TEXAS FAMILY PHYSICIAN VOL. 67 NO. 1 WINTER 2016
PLUS: What You Need To Know About Medicare’s New Merit-Based Incentive Payment System And Alternative Payment Models Report, Photos From Annual Session & Primary Care Summit
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INSIDE TEXAS FAMILY PHYSICIAN VOL. 67 NO. 1 2016
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The richest man in the world
Meet the 2015-2016 Texas Family Physician of the Year: Antonio Falcon, MD. Born and bred in Rio Grande City, Falcon knew he wanted to return to the small town to practice family medicine after finishing residency. He saw the need there for more physicians and wanted to help. He has been in the border town ever since, growing a bustling practice and raising a family.
6 FROM YOUR PRESIDENT An adaptation of the 2015-2016 incoming president’s address 8 NEWS FROM AAFP The end of Medicare bonuses for primary care underlines the need for new payment models.
By Samantha White
After the SGR: Alternative payment models
14 MEMBER NEWS Annual Session highlights and photos| In memoriam: Glen Journeay, MD, PhD
With the sustainable growth rate gone, now is the time to familiarize yourself with what the Centers for Medicare and Medicaid Services are bringing online next.
27 HHSC NEWS New tool makes finding Medicaid patient records easy.
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By Jim Walton, DO, MBA
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MACRA FAQ
AAFP’s practice management experts present another excellent resource. Here’s what you need to know about the new payment models in the Medicare Access and CHIP Reauthorization Act of 2015.
By AAFP Staff
30 FOUNDATION FOCUS Thanks to 2015 TAFP Foundation donors. 30 TAFP PERSPECTIVE Skipping the negative and accepting the maybe
SAMANTHA WHITE
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PRESIDENT’S COLUMN
TEXAS FAMILY PHYSICIAN VOL. 67 NO. 1 WINTER 2016 The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. TEXAS FAMILY PHYSICIAN is published quarterly by TAFP at 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Contact TFP at (512) 329-8666 or jnelson@tafp.org.
OFFICERS president
Ajay Gupta, MD
president-elect vice president
Tricia Elliott, MD
Javier “Jake” Margo, MD
treasurer
Janet Hurley, MD
parliamentarian
Rebecca Hart, MD
immediate past president
Dale Ragle, MD
EDITORIAL STAFF managing editor
Jonathan L. Nelson
associate editor
Samantha White
chief executive officer and executive vice president
Tom Banning chief operating officer
Kathy McCarthy, CAE
advertising sales associate
Michael Conwell CONTRIBUTING EDITORS Janet Hurley, MD Jim Walton, DO, MBA Robert Wergin, MD cover photograph
Samantha White
SUBSCRIPTIONS To subscribe to TEXAS FAMILY PHYSICIAN, write to TAFP Department of Communications, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Subscriptions are $20 per year. Articles published in TEXAS FAMILY PHYSICIAN represent the opinions of the authors and do not necessarily reflect the policy or views of the Texas Academy of Family Physicians. The editors reserve the right to review and to accept or reject commentary and advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorsement by the Texas Academy of Family Physicians of the product or service involved. TEXAS FAMILY PHYSICIAN is printed by AIM Printing and Marketing, Austin, Texas. LEGISLATIVE ADVERTISING Articles in TEXAS FAMILY PHYSICIAN that mention TAFP’s position on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. The person who contracts with the printer to publish the legislative advertising is Tom Banning, CEO, TAFP, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. © 2016 Texas Academy of Family Physicians POSTMASTER Send address changes to TEXAS FAMILY PHYSICIAN, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6
TEXAS FAMILY PHYSICIAN WINTER 2016
Strength in numbers An adaptation of the 2015-2016 incoming president’s address By Ajay Gupta, MD TAFP President meeting your colleagues, we both get what greetings colleagues. I am humbled and we need from our association and we enable honored to serve as president of this extraorour association to provide ever greater supdinary Academy and I want to thank all of port for our specialty. those leaders and physicians who have menThat’s what membership is all about, and tored me and guided me along the way as so I encourage you to get involved and to stay well as my wonderful family for their steadinvolved. If you’re already involved—thank fast support. you, keep it up, we need you. If you are sitting I became involved in the Texas Academy on the sidelines and waiting in my second year of pracfor the right moment, now is tice because it equipped the time to suit up. me with the tools to make Our membership Let me give you a recent my practice better. As you in TAFP gives us personal example of why it is know, TAFP provides some so important to be involved of the best CME available the opportunity and how TAFP helped me. and is produced for family to do things Over the last year I’ve physicians by family phycollectively that spent a good deal of time sicians. The Academy has learning about alternative helped me maintain board we can’t do payment models—accountcertification, which as you individually— able care organizations or all are aware is an important whether it is to ACOs, in particular. After process and not easy to do. The Academy also provides support a medical much thought and considerour practice decided to a range of practice support student interested ation, join two ACOs in our city—a services to help my practice in becoming a hospital-directed ACO and a be more efficient. At our physician-led ACO. statewide meetings I get family physician I was asked to serve on the the chance to network with or to influence board of the hospital ACO, other family physicians to public policy while my partner joined a hear about the latest trends committee on the other one. in health care delivery and decisions. The Now let me give you a payment—what’s working Academy gives us little background on our and what’s not working. a voice. hospital ACO. Their board is But perhaps most imporcomprised of five physicians, tantly, the Academy gives us two of whom are primary the opportunity to do things care doctors and I’m the only family physician. collectively that we can’t do individually— So I probably don’t need to tell you how the whether it is to support a medical student conversation went when we began discussinterested in becoming a family physician ing how money should be distributed when it or to influence public policy decisions. The came to things like shared savings. I think the Academy gives us a voice. last four decades of payment in the health care So, what do we want to say and how industry provide a pretty good guide. should we go about saying it? It’s through But quite to my surprise, after getting our involvement that our message is shaped, some advice from TAFP staff and coaching that our ideas are generated, and our Acadfrom a couple of past TAFP leaders, I was emy is strengthened. By joining commitable to make a compelling argument to the tees and commissions, attending section board and my specialist colleagues that primeetings, coming to CME conferences and
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mary care needed to be fairly and appropriately compensated in any shared savings. As you can imagine things got a little tense. I was even asked at one point what would happen if specialists did not join the ACO. I retorted that primary care was doing the majority of the work to earn any shared savings, so what would happen if there were no primary care physicians to create the savings for everyone to share? In the final accounting, my voice was heard and the outcome was much more favorable then it would have been had I not been involved in our Academy and had I not had the resources and counsel TAFP provided me. Our collective voice was also heard when the U.S. Congress finally repealed the Medicare SGR. Our work, however, is not done. Starting in 2019, Medicare will institute two bonus payment tracks for physicians: a Merit-Based Incentive Payment System that consolidates existing Medicare fee-for-service physician incentive programs and a separate pathway to reward physicians for participating in alternative payment models, including ACOs and the patient-centered medical home. Our members need to be preparing now to choose a pathway or face penalties. Your Academy will be launching an aggressive education campaign, developing CME, webinars, and other resources to help its members make the best decision for their practice. Now is not the time to rest on our laurels. We need to continue to remind everyone that family medicine is the best hope to mend our broken health care system. We provide the best value out there, the most comprehensive care. The essence of our specialty is the key to fixing the system. We are compassionate. We treat the whole patient. It is who we are. Get involved in the Academy. Continue to make a difference with your patients, your community, and the health care system. Don’t let others decide what is best for family medicine and our patients. I appreciate the opportunity to serve as president of the Texas Academy of Family Physicians. I will provide all my effort to serve our state and national health care system. It will take all of us working together to improve health care in America. I’m excited to lead the path into a new chapter.
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AAFP NEWS
TAFP 2016
CME SCHEDULE C. Frank Webber Lectureship & Interim Session April 15-16, 2016 Omni Austin Hotel at Southpark Austin, Texas Texas Family Medicine Symposium June 3-5, 2016 La Cantera Hill Country Resort San Antonio, Texas Annual Session and Primary Care Summit Nov. 4-6, 2016 Nov. 2-3: Business meetings and preconference workshops
The Westin Galleria Dallas, Texas
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TEXAS FAMILY PHYSICIAN WINTER 2016
End of Medicare bonuses underlines need for new payment models By Robert Wergin, MD all physicians participating in Medicare will more than just the calendar year ended fall into one category or the other. on Dec. 31. The new year also marked the MIPS, while attempting to promote end of the Primary Care Incentive Program. quality and added value, still is based on The PCIP, created in 2010 as part of the fee-for-service. And as we have seen, that Patient Protection and Affordable Care Act, model continues to be a popular target pays family physicians and other primary for spending cuts. A multi-year federal care providers bonuses equal to 10 percent budget agreement led to a 2 percent cut of the amount Medicare paid them for to Medicare payments in 2013 and further primary care services if they met certain incremental reductions for several years, conditions. This bonus was an overdue step and Congress allowed the toward recognizing the Medicaid parity program— value of primary care. a provision of the ACA that The program paid $664 What it boils raised Medicaid physician million to primary care down to is that payments in line with practices in 2012, but how Medicare—to expire in much it will be missed alternative December 2014. depends somewhat on payment models The 2016 physician fee whom you ask. A survey are the path schedule called for a modest of primary care physi0.5 percent increase in the cians found that half were forward that physician payment converunaware of the program’s will provide sion rate. However, other existence. Some physicians stability and give legal mandates made even “boutique” their practices, that minimal increase too limiting their number of our practices tall a task for CMS because Medicare patients. But the greatest it failed to identify and many practices in rural and opportunity to adjust a required percentage underserved areas can’t do of overvalued CPT codes. As this, and they benefited thrive. a result, the Medicare physigreatly from the bonus paycian fee schedule will see a ments. Practices with large fractional decrease in the conversion factor Medicare panels certainly will feel the hit. in 2016, rather than a half-percent increase. Qualifying primary care physicians received What it boils down to is that alternative an average of nearly $4,000 a year. payment models are the path forward that Although the AAFP and other primary will provide stability and give our practices care advocates fought for an extension of the greatest opportunity to thrive. Onethe program, Congress showed little interthird of family physicians already are pursuest in prolonging a bonus program based ing value-based payments. on the fee-for-service model. As we have The AAFP recently submitted detailed seen in the Medicare Access and CHIP responses to 126 questions as part of a CMS Reauthorization Act of 2015 (MACRA)— request for information on how to implethe law passed earlier this year that ment new payment models associated with repealed the flawed Medicare sustainable MACRA. Early in 2016, the Academy will be growth rate formula—legislators are more rolling out materials that will help family interested in linking increased physician physicians better understand the choices, payments to certain quality and perfordeadlines and challenges that MACRA presmance standards. ents. Stay tuned. If you haven’t already, I strongly encourage you to start making yourself familiar Robert Wergin, MD, is Board Chair of the AAFP. with the alternative payment models and the merit-based incentive payment system, Source: AAFP Leader Voices Blog, Dec. 23, 2015. or MIPS, described in the new law. By 2019, © American Academy of Family Physicians.
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MEMBER NEWS
Family medicine thrives in The Woodlands Words and photos by Samantha White and Jonathan Nelson
family physicians and other health professionals from around the state gathered in The Woodlands Nov. 12-15, 2015 for TAFP’s Annual Session and Primary Care Summit. This was TAFP’s most well-attended conference ever, with almost 600 total registrants. Attendees networked, earned CME, shaped TAFP policy at committee and commission meetings, and celebrated the specialty of family medicine As always, attendees had opportunities to learn about a variety of topics during the scientific portion of the conference. Participants could also attend three Self-Assessment Module workshops Wednesday, Thursday, and Saturday, on childhood illnesses, geriatric care, and heart failure. The National Procedures Institute offered two popular courses, Casting and Splinting, and Sideline Management Assessment Response Techniques. The TAFP Foundation held a cocktail cruise on The Woodlands Waterway to benefit the Tamra Deuser, MD, Endowment. Thank you to Baylor Scott & White; The Dallas County Chapter of TAFP; Lewis Foxhall, MD; Memorial Hermann Health System; Texas Medical Association; and Texas Medical Liability Trust for being Gold 10
TEXAS FAMILY PHYSICIAN WINTER 2016
Level sponsors. Thank you also to Cory and Melissa Gerdes, MD; Nancy and Tim Lambert, MD; and ProAssurance for being Silver Level sponsors, and to Edwin Franks, MD, and Lisa and Jake Margo, Jr., MD, for being Bronze Level sponsors. The CME general session opened Friday morning with a presentation by TAFP CEO Tom Banning on the state of the Academy and of family medicine during this time of great change. The rest of the weekend’s CME included topics on risk evaluation and mitigation strategies for extendedrelease and long-acting opioid analgesics, common teen eating disorders, an ethics talk on cancer survivorship, a discourse on Medicare’s new payment structure after the repeal of the SGR, and much more. AAFP board member Jack Chou, MD, of California addressed attendees Sunday morning on advocacy, education, and family medicine for the nation’s health. Clare Hawkins, MD, gave a TAFP update during Friday’s Member Assembly Luncheon. Delegates from TAFP’s local chapters elected Brett Johnson, MD, and Christina Kelly, MD, to serve as at-large directors, and Emily Briggs, MD, to serve as the new physi-
cian director on the TAFP Board of Directors. Farron Hunt, MD; Shivum Agarwal, MD; and Chis Trinh were elected to serve as the special constituencies director, the resident physician director, and the medical student director respectively. TAFP’S 2015 AWARD RECIPIENTS AND NEW OFFICERS Saturday’s Annual Business and Awards Lunch began with members present voting to adopt the TAFP bylaws changes. Next, TAFP’s top honors were announced. Here’s a list of this year’s winners. PHYSICIAN OF THE YEAR: ANTONIO FALCON, MD Falcon returned to his hometown in the Rio Grande Valley after completing medical school in Houston and a residency in Waco. He has been practicing in Rio Grande City since 1980 and remains a staple of the community, helping to bring the first specialists to town in the mid-1980s because patients could not afford the drive to McAllen for appointments. Falcon also helped the community receive an additional nursing home, dialysis centers, and a permanent MRI. He co-chaired Governor Perry’s Proposition 12 campaign in 2003, recently served on the Texas Parks and Wildlife Commission, and was a presidential appointee to the United States-Mexico Border Health Commission. He is also a current member of the Texas Health and Human Services Council, mentors medical students through the Texas Statewide Family Medicine Preceptorship
Program, and serves as a clinical assistant professor for UTMB. After accepting the award, Falcon gave a little advice to his colleagues. “Always be kind to the patients. It’s just incredible how one act of kindness can be worth more than 10 prescription drugs. Don’t ever forget to tell your patient something nice about them when they are in that office with you. And don’t forget to touch them. Sometimes we forget how important the human touch is.” Read more on Falcon’s life in this issue’s cover story on page 16.
family physician in 1961. Over the years he worked in solo practice, a multi-specialty clinic, a 100-bed Catholic hospital, Christian missions worldwide, as medical director for numerous nursing homes, and more. He was vital in the creation of the Texas A&M Family Medicine Residency program in Bryan, and TAFP’s Brazos Valley Chapter. Pope still travels to the Texas-Mexico border multiple times a year for Christian missions, serves as Physician of the Day during the Texas Legislature every session, and is active in his church and community.
PHYSICIAN EMERITUS: H. DAVID POPE, JR., MD After graduating high school second in his class, getting his medical degree from Tulane, an Air Force internship, flight surgeon school, and a residency at a charity hospital, Pope fulfilled his calling and became a practicing
PATIENT ADVOCACY AWARD: BLAIR CUSHING, DO Cushing completed a public policy rotation with TAFP as a medical student during the 84th Texas Legislature, helping develop policy options for legislators to consider involving physician workforce. Her efforts
Clockwise from top left Antonio Falcon, MD, accepts the 2015 Texas Family Physician of the Year Award at Saturday’s Business and Awards Lunch. Dale Ragle, MD, gives the Physician Emeritus Award to H. David Pope, Jr., MD. Lloyd Van Winkle, MD, and Mary Nguyen, MD: “Family physician, because freakin’ awesome is not an official job title.” TAFP Foundation members Justin Bartos, MD, Doug Curran, MD, TAFP COO Kathy McCarthy, and Leah Raye Mabry, MD, serve breakfast to attendees in the exhibit hall.
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resulted in the passage of Senate Bill 18 by Sen. Jane Nelson, R-Flower Mound, which prioritized the creation of new primary care residency positions and funding for the Texas Statewide Primary Care Preceptorship Program. Cushing graduated from the University of North Texas Health Science Center and is a family medicine resident at Natividad Medical Center in Salinas, California. PUBLIC HEALTH AWARD: BRIAN SMITH, MD, MPH Smith served as the Regional Medical Director for the Texas Department of State Health Services Region 11 for 17 years, and for five additional years as the communicable disease clinician. In this role, he was responsible for 19 counties in South Texas, dealing with tuberculosis, diabetes, ebola, and other cross-border issues, and provided emergency preparedness for many hurricanes along the coast. Before joining DSHS, he practiced medicine in South Texas community health centers, with the Cherokees and Choctaws in Oklahoma, and in various countries including Guatemala and Nigeria. EXEMPLARY VOLUNTEER TEACHING AWARD: ADRIAN BILLINGS, MD, PHD Billings is a professor for both the UTMB and Texas Tech Permian Basin, and has been a preceptor in the Texas Statewide 12
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Family Medicine Preceptorship Program for many years, precepting about 100 medical students total. He recently became the program’s director. He also hosts residents in the Big Bend area, working alongside them to demonstrate true rural family medicine. He is known for incorporating the students and residents into every aspect of his practice. His community has seen three former trainees return to the area to practice.
sician co-convener, she was elected convener for the newly renamed National Conference of Constituency Leaders. While her time as a new physician is now over, her nominator is sure Kelly will remain a strong, female leader to both TAFP and AAFP.
EXEMPLARY TEACHING AWARD: NORA GIMPEL, MD Gimpel is an assistant professor of family and community medicine and chief of the Community Medicine Division in the Department of Family Medicine at UT Southwestern. She is the director of numerous training programs at UT Southwestern including a predoc training program and a postdoc training program in community medicine. Gimpel is also on the advisory board for the Texas Area Health Education Center East DFW Region.
TAFP FOUNDATION PHILANTHROPIST OF THE YEAR: NANCY AND DR. PATRICK LEUNG Leung has practiced family medicine in Midland since 1980 where Nancy, a registered nurse, manages their office. They want to attract more medical students to the family medicine, ensuring that the next generation of doctors includes enough family physicians for the population. Earlier this year the Leungs made a generous donation to the TAFP Foundation to fully endow the Patrick Leung, MD, Medical Student Scholarship. It was awarded this summer to a student who had just finished his first year of medical school and participated in a family medicine preceptorship.
SPECIAL CONSTITUENCY LEADERSHIP AWARD: CHRISTINA KELLY, MD Kelly has been active in AAFP since her time as a medical student and after moving to Texas in 2011, she immediately got involved with TAFP. After serving the National Conference of Special Constituencies as new phy-
TAFP POLITICAL ACTION COMMITTEE AWARD: TROY FIESINGER, MD Fiesinger is a longtime advocate for family medicine, working hard to develop local relationships with his elected officials. Not only does he serve as a key contact, but he is also regarded as an expert in health policy. He is
active with TAFP’s Political Action Committee and currently serves on AAFP’s Commission on Governmental Advocacy.
Following the presentation of awards Chou installed TAFP’s 2015-2016 officers. They are President Ajay Gupta, MD; President-elect Tricia Elliott, MD; Vice President Javier “Jake” Margo, Jr., MD; Treasurer Janet Hurley, MD; and Parliamentarian Rebecca Hart, MD. In his inaugural address, Gupta thanked the many physician leaders who have gone before him and several mentors who have guided him along his path. He encouraged family physicians to become involved in the Academy for the sake of the specialty as well as their own fulfillment. “I appreciate the opportunity to serve as president of
the Texas Academy of Family Physicians,” he told the audience. “I will provide all my effort to serve our state and national health care system. It will take all of us working together to improve health care in America. I’m excited to lead the path into a new chapter.” Read an excerpt of his address in this issue’s President’s Column on page 6. Mark your calendars now for upcoming symposia. The 2016 C. Frank Webber Lectureship will be held April 15-16 at the Omni Austin Hotel at Southpark. The Texas Family Medicine Symposium will be June 3-5, 2016 at La Cantera Hill Country Resort and Spa in San Antonio, and next year’s Annual Session and Primary Care Summit will be Nov. 4-6, 2016 at The Westin Galleria Dallas. For the full 2016 schedule, go to www.tafp.org/professional-development.
Clockwise from top left TAFP 2015-2016 officers, left to right: Parliamentarian Rebecca Hart, MD; Treasurer Janet Hurley, MD; Immediate Past President Dale Ragle, MD; PresidentElect Tricia Elliott, MD; President Ajay Gupta, MD; and Vice President Javier “Jake” Margo, Jr., MD. Drs. Justin Bartos, Jack Chou, Rebecca Hart, and T. David Greer enjoy casino night at the President’s Party. Dale Ragle, MD, presents Christina Kelly, MD, with the Special Constituency Leadership Award. TAFP members Irvin Sulapas, MD, and Thomas Kim, MD, MPH, network with AAFP board member Jack Chou, MD, and TAFP guest and CME speaker Mike Sevilla, MD. Attendees gather at Friday night’s student and resident reception. www.tafp.org
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MEMBER NEWS
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In memoriam: Glen Journeay, MD, PhD tafp past president Glen Journeay, MD, PhD, passed away at the age of 90 after battling pancreatic cancer. Journeay served as TAFP president in 1983-1984 and was a life member. He practiced in Austin for 30 years and taught biomedical engineering at the University of Texas for 35 years. Journeay earned two undergraduate degrees from Rice University, one while participating in the NROTC V-12 program. He later served on the USS Barnegat AVP-10 and was discharged from active duty in 1946. After receiving a doctorate in chemistry from UT and working in the research department of Monsanto Chemical in Texas
City, Journeay returned to school to receive his medical degree from the University of Texas Medical Branch at Galveston. He practiced family medicine in Texas City until the Journeay family home was flooded by Hurricane Carla in 1961, when he returned to Austin and began his practice there. Journeay married the girl next door, Betty Jo Cooper, in 1948 while earning his PhD from UT. His is survived by his wife and their five children: Carol Journeay, David Journeay, Stephen Journeay, Nancy Jackson, and Janet Slack, as well as twelve grandchildren and eight great-grandchildren.
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MEET THE 2015-2016 TEXAS FAMILY PHYSICIAN OF THE YEAR: ANTONIO FALCON, MD
THE RICHEST MAN IN THE WORLD BY SAMANTHA WHITE
It’s 6 a.m. on a typical Thursday at the Family Health Center in the small border town of Rio Grande City, Texas. Antonio Falcon, MD, pulls into the clinic’s parking lot to see a handful of early morning patients already waiting for him. He enters the building through his office’s side door to avoid the waiting room. While he loves his patients and they will all get his full attention in the exam room, he knows if he walks through that room this early in the morning when it is full of people, his day will never begin. Falcon greets his medical assistants, taking a few moments to catch up with their personal lives or the latest local news stories. He sets his things down and settles in, preparing for the 20 or so appointments and seemingly endless line of walk-in patients he’ll see. The clinic will have to stop taking walk-ins within the next hour or he’ll have more patients than he is able to see. On this day he will end up seeing 37 or 38 patients over the next six hours in the clinic—a pretty typical day for Falcon and the Family Health Center. 16
TEXAS FAMILY PHYSICIAN WINTER 2016
The Family Health Center in Rio Grande City invites patients to bring in photos of loved ones who have previously served or are currently serving in U.S. military forces as a way to honor community members. The photos line the clinic’s waiting room walls, alongside a colossal American flag. Falcon has a long line of family members who have served in the armed forces, including his son who is a brigade surgeon.
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F
amily medicine isn’t just about filling prescriptions and conducting well visits, though family docs spend a lot of time on both. It’s not just delivering babies and diagnosing the common cold, though both happen frequently. It’s more than geriatrics and pediatrics, and it’s more than caring for multiple generations of one family. “I think the most important thing is not to forget patients have feelings,” Falcon says. He knows family medicine is so much more than the actual medicine itself. “Being sensitive to their needs is probably the most critical thing. I don’t think patients ever expect you to have everything right, but I think they expect you to listen.” Listening to patients and showing them you care is just as vital as prescribing medications, Falcon explains. Touching them, greeting them with a hug or a quick peck on the cheek, smiling—all simple acts of kindness that can go a long way in the exam room he says. “I’m one of those who feels that touching a patient is very important. Especially the older individuals. Sometimes nobody ever gives them a hug or tells them they look nice or they smell nice. Sometimes when you’re in that age group of your 70s and 80s, sometimes people forget that you need strokes of kindness, and the family doctor can do that. One act of kindness in the examining room can be worth a ton of medications.”
plans to do the same. It was just after Vietnam though, and his educator father felt there would be too many distractions in Austin. Falcon instead attended Baylor for his undergraduate degree, Baylor College of Medicine in Houston for his medical degree, then he completed a family medicine residency back in Waco. After his father passed away in 1972, Falcon became the father figure to his three younger brothers. While in Houston he met a nurse named Kathy, who relocated from Vermont after nursing school. The two married during his second year of residency. We he had completed his residency, the Falcons returned to Rio Grande City in 1980 and he began practicing. He became a father that same year when Kathy gave birth to their only son, James. Over the next decade, four daughters followed: Sarah, Emily, Kelly, and Patty. Raising their five children is obviously the Falcons’ proudest achievement in life. All five are now successful in their respective careers: A brigade surgeon in the U.S. Army, a family physician, a speech pathologist, an attorney, and realtor. Though his office’s physical location and practice type has changed a few times over the last three and a half decades, he never saw himself leaving his hometown to practice anywhere else. “I saw the need here,” Falcon says. “I grew up here and saw that the area was desperate for more practitioners. When I came to Starr County it was labeled the poorest county in the country.” In his acceptance speech at TAFP’s Annual Session and Primary Care Summit, he talked about moving back home to the poverty-stricken Rio Grande Valley to not only practice family medicine, but to raise a family. “I went to the poorest county in the country and became the richest man,” Falcon said. “I say that because I am absolutely blessed with richness from my family.” Falcon went on to humbly thank his peers for nominating him for the award and give medical students and residents in the audience some tips on being a family physician. “Don’t forget that it’s not about the money. It’s about what happens in your heart. It’s about the relationship with your patients.” Just like many other family physicians across the country, “family doc” isn’t Falcon’s only job title. Falcon MD served as the local high school’s team physician for multiple decades and served for nine years on the school board. He is an active preceptor in the Texas Statewide Family Medicine Preceptorship Program. He is a clinical assistant professor for the University of Texas Medical Branch Department of Family Medicine. He served as the emergency medical services director for Starr County Memorial Hospital for many years. He is active in the Hidalgo-Starr County Medical Society and once served as president of the TAFP Valley Chapter. He spent many years on the Texas Medical Association’s Foundation Board and TMA’s Political Action Committee. Falcon is not only a humble, small town physician. He’s also a politically active heavy hitter with strong governmental ties. In 2003, Governor Rick Perry appointed Falcon as co-chair to the Proposition 12 campaign, a tort reform that fought to protect physicians from lawsuits by capping malpractice suit payouts. In 2007, Falcon was appointed by President Bush to the United States-Mexico Border Health Commission where he collaborated with other states and both countries’ federal governments to give recommendations to the Secretary of Health and Human Services on border health. More recently, Gov. Perry once again appointed Falcon, this time to the state’s Health and Human Services Council, a duty he is currently fulfilling.
“I went to the poorest county in the country and became the richest man. I say that because I am absolutely blessed with richness from my family.”
— Antonio Falcon, “I try to compliment my patients as much as possible. Sometimes the little grandmothers that are 90 are never told that their blue hair is cute. It’s okay to do that and they love it! It’s an easy thing to do. It costs you absolutely nothing.” Other lines of work might frown upon getting to know your patients personally, but Falcon thinks it makes family doctors even better physicians. “Never giving up hope for the patient is another thing. You can get involved and emotional with your patients. You can hurt when they hurt. I think when you do that they feel closer to you. They have a greater tendency to follow your advice. They’ll listen to your words and if you give encouraging words and words of comfort, you’ve done 99 percent of what a good family doctor will do.” Falcon, the 2015-2016 Texas Family Physician of the Year, was born in Edinburg and raised in Rio Grande City, where he continues to practice today. He only left his hometown for long enough to attend school and complete his residency. A long line of Falcon’s family members attended the University of Texas at Austin for their undergraduate education, and Falcon had 18
TEXAS FAMILY PHYSICIAN WINTER 2016
Falcon celebrates receiving the award with his family at November’s Annual Session and Primary Care Summit.
One of Falcon’s favorite professional accomplishments is having served on the Texas Parks and Wildlife Commission for seven years. Whereas the Health and Human Services Council is strictly advisory, the parks commission was given direction from the legislative branch and actually put laws into place. He says seeing how the government works from the inside broadened his outlook on the state of Texas and that he was honored to serve a bigger community in all of these capacities. “To be in a leadership position where you can make changes, rules, regulations, that affect the everyday life of an individual, is critical. There’s nobody in better positions in small communities than family docs to do that.” Falcon also stresses the importance of rural physicians specifically being active members of the political landscape to fight for their communities. “Sometimes the family docs are the only people who are going to advocate for patients out in rural areas. The only ones who are really going to understand out in rural areas are the rural practitioners because they live in town. I think it’s absolutely critical that family docs continue to participate and be a voice in state government. It’s important to be heard, to be loud when you have to be loud, and to not be afraid to say what you think.” Rural medicine has its ups and downs for sure Falcon says, but it is also the only type of medicine he can imagine himself doing. “There are difficulties in rural medicine. You really have to love it. On the other hand, it’s super rewarding to be involved with the community and to know the community.”
Over the years Falcon saw more and more patients unable to make the drive to McAllen to meet with specialists. They couldn’t afford the gas, couldn’t take the time off work, or didn’t have a car, among other reasons. The sensible solution was to bring the specialists to town, so that’s what he did. On his suggestion, multiple specialists set aside a half day outside of their clinics to travel the 40 miles from McAllen to Rio Grande City and see patients. It started with nephrologists, then expanded to cardiologists, optometrists, and pediatricians. There are also now two dialysis centers, an additional nursing home, and a permanent MRI in the area, all of which Falcon had a strong hand in. It’s this type of concern for and action to better the community that makes Falcon a local leader. Audencio Garza has lived next to the Falcons for over 15 years now and says relating to his patients culturally allows Falcon to be the best possible physician. “If you’re born here, raised here, you know the conditions, you know the people,” Garza says. “The better doctor would be somebody who is locally grown because he or she would know what’s needed for the community.” Having only left for a handful of years, Falcon was already active in the South Texas community when he returned to practice medicine. Many people were already familiar with him, or at least with the Falcon name. The Falcon family has been in the Rio Grande Valley for multiple generations and many Falcons hold notable positions in the area. His brothers alone, now all retired, were the county’s emergency coordinator, a longtime teacher, and a border patrol officer. Everyone in the community knows the Falcon name one way or another. www.tafp.org
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nience. How else could he instill Another homegrown local such loyalty in his patients that physician, Jake Margo, Jr., MD, is they would often rather go back active in TAFP, currently serving home than be seen by someone as the organization’s vice presielse in the clinic?” dent and the Valley Chapter’s Rosa Garza has been a medipresident. Margo echoes Falcon’s cal assistant with Falcon for 11 sentiments on the importance years. When she was hired she of docs being active community only planned on staying for a year members. or two before finding another “It’s not enough to be a physicareer. She says Falcon is the cian,” Margo says. “You’re looked reason she has stayed in the proup to in the community. You are fession for so long. “I love workexpected to be involved. Your ing with Dr. Falcon so much it’s opinion matters, not just when it like, why leave?” comes to medical issues, but local “He’s very down to earth,” politics, schools.” Garza says, “and patients can Seeing a homegrown resident actually talk to him. When I go to become a family doc like Falcon the doctor I feel intimidated and inspires younger residents. Stella Falcon receives the 2015-2016 Texas Family Physician of the scared, but Dr. Falcon is so down Winters, a third-year resident Year Award from TAFP Immediate Past President Dale Ragle, MD, at TAFP’s Annual Session and Primary Care Summit. to earth. You just feel so much… at the John Peter Smith Family he’s not even a doctor. He’s just Residency Program, grew up in your friend.” Rio Grande City and is currently His willingness to listen to rotating there. She credits Falcon patients is a gift from God, Falwith supporting her pursuit of con’s brother Gene says. education to become a physi“So many of his patients cian, by mentoring her as she always tell me, ‘after I saw Dr. volunteered at the hospital and Falcon I feel so much better.’ I financially helping her attend a ask them if he gave them medipre-med conference, both while cine. ‘No, we just talked,’ they say. she was still in high school. ‘After I left, I felt great!’” “He’s been very inspirational Nanette Garcia, another family to the young people, the next friend, says Falcon has a way of generation,” Winters says. “He’s making you feel good even at your the role-model-type figure saying worst times. He helped Garcia ‘this is possible, you can do this, through her mother’s stroke and somebody from here has done death in 2015, visiting her McAlit.’ He’s been very supportive in len nursing home weekly. He’s a developing potential for young people person, she says. people here in this small city.” “People tend to gravitate It’s difficult to find someone — Antonio Falcon, MD toward him. He knows how to in Rio Grande City who doesn’t make everybody feel comfortknow and love Falcon. Margo able. I don’t think it’s something first met Falcon as a kid when he he does on purpose, it’s just part of his personality.” sprained his ankle. He says Falcon has always been casual, making Long-time patient Yolanda doesn’t know what she will do if Falcon you feel relaxed and like you are part of the Falcon family. His youngever retires. They grew up together, working in the melon sheds as est daughter, Patty, says that’s what makes him a good family doctor kids, and she can’t imagine anyone else as her health care provider. —his ability to make patients feel so comfortable they feel like a part “He has helped me a lot when I couldn’t afford it. I didn’t have of his family. insurance or anything, but it didn’t matter to him. He looks after his A patient and friend of Falcon, Ivo Perez, had a stroke in 2011 and patients. He knows you, and he hears you.” now comes to the clinic to get his blood pressure checked twice a It’s now Thursday evening and after spending his afternoon week, a service Falcon doesn’t charge him for despite its frequency. working on paperwork and fielding calls from people asking for Perez is grateful to have Falcon as a friend and physician. medical advice, Falcon is enjoying a dinner out with his wife. They “Like they say, you only have friends when you’re in jail, when discuss the events of the day and what’s to come in the next few somebody passes away, and when you’re in the hospital,” Perez says. weeks—a visit with his friends from his undergrad days at Baylor, a After the stroke Perez suffered, he says Falcon came to the hospital and daughter’s wedding in Austin, and the upcoming birth of their sixth checked on him often. “To me he’s a good friend.” granddaughter. The satisfaction in Falcon’s smile when discussing “All his care is patient-oriented and often includes the entire these family milestones says it all. In this moment, Falcon is the richfamily for the betterment of the patient,” Margo says. “This often est man in the world. includes seeing several family members at once for their conve-
“To be in a leadership position where you can make changes, rules, regulations, that affect the everyday life of an individual, is critical. There’s nobody in better positions in small communities than family docs to do that.”
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TEXAS FAMILY PHYSICIAN WINTER 2016
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Figure 1: Range of MIPS Payment Adjustments
After the SGR: ALTERNATIVE PAYMENT MODELS
10%
5%
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9%
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0%
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Reward
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Jim Walton, DO, MBA
Jim Walton, DO, MBA, is president and CEO of Genesis Physician Group, and he is president of the Dallas County Medical Society. He is board certified in internal medicine. This article first appeared as the “President’s Page” in the Oct. 2015 issue of the Dallas Medical Journal.
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TEXAS FAMILY PHYSICIAN WINTER 2016
last year the much maligned sustainable growth rate cost control scheme used by The Center for Medicare and Medicaid Services was repealed. If you are like me, you are celebrating this legislative victory, which took too many years to achieve. It is estimated that the cost of repealing SGR would be $150 billion over 10 years, because in the simplest terms, the SGR law attempted to control growth in Medicare costs by reducing the reimbursement rate for each unit of service provided by physicians. But as Joel White, president of the Council for Affordable Health Coverage reports, the SGR resulted in a reflexive increase in the volume of services as physicians attempted to maintain revenues. Where SGR failed, new strategies, rules, and regulations are now being rolled out for our profession. As we enter the post-SGR phase of CMS’ attempt to control the burgeoning baby boomers’ impact on the total cost obligations of the federal budget, CMS is launching its new strategy, and we should all become familiar with its new terminology: “alternative payment models.” Through APMs, CMS and Medicare have made a commitment to value-based payments, incentivizing provid-
ers to adopt this model to promote better health outcomes at lower costs. Some familiar examples of APMs include: • Accountable care organizations • Capitated and bundled-based payments • Patient-centered medical homes We must recognize that in the wake of the SGR repeal, Medicare has accelerated its transition away from fee-for-service as its sole mechanism for reimbursing physicians. To ease the transition for physicians, there is a narrow window of time in which Medicare will provide standard annual FFS rate increases of half a percent, from July 2015 through 2019. In the APM strategy, which will start in 2019, CMS has committed to rewarding physicians who achieve the transition to quality improvement and cost reduction in an APM contract. Physicians and their Medicare patients who do not participate in APMs will be captured in a value-based financial reward program called Merit-based Incentive Payment System. Starting in 2019, the standard FFS rate increases will be replaced by MIPS, rewarding
Figure 2: Year One Texas Medicare ACO Performance, Jan. 1, 2014 – Dec. 31, 2014
Baroma Health Partners
10%
Total benchmark minus assigned beneficiary expenditures as % of total benchmark
ACO Providers UPSA ACO, LLC Buena Vida y Salud, LLC 6%
St Joseph Health Partners ACO Accountable Care Coalition of Greater Houston, LLC
2%
9.2%
7.5%
5.6%
4.2% 2.7%
1.5%
0.9% -0.3% -1.7% -1.8% -3.7% -4.1% -5.4%
-2% SW Provider Partners, LLC USMD Physician Services UT Southwestern Accountable Care Network Premier Patient Healthcare, LLC
-6%
Genesis Accountable Physician Network, LLC Sunshine ACO, LLC Seton Accountable Care Organizations, Inc. -10%
physicians based on how they perform on many of the now familiar quality measures outlined in the current quality payment programs. The MIPS will consolidate the following Medicare quality payment programs: • Physician Quality Reporting System • Electronic Medical Record Meaningful Use • Value-based Payment Modifier Figure 1 illustrates the potential financial rewards or penalties for physicians treating Medicare patients beginning in 2019. As you can see, the range of MIPS-related payment adjustments begin at 4 percent in FY-19 and peaks at 9 percent a short four years later. The MIPS program differs from current PQRS and MU incentives that are “all or nothing.” The MIPS program also rewards those with exceptional performance (top quartile) with separate bonuses. Important exceptions are: • Physicians may opt out of the MIPSrelated payment adjustments if they choose to be engaged in the APM programs noted above.
• Physicians choosing to participate in APMs and receive a substantial share of Medicare revenues through an APM will receive FFS bonus payments of 5 percent annually for six years. • Physicians participating in APMs may also be eligible for shared savings bonuses (typically paid six months after the end of the calendar year). In the immediate future, physicians will be weighing the decision to become more engaged in APMs. It is also fairly certain that commercial insurers will be following the same basic formula to control costs. With all this change where should we look for good news? Recent reports reveal that several North Texas ACOs who contracted with CMS’ APM —Medicare Shared Savings Program—have reported good progress related to improving quality while reducing costs. These early reports suggest that DFW’s high-flying health care costs and utilization can be controlled, providing participating physicians with new financial reward opportunities. Figure 2 illustrates the progress. We can and will succeed in this brave new world of APMs. RIP SGR!
We must recognize that in the wake of the SGR repeal, Medicare has accelerated its transition away from fee-forservice as its sole mechanism for reimbursing physicians.
www.tafp.org
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Frequently Asked Questions: Medicare Access and CHIP Reauthorization Act of 2015
PRACTICE MANAGEMENT 24
TEXAS FAMILY PHYSICIAN WINTER 2016
1
How does the Medicare Access and CHIP Reauthorization Act of 2015 impact my Medicare payments? This law repeals the flawed Medicare sustainable growth rate formula that calculated payment cuts for physicians. MACRA establishes an alternative set of predictable annual baseline payment updates and two payment tracks: the Alternative Payment Model track and the Merit-Based Incentive Payment System track. The following is a timeline for MACRA implementation: July 2015 through December 2015: Medicare physician payments increase by 0.5 percent. 2016 through 2019: Medicare physician payments increase by 0.5 percent each year. January 2019: Based on eligibility, physicians enter either the APM track or the MIPS track. 2020 through 2025: Medicare physician fee-for-service payments remain at 2019 levels with no updates.
2
What is an alternative payment model? MACRA defines any of the following as an alternative payment model: • An innovative payment model expanded under the Center for Medicare & Medicaid Innovation, including Comprehensive Primary Care initiative participants but not Health Care Innovation Award recipients
3
Does MACRA specify additional qualifying criteria for APMs? Yes. An APM must require participants to meet all of the following criteria: • Uses quality measures comparable to measures under the MIPS • Uses certified electronic health record technology • Bears more than nominal financial risk or is a medical home expanded under the CMMI • Has increasing percentage of payments linked to value through Medicare or all-payer APMs
4
The Comprehensive Primary Care initiative is an APM option for practices of all sizes. What are the expectations of that program?
The aim of the CPC initiative is to strengthen primary care in order to support better care, lower costs, and improved population health. Through collaboration between the Centers for Medicare & Medicaid Services and commercial and state health insurance plans, participating primary care practices in seven U.S. regions receive populationbased care management fees and shared savings opportunities. In return for this financial support, each practice is expected to provide a core set of five “comprehensive” primary care functions: • Access and continuity
• A Medicare Shared Savings Program accountable care organization
• Planned care for chronic conditions and preventive care
• Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program, or another demonstration program required by federal law
• Risk-stratified care management • Patient and caregiver engagement • Coordination of care across the medical neighborhood
5
How would I be paid under an APM?
If you are eligible and choose to participate in a qualifying APM, you will receive a 5 percent lump-sum bonus on your Medicare payments for 2019 through 2024. Beginning in 2026, you will qualify for a 0.75 percent increase in your payments each year.
6
What is the Merit-Based Incentive Payment System?
The Merit-Based Incentive Payment System is a new program in the Medicare fee-for-service payment system. It consolidates three existing programs—Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier—into a single program. The MIPS will assess individual physician performance in four categories to generate a composite score on a 0- to 100-point scale. The categories are: • Quality • Resource use • Meaningful use of certified EHR technology • Clinical practice improvement activities
7
How would I be paid under the MIPS?
Beginning in 2019, physicians participating in the MIPS will be eligible for positive or negative Medicare payment adjustments that start at 4 percent and gradually increase to 9 percent for 2022. The threshold for these payment adjustments will be the mean composite score for all MIPS-eligible professionals during the previous performance period. Distribution of payment adjustments will follow a bell-shaped curve. [cont. on 26]
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[cont. from 25] • Physicians who score at the threshold (i.e., earn the mean composite score) will receive no payment adjustment. • Physicians whose composite score is above the mean will receive a positive payment adjustment on each claim for the following year. • Physicians whose composite score is below the mean will receive a negative payment adjustment on each claim for the following year. Physicians with high composite scores will be eligible for a positive payment adjustment that is up to three times the baseline positive payment adjustment for a given year. For example, the baseline positive payment adjustment for 2019 will be 4 percent, so high performers will be eligible for a positive payment adjustment of up to 12 percent. For 2019 through 2024, an additional positive payment adjustment of up to 10 percent will be available to exceptional performers. Beginning in 2026, all physicians participating in the MIPS will be eligible for a 0.25 percent increase in their payments each year.
8
How does MACRA help small practices?
The law allocates $100 million for the U.S. Department of Health and Human Services to support organizations (e.g., quality improvement organizations, regional extension centers) that provide technical assistance to practices with 15 or fewer eligible professionals participating in an APM or the MIPS.
Watch TAFP’s EMBRACING CHANGE videos at www.tafp.org/ practice-resources/ change/video1.
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TEXAS FAMILY PHYSICIAN WINTER 2016
Priority will be given to practices in rural areas, health professional shortage areas, and medically underserved areas, and to practices with low composite scores. The allocated money will not fund changes at the individual practice level.
9
What is the AAFP doing to help me?
As always, we’re committed to keeping you informed, developing resources to support your quality improvement efforts, and helping you provide cost-effective care. We also want to know more about your experience with MACRA, and your decisions about APMs and the MIPS. As information, tools, and resources to help you comply with and benefit from MACRA become available, we will update AAFP.org and spread the word through AAFP News and Family Practice Management. We will also tell the Secretary of Health and Human Services what family physicians think about provisions within MACRA. In particular, we will continue to advocate vigorously for the following: • Improved payment for primary care • Administrative simplification • Harmonization of measures across all private and public payers • Reasonable reporting requirements
10
What can I do now to prepare for MACRA implementation?
If you haven’t reported data on quality measures through the PQRS or as part of meaningful use, start as soon as possible. Penalties for not reporting or for low quality may impact you this year. More information on Medicare penalties is available. Go to www.aafp. org/practice-management/regulatory/ bonus-penalty.html.
HHSC NEWS If you submitted quality data during the last calendar year, you should have access to your Quality and Resource Use Report. This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement. If your practice doesn’t provide chronic care management services, consider starting now. Medicare began paying for CCM codes on January 1, 2015. By offering CCM services, your practice will be a step closer to implementing the five comprehensive primary care functions promoted by the CPC initiative. You may also qualify to participate in the APM track. Information on chronic care management and resources to help you start providing CCM services in your practice are available. Go to www.aafp.org/ practice-management/payment/ coding/ccm.html.
11
Where can I find more information on MACRA? Information, tools, and resources to help you comply with and benefit from MACRA are available from the AAFP and from FPM. Go to www. aafp.org/practicemanagement/payment/medicarepayment.html and www.aafp.org/ journals/fpm.html. The latest news about MACRA and other payment reform topics is available from AAFP News at www.aafp.org/ news/government-medicine.html.
12
How can I get answers to my practicespecific questions? AAFP members can contact an AAFP subject matter expert at www.aafp.org/ practice-management/administration/ ask.mem.html or call (800) 274-2237.
Blue Button makes finding Medicaid patient records simple Medicaid providers can now find their patients' medical histories on YourTexasBenefitsCard.com. Medicaid Eligibility and Health Information Services added the Blue Button to the site in September. Once a provider or office staff receives a client's consent, they can log in to the site and click on the Blue Button to see and download the client's health information. The information can then be saved as a Portable Document Format document, a Clinical Document Architecture data file, or a simple text file. Once saved, it can be imported into the provider's health management tool. The YourTexasBenefitsCard Blue Button is assembled from client data found in the
current database and claims data stored in the Medicaid Claims Administrator System. It generates easily accessible patient records on the website for providers to download, import, or print. Having access to reliable health information gives providers a more complete picture of their patients’ health. Having the ability to view, print, and export the client’s health information could make it easier to transfer information when referring patients and taking on new ones. It keeps everyone on the same page when multiple doctors are treating a patient. For more information, email Alessandra Reyes at Alessandra.Reyes@hhsc. state.tx.us.
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27
FOUNDATION FOCUS
2015 TAFP Foundation donors
Kavitha Moolamalla, MD
Thank you to these 2015 TAFP Foundation donors, whose contributions fund scholarships for Texas medical students, family medicine research grants, and travel scholarships for residents to attend continuing professional development activities.
★ Carol and Dale C. Moquist, MD ★ Graciela Moreno, MD ★ Mary Helen Morrow, MD ★ Estela Mota, MD Bonnie Eugenia Muncy, MD James A. Murphy, MD W. Darell Murphy, MD Nancy Naghavi, DO Jonathan Nelson ★ Mary S. Nguyen, MD Donald R. Niño, MD ★ Paul B. Oliver, MD
★ = TAFP Foundation monthly donor
Didier F. Piot, MD ★ Henry David Pope, MD Teresita Ramirez-Scott, PA
Baylor Scott & White Health
Alice Dilling Cox, MD
★ Rebecca Eileen Hart, MD
Memorial Hermann Health System
Michael Avery Crouch, MD
Bill and Gail Hartin
ProAssurance
Douglas W. Curran, MD
Sharon Hausman-Cohen, MD
TAFP Dallas Chapter
Darnel Viray Dabu, MD, MPH
Clare Arnot Hawkins, MD, MSc
Texas Medical Association
★ Kenneth Gayle Davis, MD
★ James Michael Henderson, MD
Texas Medical Liability Trust
Manuel De Los Santos, MD
Harriet Nailor Hilliard, MD
Shivum Agarwal, MD
Paula L. Denson, MD
★ Terrance S. Hines, MD
Ruben Aleman, MD
★ Tamra K. Deuser, MD
★ Farron Cheryl Hunt, MD
★ Trisha A. Allamon, MD
★ Chrisette M. Dharmagunaratne, MD
★ Janet L. Hurley, MD
Victor Lee Allen, MD
Darrell R. Dixon, MD, MBA
Lee Janson, MD
Gary R. Allen, MD
★ Jorge Duchicela, MD
★ Audrey Lee Jones, DO
Dale Crawford Allison, MD
★ Tamarah L. Duperval-Brownlee, MD
Brian D. Jones, MD
★ Erick Fernando Alvarez Mosqueira, MD
Carolyn Eaton, MD
★ David Arthur Katerndahl, MD
★ Bruce Alan Echols, MD
★ Christina Marie Kelly, MD
★ Tricia C. Elliott, MD
★ Shelley Kohlleppel, MD
Sheridan Scott Evans, MD Christopher S. Ewin, MD
★ Kaparaboyna Ashok Kumar, MD, FRCS
★ Robert Floyd Ezell, MD
★ Cyrus Timothy Lambert, MD
★ Antonio Falcon, MD
★ Don A. Lawrence, DO
★ Troy Treanor Fiesinger, MD
Huong Le, MD
★ Aimee Lyn Flournoy, MD
Patrick Ys Leung, MD
★ Lewis Emory Foxhall, MD
Kathy and Paul Locus, MD
Thuy Hanh Thi Trinh, MD, MBA, FAAHPM
Edwin R. Franks, MD
Donald E. Lovering, MD
★ Ashok Tripathy, MD
★ Kelly A. Gabler, MD
★ Leah Raye Mabry, MD
★ Thao Minh Truong, MD
Oscar Garza, MD
McDavid Michael Mahaffey, MD
★ Lloyd Van Winkle, MD
★ Melissa Susan Gerdes, MD
Ernesto Malave, MD
Samuel C. Wang, MD ★ Isaac A. Watemberg, MD
Adanna Juliet Amechi-Obigwe, MD Ichabod L. Balkcom, IV, MD ★ Maria Diana Ballesteros, MD Madhumita Banga, MD ★ Tom Banning ★ Lynda Jayne Barry, MD ★ Justin V. Bartos, MD David W. Bauer, MD, PhD ★ Stephen Douglas Benold, MD ★ Teddy and Henry Julius Boehm, Jr., MD Robert John Bolster, MD ★ Lindsay Kathryn Botsford, MD, MBA
★ John R. Richmond, MD ★ Shelley Poe Roaten, MD Leon Rochen Alex Salazar, MD ★ Sarah Samreen, MD Ramiro Sanchez, MD ★ M. Sandra Scurria, MD ★ Stephanie Segal, MD Jennifer Cobb Seger, MD Puja Anil Sehgal, MD Mike Sevilla, MD ★ Amer Shakil, MD H. Kyle Sheets, MD ★ Zafreen Arfeen Siddiqui, MD ★ Linda Marie Siy, MD ★ Mary Carmen Spalding, MD ★ Charles Stern, MD ★ Sharon Stern, MD ★ Donald E. Stillwagon, MD ★ Paul and Erica Swegler, MD
★ Lisa Biry Glenn, MD
★ Javier D. Margo, MD
★ Emily D. Briggs, MD, MPH
★ Roland A. Goertz, MD
James Charles Martin, MD
★ Sally Pyle Weaver, MD
★ Dennis L. Brown, MD
Ty Lee Gore, MD
★ Kathy McCarthy, CAE
Judge Marcia Weiner
Raul Niduaza Calvo, MD
Geraldine Gossard, MD
Jimmy Eugene McCoy, MD
★ Jim and Karen White
★ Chinglin Lillian Chan, MD
★ John Edward Green, MD
★ William Mike McCrady, MD
Walter D. Wilkerson, MD
★ C. Mark Chassay, MD
★ Thomas David Greer, MD
★ John M. McCullough, MD
★ Hugh H. Wilson, MD
Joanna Clark
★ Ajay Kumar Gupta, MD
★ Susan Clymer McMullen, MD
Keith Allen Wixtrom, MD
Jill Clay, MD
★ Natalia Gutierrez, MD
Victor O. Mendiola, MD
★ Khalida Yasmin, MD
Oscar Cortes, MD, MBA
★ Lesca C. Hadley, MD
★ Gary R. Mennie, MD
★ Robert Allen Youens, MD
★ Seth B. Cowan, MD
★ Suhaib W. Haq, MD
★ Jessica Miley
★ Richard A. Young, MD
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Early diagnosis and treatment of HIV saves money and improves health outcomes. Routine HIV testing in health care settings is as cost effective as other screening programs, including type 2 diabetes and breast cancer mammography. Learn more at
www.testtexashiv.org
Krentz HB, Auld MC, Gill MJ. The high cost of medical care for patients who present late (CD4 < 200 cells/μL) with HIV infection. HIV Medicine. 2004;5:93-8.
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Confidential and experienCed LegaL RepResentation
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Representation before the Texas Medical Board, The Texas Medical Foundation and Medical Staff Peer Review. Medical Practice Act and Medical Board Actions (hearings, settlement conferences and licensure) • Personal Counsel in Medical Liability Cases • Probation Modification / Termination • Managed Care Exclusions • Licensure • Reinstatement • Medico-legal Issues • Expert Review • Telemedicine • Medicare/Medicaid Appeals • Medical Ethics Opinions • Physician Assistants. tony cobos*
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12/21/09 2:52:24 PM
PERSPECTIVE
Accepting the maybe By Janet Hurley, MD
in my leadership duties for the Texas Academy of Family Physicians and within my personal job as family physician and operational chief of primary care for Trinity Mother Frances Health System, I continue to see pockets of skepticism, frustration, and fear among my primary care physician colleagues. In some of my most difficult assignments, I have felt that the greatest barrier occurs when some physicians go straight to the negative with their thoughts as we begin discussions. Our specialty is rife with physicians that go straight to the negative. When we consider the high rates of physician burnout in our country we begin to understand why this is true. Primary care physicians have felt overworked and underpaid for quite some time. The current fee-for-service payment system has created inefficient patient management practices that prevent care for simple conditions over the phone, lead to unnecessary follow-up appointments, and encourage physicians to pack more patients into their clinic day to generate volume. Transitioning these practices to a value-based payment world is truly a challenge. When family medicine leaders reach out to constituents in private practices, we commonly find that physicians do not trust their nearby hospital administrators, they see neighboring practices as competition, and they are quick to blame insurance companies for most of their payment problems. While a lot of this frustration is justified, it hinders their ability to make the necessary changes in their practice that will make them viable in the medical marketplace of the future. I propose another way of thinking. What if instead of going straight to the negative, we begin accepting the maybe. Maybe hospitals really do understand the need for a strong primary care infrastructure within the community to provide good care to the patients they serve. Maybe their appeal to provide EMR support, shared savings benefits, or other amenities to local physicians is generated with honest intent.
Maybe insurance companies really do want to partner with us to create a higher quality, lower cost health-delivery product for our communities. While we realize every business needs to make money to stay afloat, maybe we can begin to believe that insurers see patients as more than covered lives. Maybe we will realize that employers are the true customers in the insurance marketplace and they value our ability to see their employees efficiently so they can receive the needed treatments and get back to work. Maybe we will realize our desire for autonomy must also come with accountability. The future health care marketplace will demand a commitment to following evidence-based guidelines and providing reports on quality. We should realize that patients are demanding this and they are becoming much more sophisticated in their research efforts and physician selection. We should be motivated by a desire to improve and not offended because people ask about our credentials and quality ratings. Maybe we can accept that there is strength in numbers and that integrating with neighboring independent primary care physicians or health systems will make the transition to these changes more palatable. Maybe we will realize our true customers are our patients and they are demanding these health care changes as much as anyone else. Once local primary care physicians begin to have collegial discussions with hospitals, insurers, or employers, maybe these other entities will begin to trust that the physicians care more about their patients and the community than their own bottom line. And maybe, just maybe, primary care physicians will once again enjoy being doctors.
Many physicians do not trust their nearby hospital administrators, they see neighboring practices as competition, and they are quick to blame insurance companies for most of their payment problems. While a lot of this frustration is justified, it hinders their ability to make the necessary changes in their practice that will make them viable in the medical marketplace of the future.
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Janet Hurley, MD, is TAFP Treasurer and the operational chief for primary care for Trinity Mother Frances Health System, South Region. Read her blog at http://acceptingthemaybe. blogspot.com/.
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