat patients with acute health needs affecting any number of body systems, including cardiovascular, respiratory, neurological, maternity, psychological, or musculoskeletal conditions.
- Incorporate emergency plans into practice, including written protocols and necessary equipment/tools for treatment.
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Recent challenges to a culture of patient safety
By Travis Bias, DO, MPH
A culture of patient safety built over the past 20 years is encountering roadblocks. Policies and recent events that defy both research and initiatives geared towards strengthening health care safety, whether intentional or not, must be highlighted to ensure we continue to move the ball in the right direction.
Recently a New York Times story highlighted the “culture of secrecy” that protects hospitals from disclosing their name when an outbreak of a drug-resistant bug occurs within their walls. Defenders of the policy argue this encourages hospitals to promptly report these outbreaks to the Centers for Disease Control and Prevention without fear of negative publicity.
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President's Letter
Mergers, acquisitions, and the family physician — where do we fit in?
By Rebecca Hart, MD
TAFP PresidentRecently I have been hearing a lot of angst from colleagues about all the impending mergers of large retail corporations, insurance companies, and pharmacies starting up primary care clinics complete with urgent care, lab, imaging, and other amenities. My colleagues are gnashing their teeth wondering if they’ll be forced out of business by yet another corporate takeover. First the hospitals, now this.
The CVS/Aetna partnership brings us HealthHUBs in CVS stores, a health care “destination” with nurse practitioners at the helm and a “care concierge” to direct the patient to CVS services. They are associated with physicians only as reviewers of the NPs, because this is required by Texas law. They are not even on the payroll, but act as consultants — a very distant role. These physicians are not involved in directing the company or directing the primary care at all.
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Border crisis: How you can help
With the increase in immigrants seeking asylum along the southern border, physicians and charitable organizations are struggling to provide needed care, supplies, and shelter to migrants in their communities. A recent article in Kaiser Health News describes the situation this way:
“In the absence of a coordinated federal response, nonprofit organizations across the 1,900-mile stretch have stepped in to provide food, shelter and medical care. Border cities like El Paso, San Diego and McAllen, Texas, are used to relying on local charities for some level of migrant care. But not in the massive numbers and sustained duration they’re seeing now. As the months drag on, the work is taking a financial and emotional toll. Nonprofit operators are drawing on donations, financial reserves and the generosity of medical volunteers to meet demand. Some worry this “new normal” is simply not sustainable.”
Many members along the border are working with local charities to provide care and services and we know many more members would like to help. Here are some organizations and opportunities to contact if you are interested. If you are working with other organizations or know of other opportunities, please email Jonathan Nelson, jnelson@tafp.org.
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TAFP residents and students elect their 2019-2020 officers
The 2019 CFW Resident and Student Track drew family medicine students and residents from all over the state. Participants received a warm welcome from TAFP President, Rebecca Hart, MD, learned how to break bad news to patients, explored physician employment contracts, got an in-depth look into the 86th Legislative Session from CEO/EVP of TAFP, Tom Banning, and much more.
In addition to lively 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. The following are the 2019-2020 resident and student officers.
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TAFP members ask House committee to invest in physician loan repayment program
By Jonathan Nelson
Last week two TAFP members testified before the House Higher Education Committee, asking for support for House Bill 2261 by Rep. Armando Walle, D-Houston, and Rep. Matt Schaefer, R-Tyler. The bill would increase the maximum payout of the Physician Education Loan Repayment Program from $160,000 to $180,000 for physicians who agree to practice for four years in a federally designated Health Professional Shortage Area. The bill has a companion in the Senate, SB 998 by Sen. Juan “Chuy” Hinojosa, D-McAllen.
In 2009, the Texas Legislature greatly enhanced the existing Physician Education Loan Repayment Program by changing the way smokeless tobacco is taxed and designating part of the difference to physician loan assistance. That allowed physicians to receive up to $160,000 to pay off their educational debt in return for four years of service, and that’s a deal many physicians have been eager to make. In the past five years, the program has enrolled well over 750 physicians who are now caring for patients in rural communities, urban centers, community health centers, and correctional facilities – all places where Texans suffer a lack of access to care.
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Your Academy in 2019 and beyond
By Jonathan Nelson
TAFP’s new strategic plan focuses on helping members care for patients
Last fall, the TAFP Board of Directors approved a new strategic plan for the Academy designed to strengthen the organization and ensure it works to help members do what they do best: take care of their patients and their communities. The plan is the culmination of a yearlong process led by TAFP’s elected leaders and a select group of other leaders. It will help guide Academy actions and endeavors for the next three to five years.
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The aging physician model
By Larry Kravitz, MD
I had a retirement role model once. A secret role model, who didn’t retire. In the moment, I never told him of my admiration. I was just passing through his clinic, 40 years ago, and never knew how long his impact would remain within me.
As a fourth-year medical student at George Washington University, I had signed up for a tropical medicine elective at the Gorgas Institute in Panama, one of the top infectious disease research institutes in the Western Hemisphere. Gorgas was created in 1921, named for Dr. William Crawford Gorgas, who eradicated yellow fever in Panama, thus facilitating the construction of the Panama Canal. Interspersed with the daily lectures, we rounded in the hospitals and saw florid cases of tetanus, measles, and typhoid. We went on field trips including visiting a leper colony, a living museum of medical history.
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President's Letter
Strong family physicians, strong medicine, strong patients
An excerpt from the inaugural speech of the new TAFP PresidentBy Rebecca Hart, MD
TAFP PresidentI am so humbled, joyful and happy to begin work as your new president. Thank you for electing me and giving me this opportunity to serve you. I hope you join me this year in working harder than ever to keep our profession strong, our physicians inspired, and our workforce increasing.
When I began my career as a resident in Family Medicine at Baylor College of Medicine Residency Program in 1988, I was naïve. I knew nothing of the big issues that would face me in my future as a family physician. I knew nothing of CMS, preauthorization, payment reform, physician shortages, mid-levels, MACRA, EHRs, quality incentive programs, or Medicare Advantage plans. Heck, most of these things didn’t even exist back then! I knew only that I loved every rotation back in medical school, so family medicine was right for me. I wanted to be a full-scope family doctor, deliver babies, and work in a small town in Texas to make a difference in people’s lives.
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FPs testify before appropriations committees
By Jonathan Nelson
In yet another week of important committee meetings at the State Capitol, two family physicians provided testimony on some of TAFP’s top legislative priorities for the 86th Texas Legislature. On Monday, February 11, the House Appropriations Subcommittee on Article II convened to hear testimony from agencies and the public. Article II of the state budget contains funding for all agencies and programs that fall under Texas Health and Human Services, including Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more.
TMA President and former TAFP President Doug Curran, MD, of Athens, told the committee that while Texas is indeed booming with a strong economy and lots of opportunity, many of the state’s health care statistics rank well below the national average.
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Family doctors tell Senate Committee to expand access to women's health services, raise Medicaid payment rates
By Jonathan Nelson
The Texas Legislature approached full stride this week as some of its most powerful committees began hearing testimony from state agencies and the public. The Senate Finance Committee took up Article II of the state budget, which contains funding for all agencies and programs that fall under Texas Health and Human Services. That includes Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more. At roughly $80 billion for the biennium, Article II accounts for more than a third of total state expenditures.
Antonio Falcon, MD, of Rio Grande City, was the first TAFP member to address the committee on Wednesday morning, February 6, advocating for one of organized medicine’s top legislative priorities, the allocation of funding to ensure competitive and appropriate Medicaid payments. Those payment rates have not been increased in a meaningful or enduring manner in nearly two decades. Yet physician practice costs have increased by about 3 percent each year.
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Restoring funding to family medicine residency programs a top priority for TAFP in the 86th Lege
By Jonathan Nelson
We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.
This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.
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