Advanced Coding Tips | C. Frank Webber Report
texas family physician VOL. 64 NO. 2 SPRING 2013
plus: Proposed Bylaws Changes Inside
DAMAGE CONTROL
Mending The Women’s Health Care Safety Net In Texas
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INSIDE
TEXAS FAMILY PHYSICIAN VOL. 64 NO. 2 SPRING 2013
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Damage control: Mending Texas’ women’s health care safety net
The health care safety net for women in Texas is in tatters after state budget cuts enacted in 2011. So says TAFP member Janet Realini, M.D., M.P.H., chair of the Texas Women’s Healthcare Coalition. This legislative session, she leads a coalition of advocates aiming to restore funding for women’s health services. – By Kate Alfano
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Family medicine match rates climb
Both the number of residency positions offered and the number of positions filled in family medicine are up again this year in the National Residency Matching Program. 6 PRESIDENT’S LETTER Embracing the slow march of technological innovation 10 NEWS IN BRIEF Texas Medicaid begins accepting primary care attestation. | Give patients clinical summaries to meet meaningful use standard.
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What you don’t know can hurt you
Some private health insurers are beginning to review a new set of billing and coding practices with increased scrutiny. TAFP’s practice management expert describes the changing environment. – By Bradley Reiner
12 MEMBER NEWS Family docs gather in Austin for CME and Interim Session. | Two TAFP members make bids for TMA leadership roles. 18 Foundation Focus A second-year family medicine resident recounts her advocacy experience as part of a Foundation scholarship. 24 INTERIM SESSION SUMMARY
27 PROPOSED TAFP BYLAWS CHANGES As the Academy considers a significant restructuring of its governance, TFP has published the complete bylaws with proposed changes. 38 TAFP PERSPECTIVE Let your light shine for your specialty.
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president’s column
TEXAS FAMILY PHYSICIAN VOL. 64 NO. 2 SPRING 2013 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
Troy Fiesinger, M.D.
president-elect
Clare Hawkins, M.D.
vice president treasurer
Ajay Gupta, M.D.
Dale Ragle, M.D.
parliamentarian
Tricia Elliott, M.D.
immediate past president
I.L. Balkcom IV, M.D.
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, C.A.E.
advertising sales associate
Michael Conwell Contributing Editors Kate Alfano Katie Barckholtz, M.P.H., R.D., L.D. Anastasia Benson, D.O. Janet Hurley, M.D. Sheri Porter Bradley Reiner Linda Siy, M.D.
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 The Whitley Company, 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. © 2013 Texas Academy of Family Physicians postmaster Send address changes to Texas Family Physician, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6
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So easy a child can do it By Troy Fiesinger, M.D. TAFP President When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments. This was my first time to take them to the dentist, as my wife usually drives them. My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats. Freed from manually registering patients, the front-desk clerk monitored patient flow and welcomed everyone to the clinic with freshly-baked chocolate chip cookies. Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waited in the lobby as patients have done for decades. His office has the same electronic medical record as mine, but his clipboard system has not changed in decades. My clinic has an electronic medical record with a web portal and secure patient e-mail, but our patients still queue at the front desk to give their information to a clerk. At the gas station, I swipe my credit card and fill my gas tank without talking to another human being. At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before. We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation. We complain about the inefficiencies of our EMRs but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices. Are we so focused on our frustrations that we forget our patients? Some of this skepticism is well founded. For the past four years I have used the same EMR software I helped implement in my own residency 14 years ago. I can do work but do not save time. It still cannot talk to the hospital system so I do not have to look up the results of lab tests drawn five miles away. Although the computer file format that allows EMRs to communicate with each other has existed for years, I recently read another editorial lamenting the lack
of interoperability between competing software products. While I firmly believe that such technology can improve patient care, these benefits are far from inevitable. In the United States, we believe in the goodness of technology like an article of faith. If you don’t think that technology will make your life better, you must be old-fashioned, or tragically unhip. Too often, however, we fail to adequately question whether the benefits the vendor promised are as good as advertised. In a recent discussion thread, colleagues compared the latest fitness apps for their smart phones and GPS-based devices. I have tried similar devices but have found an “oldfashioned” running watch to be far more reliable. While I enjoy my smart phone, tablet, and laptop, I think we must still channel our inner Luddite by asking: Is this technology really improving our lives as much as we think? Are there unintended consequences we will regret in years to come? On the other hand, we shouldn’t simply disregard potential benefits based on such concerns. If my children can check in to their own appointments, why don’t we make this available for all our patients? If my 80-year-old patient can learn to use secure e-mail to communicate with me, why can’t you? If my 50-year-old patient on Coumadin can check his own INR at home, e-mail me the results, and adjust his medicine based on my e-mailed response, why don’t more patients adopt this technology? My father learned engineering with a slide rule, was one of the first to use the “revolutionary” Hewlett Packard desktop calculator, taught himself DOS and Windows a decade later, and now is mastering the iPad. While he is not sure he likes how the screen orientation changes when he turns it, I doubt he would give up his iPad for a slide rule. Such technological changes are inevitable, but our responsibility is to ensure they benefit our patients. The genie is out of the bottle and it’s too late to put him back.
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AAFP NEWS
Family medicine fill rate for the 2013 National Residency Matching Program 3,500
Positions offered Positions filled 3,000
2,940
3,062
2,884 2,764
2,782 2,727
2,730 2,621
2,654 2,555
2,500
2,576
2,239
2,273
2,292
2004
2005
2,313
2006
2007
2,611
2,404
2,404 2,318
2,938
2,630
2,329
2,000 2003
2008
2009
2010
2011
2012
2013
Family medicine match rate increases slightly again in 2013 AAFP President: ‘Our work is far from finished’ By Sheri Porter results of the 2013 National Resident Matching Program—commonly referred to as the Match—are in, and for the fourth consecutive year, the number of medical students choosing family medicine increased. A total of 2,938 positions were filled out of 3,062 positions offered for a fill rate of 96 percent compared with the 2012 fill rate of 94.5 percent. Family medicine positions available in 2013 were the most offered since the 2001 Match. Add to that the fact that 1,374 U.S. seniors—39 more than in 2012—matched to family medicine, the highest number since 2002. On the other hand, the number of U.S. seniors has increased, so the fill rate in 2013 in family medicine was 44.9 percent, or a 3.4 percent decrease from 2012. AAFP President Jeff Cain, M.D., of Denver, characterized the Match results as a “call to action moment” for family medicine. “The results of the 2013 Match highlight the AAFP’s ongoing efforts to position family medicine as a solution to the country’s health care challenges,” said Cain. “Students are hearing that choosing family medicine offers them a chance to enter a rewarding career with a bright future, and we need to 8
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continue to focus on that message and build momentum moving forward.” Increase in Available Slots Comparing some of the statistics for the 2013 Match to previous years is risky because not only did the methodology of counting students change, but percentages were skewed because the number of available slots rose dramatically. According to Stan Kozakowski, M.D., director of the AAFP Medical Education Division, 2013 marked the first time since 2001 that the number of family medicine residency positions topped 3,000. He attributed part of that increase to an explosion in the number of new family medicine residency programs. “Between January 2012 and March 2013, 18 new family medicine residences were approved by the Accreditation Council for Graduate Medical Education,” said Kozakowski. “We calculated the programs could account for 72 to 126 new positions in 2013.” In addition, according to a preliminary 2013 match report prepared by the AAFP Medical Education Division, the NRMP’s new Match methodology—dubbed the “all
in” policy—likely affected the number of positions available. For the first time in 2013, residencies participating in the Match were not able to sign agreements with eligible applicants outside of the Match. In 2013, programs had to decide whether to fill spots inside or outside of the Match protocol. The new rule meant programs that in the past had signed agreements before the Match process probably entered all of their available positions in the 2013 Match. In previous years, some graduating seniors from osteopathic and international medical schools were picked up before the Match because of their ability to enter residencies between February and July. According to Kozakowski, the availability of more slots affected the denominator of the equation used to calculate pertinent Match percentages, thus making comparisons between years difficult. Rising Medical School Enrollment According to the same AAFP report, medical school enrollment is on the rise in both osteopathic and allopathic U.S. medical schools. In particular, the number of osteopathic medical schools increased dramatically in the past decade, from 19 schools in 2002 to 37 in 2013 with the inclusion of branch and satellite campuses. First-year enrollment between 2002 and 2012 surged from 2,968 to 5,627. Allopathic medical schools also increased enrollment by 30 percent since 2003, and 15 new medical schools are pending accreditation by the Liaison Committee on Medical Education. Although it might seem that more medical students in the system would be just the boost primary care needs to strengthen its ranks, the 2013 Match proved otherwise. “Unfortunately, this year’s Match numbers are proof that increasing enrollment in our medical schools did not translate into an increase in the percentage of U.S. seniors entering family medicine,” said Cain. “Our work is far from finished,” he added, noting that the country still is far short of recommendations made in a 2010 report titled “Council on Graduate Medical Education Twentieth Report, Advancing Primary Care.” Authors of the COGME report called for an increase in the percentage of U.S. primary care physicians from 32 percent to 40 percent of the total U.S. physician workforce. Authors also called for a narrowing of the payment gap between primary care and specialty care physicians.
“Students are hearing that choosing family medicine offers them a chance to enter a rewarding career with a bright future, and we need to continue to focus on that message and build momentum moving forward.” Jeff Cain, M.D. AAFP President Positive Student Trends If health care policymakers expect physicians and other health care professionals to provide the higher quality health care and lower costs offered by the patient-centered medical home model, then stakeholders must make the necessary investments to produce and maintain a robust primary care workforce, said Cain. As for the AAFP, “We must continue our efforts to show students the value that family medicine brings to the U.S. health care system,” said Cain. “In addition, the Academy must support graduate medical education reforms that are good for primary care because continuing to tilt our health care system in a way that favors a higher ratio of subspecialists in the physician workforce moves our country in the wrong direction.” Despite some concerns about the 2013 Match results, Cain ticked off several positive trends that signal the student interest pendulum is poised to swing family medicine’s way in the near future. For example, AAFP student membership numbers have surged to an alltime high of 20,600. Medical student attendance at the AAFP’s National Conference for Medical Students and Family Medicine Residents increased to a new high of 889 in 2012. Furthermore, family medicine interest groups—located on medical school campuses and vital to AAFP efforts to expose medical students to the joys and challenges of family medicine—are at a record high of 147 groups. “I believe that students can see the value of what we do as family physicians, both for our patients and for our country, and that’s an important step in reaching our goals,” said Cain. Source: AAFP News Now, March 15, 2013. © American Academy of Family Physicians.
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NEWS CLIPS
Texas Medicaid contractor begins accepting primary care attestation Complete form to qualify for primary care rate increases retroactive to Jan. 1, 2013 under the patient protection and Affordable Care Act, primary care physicians are supposed to be receiving Medicaid fees for evaluation and management services and vaccinations at Medicare payment rates as of Jan. 1, 2013. To be eligible for the increased fees, physicians must attest that they are board certified in a primary care specialty or that at least 60 percent of their total billings are for evaluation and management services and vaccine administration. Even though the promised Medicaid fee increases haven’t happened yet, Texas physicians can now complete the attestation process. The Texas Medicaid and Healthcare Partnership, the state’s Medicaid contractor, made the attestation form available on March 8, according to an article on the TMHP website. To complete the form, you will need your National Provider Identifier, your Texas Provider Identifier, and a copy of your board certification if available. The Centers for Medicare and Medicaid Services published rules on how the fee increases should be implemented in
November 2012, which didn’t give states enough time to amend their Medicaid plans to reflect the increased rates and obtain approval from CMS before the payments were due to begin. This year could be half over before the increases go into effect, but TMHP confirms the increases will be paid retroactively to Jan. 1, 2013 for qualified providers. A recent Medscape article stated that some states have placed a deadline on physicians to complete the primary care attestation process, but TMHP has not set such a deadline as of yet. According to the Kaiser Family Foundation, Texas Medicaid fees for E/M services and vaccine administration should increase by 66 percent because of the change. These rate increases are for services provided to existing Medicaid patients, so they will be paid whether or not Texas agrees to expand Medicaid to newly eligible patients under the ACA. To access the form, go to: www.tmhp.com.
Professional Development www.tafp.org/professionaldevelopment/events SAM Group Study Workshop on Depression May 18, 2013, 9 a.m. - 2 p.m. Omni Corpus Christi Hotel Bayfront Tower, Corpus Christi 64th Annual Session & Scientific Assembly July 31 - Aug. 4, 2013 Omni Fort Worth Hotel and Fort Worth Convention Center, Fort Worth 3 SAM Group Study Workshops (Pain Management, Well Child Care, and Diabetes) July 31, 2013 Omni Fort Worth Hotel, Fort Worth For more information on these and other CME offerings, visit the Professional Development section of TAFP’s website, www.tafp.org.
Provide patients clinical summaries to help meet meaningful use One of the most difficult meaningful use measures that practices must meet is the one requiring them to give patients a clinical summary for each office visit more than 50 percent of the time. Here are some frequent questions regarding this measure. • What if my patients don’t want it? • Is this only for patients that request it? • What should be included in the summary? You must offer a summary to more than 50 percent of the patients, not just those who request one. You don’t have to give summaries to patients who don’t request them, although you may be surprised that many will appreciate having the information. You may give patients a summary in many ways. It can be printed, uploaded to a patient’s electronic personal health record, or uploaded to a patient portal. Be sure the patient has signed up for the portal for this to count. You may also give it to the patient on a portal device such as a USB drive. If the patient refuses a summary, be sure to document that you made the offer and the patient refused so that you can count that
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office visit in your numerator towards the 50-percent requirement. Some electronic health record vendors track this by asking physicians to “print to file” so it is documented. Take a moment to review what data elements are pulled into the clinical summary. Some physicians may make notations not intended for patient viewing, and it is vital that you understand exactly what is extracted into the summary. For example, one clinical summary indicated the patient was an alcoholic because the calibration within the EHR based that information on the number of drinks per week. To help physicians, the Office of the National Coordinator for Health Information Technology established regional extension centers, or RECs, to provide onsite health information technology consulting in physician practices. For questions about eligibility and REC services, visit the REC Resource Center at www.texmed.org/rec/. For questions about meaningful use or other HIT issues, contact TMA’s HIT Department at (800) 880-5720, or visit the TMA EHR Incentive Program Resource Center at www.texmed.org/EHRIncentive/.
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Report on TAFP’S 2013 C. Frank Webber Lectureship
Family physicians gather in Austin for cutting-edge CME and Interim Session Photos and story by Samantha White Clockwise from top left: Galveston medical student Evan Perez practices circumcisions at the Procedures and Residency Fair. Attendees of TAFP’s Legislative Action Day included Samuel Wang, M.D.; David Greer, M.D.; Jerry Abraham, M.P.H.; Douglas Curran, M.D.; Troy Fiesinger, M.D.; Mary Helen Morrow, M.D.; Christina Kelly, M.D.; and Jake Margo, M.D. Abraham and Margo meet with Sara Hull, J.D., legislative aide to Sen. Judith Zaffirini, during TAFP’s Legislative Action Day. TAFP President Troy Fiesinger, M.D., prepares to call the Board of Directors to order. Arlington medical student Kim Tran speaks to Angelique Wong, M.D., of Houston and a representative of the Memorial Family Medicine Residency Program during the Procedures and Residency Fair. Ashok Kumar, M.D.; Melissa Gerdes, M.D.; Mary Helen Morrow, M.D.; and Leah Raye Mabry, M.D., attend the TAFP Political Action Committee reception.
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Member news ore than 400 physicians, residents, and medical students congregated at the Omni Austin Hotel at Southpark to attend events surrounding this year’s C. Frank Webber Lectureship and Interim Session, Feb. 28 – March 2. The weekend included CME lectures, two ABFM SAM Group Study Workshops, TAFP business meetings, the Texas Conference of Family Medicine Residents and Students, and the Clerkship and Residency Coordinators Conference. Throughout the weekend TAFP interacted with members and attendees through Facebook and Twitter. Search our hashtag— #TAFP—on Twitter to see tweets surrounding the weekend’s events or go to twitter.com/ TXFamilyDocs. There is also a Facebook album of all photos taken during the weekend on our Facebook page at facebook.com/txafp. The first SAM Group Study Workshop of the weekend was held Thursday, giving diplomates of the American Board of Family Medicine a chance to get credit for the SelfAssessment Module portion of their Maintenance of Certification. Attendees discussed mental health in the community and completed the 60-question knowledge assessment portion of the module, making them eligible to complete the clinical simulation online to receive full credit. Thursday also included TAFP’s Legislative Action Day, where a group of members met with TAFP CEO Tom Banning and other TAFP staff to discuss current issues facing family medicine before walking to the Capitol and meeting with their local lawmakers as a face for the specialty. Friday’s CME lectureship featured speakers on a wide array of topics, including diabetes, allergy and asthma, fracture prevention, and more. For the first time, attendees were able to complete their evaluation survey and CME recording form not only on paper, but also online. The Clerkship and Residency Coordinators Conference also took place Friday. Coordinators from across the state listened to TAFP staff give an update on the 83rd Texas Legislature, as well as a quick briefing on using social media. They were also given an update on licensing by the Texas Medical Board, and discussed clerkship-related curriculum and new SAM requirements for residents. TAFP member Joane Baumer, M.D., ended the conference with education updates for medical schools. The second SAM Group Study Workshop was held Saturday and covered heart failure.
TAFP also hosted the Texas Conference of Family Medicine Residents and Students on Saturday, giving medical school students and residents a chance to learn about the specialty. TAFP Past President Robert Youens, M.D., debunked the myth that you can’t make a good living in family medicine. The attendees were then able to interact with a panel of four TAFP members in different areas of primary care practice. These physicians were Terrance Hines, M.D.; Adrian Billings, Ph.D., M.D.; Christina Kelly, M.D.; and Emily Briggs, M.D. The student and resident conference ended with an interactive Procedures and Residency Fair, giving attendees the opportunity to talk to representatives of residency programs from around the state, as well as practice various procedures. TAFP commission, committee, and section meetings took place Friday and Saturday, and included discussions on multiple aspects of the family physician practice and policy that will guide the Academy. Banning updated the Commission on Legislative and Public Affairs Friday night, informing them of the activity thus far of the 83rd Legislative Session. The Commission put forth a motion that the Academy support Medicaid expansion to meet the health care needs of underserved Texans, which was approved Saturday night by the Board of Directors. Upon recommendation of the Task Force on Governance and the Bylaws Committee, the Board recommended adoption of all changes made to the Academy’s bylaws, which include a restructuring of the Academy’s governance. On pages 27-34 of this issue of TFP, you’ll find the complete set of TAFP bylaws with the proposed changes marked. The general membership will vote on the changes this summer at Annual Session. You can still log on to the members-only section of the website to see the final reports from all business meetings. To do so, go to v1.tafp. org/membersonly. Mark your calendars now to join TAFP for next year’s C. Frank Webber Lectureship at the Omni Austin Hotel at Southpark on Feb. 28. Also plan to join us for our largest symposium, Annual Session and Scientific Assembly, July 31-Aug. 4, 2013, at the Omni Fort Worth Hotel and Fort Worth Convention Center in Fort Worth, Texas. This fall, TAFP will host Primary Care Summit – Houston, Oct. 18-20, at the Westin Oaks, and Primary Care Summit – Dallas/Fort Worth, Nov. 8-10, at the Westin Galleria. www.tafp.org
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Start Saving Money on Vaccines Now! Discounts on Vaccines • Reimbursement Support With Payers • Timely Updates About New Products, Changes & Sales • Donations to TAFP With Every Purchase! Atlantic Health Partners is a free vaccine purchasing program open to any physician practice. Through Atlantic, your practice orders directly from manufacturers and receives discounts on a range of vaccines – infants to adults – Tdap to HPV. Atlantic also works as an advocate – working directly with payers on issues such as payment for vaccines and administration. They can provide a number of resources on billing, coding, pricing and inventory management. The program is free to your practice, and enrollment is completely voluntary. The Texas Academy of Family Physicians is partnering with Atlantic Health Partners because Atlantic can save family physicians money, advocate for fair payment and support family medicine. Atlantic Health Partners will donate 10 percent of revenue from all TAFP member sales to TAFP and provide an additional $1,000 unrestricted educational grant to the TAFP Foundation for every 125 TAFP members registered. Contact Cindy Berenson or Jeff Winokur at (800) 741-2044 or info@atlantichealthpartners.com for more information and to register.
Member news
Two TAFP members make bids for TMA leadership roles TAFP members Douglas Curran, M.D., of Athens, and Gregory Fuller, M.D., of Keller, will run for election at the Texas Medical Association’s upcoming annual TexMed conference. Curran is running for re-election to the TMA Board of Trustees, for which five physicians are vying for three spots. He currently practices in Athens, Texas, as a staff physician with East Texas Medical Center and Lakeland Medical Associates, Group Practice. Over his nearly 30 years in mediDouglas Curran, M.D. cine, he has become a recognized advocate for the patients and physicians of Texas and has been active in organized medicine, serving on numerous committees and in various officer roles for TMA, TAFP, and AAFP. He is a past president of TAFP and a former Texas Family Physician of the Year. He has chaired TAFP’s Nominating Committee, the Commission on Membership and Member Services, and the Commission on Legislative and Public Affairs. In AAFP, he currently serves as Texas alternate delegate to the AAFP Congress of Delegates and previously served as a member of the AAFP Commission for Governmental Advocacy. The TMA Board of Trustees manages business and financial affairs of the association, implements policies of the House of Delegates, establishes association policy between meetings of the House of Delegates, and monitors program activities of TMA councils and committees. Membership includes nine at-large members, six TMA officers, one resident, and one medical student. Fuller is running for a position as TMA’s alternate delegate to the American Medical Association. Three physicians are vying for two spots. He is currently a private-practice physician at North Hills Family Medicine in Keller, Texas.
Fuller is a member of TAFP, AAFP, and the Tarrant County Chapter of TAFP, and a member of AMA, TMA, and the Tarrant County Medical Society. He currently serves on the TCMS Board of Directors and previously served as their president. Fuller serves as a delegate to TMA. He previously chaired health information systems at North Hills Hospital and chaired the hospital’s family medicine department. Gregory Fuller, M.D. Members of the AMA House of Delegates link AMA and grass-roots physicians, providing information on AMA activities, programs, and policies. In this role, Fuller would contribute to the formulation and implementation of AMA policies. The election will be held during TexMed 2013 at the Henry B. Gonzalez Convention Center in San Antonio, May 17-18. Nominating speeches will be made at opening session on Friday, and the candidate forum will be conducted Friday afternoon, 2:30-3:30 p.m. The election will take place Saturday morning. Though only appointed delegates and alternate delegates in the TMA House of Delegates can vote, all TMA members can take part in their county medical society caucus, either through their specific county chapter or through consolidated meetings of smaller county chapters. Most caucuses meet Saturday morning, 6:30-8 a.m. TAFP encourages all TMA delegates, alternate delegates, and members to attend the TMA meeting and add your voice and support for Curran and Fuller, which will further amplify the voice of family medicine in the larger house of medicine. For more information on TexMed 2013 and to access the House of Delegates’ schedule, go to www.texmed.org.
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PRACTICE MANAGEMENT
What you don’t know can hurt you By Bradley Reiner you’ve probably been reading more than you should about groups of doctors sending back money. Accusations of incorrect billings, fraudulent behavior, and false claims are common occurrences. You will have to be diligent, but I will provide you with information that will help you avoid all of this. The Office of Inspector General’s Work Plan for Fiscal Year 2013 summarizes new and ongoing reviews as well as activities that the OIG plans to pursue with respect to Health and Human Services programs during this year and beyond. If you want to review their list of concerns, I would highly encourage you to review the work plan located at oig.hhs.gov/reports-and-publications/workplan/ index.asp. Familiarize yourself with what Medicare and Medicaid are looking for this year and you will see how critically important it is for you to be proactive. You can look at the work plan anytime and find out what they are reviewing, but I want to give you a taste of what the commercial plans are looking at these days. I believe most practices haven’t been that concerned with commercial payers and have focused on Medicare and Medicaid compliance. 16
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Generally, physicians haven’t felt threatened by commercial payers because in the past, health plans have lacked infrastructure and staff to keep track of how claims are being billed. This has changed dramatically with many commercial payers. They are more active in this than ever before. An example of this change is demonstrated in a letter that a large commercial payer sent to a solo family physician. The letter bore the subject “Coding,” and it started out as follows:
“ABC Insurance understands the importance of claims processing to practicing physicians. A key part of the service we provide is the facilitation of benefit payments in accordance with the terms and provisions of the member’s plan. Based on a review of claims data, we have identified concerns in your billing practices. Submitted claims and corresponding medical records have been reviewed and we would like to address the variances listed below.”
This particular doctor was then told he had a number of issues that needed correcting immediately. I want to share with you the three items in detail as well as recommendations for ensuring these things don’t happen to you. Being proactive is the key to compliance.
First Issue The first concern involves physician assistants and nurse practitioners. As you know, in primary care these physician extenders are a popular choice to employ. I’ve been asked by numerous practices to assist with hiring these individuals. They are less expensive than bringing on another physician and their extensive services can be managed and supervised with relative ease. There are requirements in regards to supervision and oversight of medical records, but these individuals can be a great asset. Of course with great assets come greater scrutiny. The thing to keep in mind is that Medicare may do things one way, but many commercial plans can follow different rules. As a refresher, Medicare has rules for billing PAs and NPs. Medicare allows a physician to file extenders under the physician’s provider number for established patients. These claims are “incident to” the physician when the supervising physician is in the office suite and immediately available to the extender during the visit. If this occurs, the claim can be billed under the physician’s provider number and payment is based on the doctor’s Medicare allowable fee. However, if the phy-
Medicare has always been a standard and benchmark in the industry. However, in this case the commercial plan is more restrictive when it comes to extender reimbursement. The moral of this story is to check all of your contracts to ensure you are billing extender services appropriately. The physician in the example unfortunately found out the hard way with refunds and scrutiny for false claims. Don’t let this happen to you.
Second Issue The second issue involves pass-through billing for services that generally require equipment to perform and subsequent interpretation. It includes billing services globally and having the entity that owns the equipment or does the interpretation then bill the practice for services. You see this when lab is drawn from the practice, the specimen is sent to the lab for testing, and the results are sent back to the doctor. The doctor bills globally for the test as if he provided the service, then the lab bills the doctor. Depending on the arrangement, this might be permissible. In other cases, the arrangement could be similar to the doctor in this case who is being questioned. The statement was defined in the letter from the payer as follows: sician is not on the premises and therefore not “incident to,” the extender must file under his or her name and provider number. A 15 percent reduction is applied to the service when this situation occurs. The commercial payer in this example would handle the claim very differently. It would be reasonable to assume that “incident to” rules would apply. However, in this example that is not the case. The first issue stated:
“Billing for medical services performed by the Physician Assistant/Nurse Practitioner (Physician Extenders) under Dr. X’s name instead of under the actual servicing provider. The contract outlines that there is a different percentage of reimbursement when services are performed by the assistant. The claims should be billed under the correct servicing provider’s name.”
In other words the payer does not recognize “incident to.” This means if the extender provided the service there is a reduction in payment regardless of whether the doctor is on the premises or not. This is becoming more of a rule than an exception. Payers are implementing reductions in payment when any extender provides the service.
“The global aspect of testing is billed by your office when the services are done by another provider or entity. Another provider is bringing the equipment into your office, performing the testing and it is sent out for interpretation. The provider who owns the equipment should be billing for
the technical component of the testing and the provider who does the interpretation should bill the interpretation.” In other words, these companies are providing testing in the office and the physician is billing globally for services the company performs. Although some payers may allow this procedure, many payers are informing providers not to bill for services that they did not provide themselves. The moral of this story is to have these arrangements reviewed by a health care attorney who has experience in these matters and get results in writing. This will protect you from payers that may frown on these situations and suggest the practice is billing false claims.
Third Issue The third and final issue involves commercial payers increasing scrutiny on evaluation and management codes. It is not unusual for payers to review levels of service to ensure medical record documentation meets the requirements for the code billed. The tenacity of payers has become more substantial as they see the opportunity of recovering revenue. The statement in the letter was:
“Medical records lacked documentation and/or appropriate documentation to support services.”
Higher level office visits are being reviewed more consistently and comparisons to peer groups are becoming more standard operating procedure. The documentation has to back up any code billed or refunds are being requested. Don’t find yourself in this situation.
So, how much do you know about evaluation and management codes? Here is a test to measure your knowledge. Answers are at the bottom. 1. What are the four key elements that make up the E/M coding system? 2. How many elements must be documented in the review of systems, or ROS, for this subcomponent of the history element to be considered complete? 3. Which E/M element establishes the medical necessity of any type of visit? 4. How many elements must be documented for an extended history of the present illness? 5. When is a patient considered a new patient to a physician? If you don’t know the answers to these questions, you need to have your records reviewed independently to determine any deficiencies and potential improvements necessary for compliance. Ensuring your documentation meets all requirements for the codes billed is more critical than ever and will continue to challenge physicians into the future. Answers 1. Chief complaint, history, exam, medical decision making; 2. 10; 3. Chief complaint; 4. Four; 5. When a patient has not been seen in over three years or someone of the same specialty in the same group over three years. Bradley Reiner, formally with Texas Medical Association, is now owner of Reiner Consulting and Associates. He can be reached at (512) 858-1570 or by e-mail at breiner@austin.rr.com. www.tafp.org
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Foundation Focus Advocating for family medicine under the pink dome By Anastasia Benson, D.O.
House Appropriations Committee, and multiple groups held a public i wasn’t sure what to expect when I walked in to the TAFP office. discussion about a set of reports touting the benefits of expansion. In Being a recipient of the TAFP Foundation’s James C. Martin, M.D., addition to national, state, and local coverage on the matter, it was all Scholarship but conducting the internship during the legislative sesthe buzz around the Capitol, TAFP CEO Tom Banning and the TAFP sion rather than in the summer was a new experience for everyone advocacy team hit the steps supporting it. involved. Looking back on my two weeks in Austin, I can say my expeThe 83rd Texas Legislature has many important issues on the rience with TAFP has forever changed my life and view of the impact docket that affect us as family physicians, and TAFP diligently sorts we as physicians have on Texas politics. Hopefully you, too, can explore through the more than 5,000 bills. During my two weeks with TAFP, our Capitol, but let’s start back at the beginning of my whirlwind trip. the Legislature debated a few issues that you may not have heard Though I attended medical school at the Arizona College of Osabout on the evening news, including changes teopathic Medicine, I am a native Texan. Hailing to the Medicaid vendor drug program, funding from Prosper, a small town just north of Dallas, I “back transfers” for NICUs, increasing GME always dreamed of becoming a family physician. I’ve always had a funding, restoring the physician loan repayment I am currently completing my residency at Methprogram, silent PPOs, price transparency, and odist Charlton Medical Center in Dallas, where I hidden passion for multiple scope of practice issues. Things move am a second-year resident. politics. Growing up in fast at the Capitol, and busy professional lives I’ve always had a hidden passion for politics. a small town, politics often make it difficult to be well informed on Growing up in a small town, politics were all these numerous bills. around us. From the school to the gas station to were all around us. In addition to lobbying on your behalf, the football game, everywhere you turned you From the school to TAFP creates multiple resources for members, were immersed in small-town politics. Perhaps the gas station to including a video newscast called Capitol these experiences kindled my interest. However, Report, TAFP News Now, and issue briefs, all events occurring in my first month of medical the football game, found on www.tafp.org. school piqued my interest in health policy. Many everywhere you turned If you are okay with others (often nonthings changed on the federal level that month, you were immersed in physicians) determining how you practice including the abolishment of the 20/220 pathway medicine, disregard everything I have said. for loan repayment, which was an important small-town politics. Otherwise, it’s your turn to speak up. We are vehicle for loan repayment during residency. I in unprecedented times, and the practice of was shocked, and this change still affects me and medicine is literally changing before our eyes. We as family physimy colleagues today. Later that year I helped with grass-root efforts to cians must not rely on our neighbors to use their voices; we must avoid the first of many potential large Medicare reimbursement cuts. each use our own voice to be heard and encourage those around us When I received notice that I had won the James C. Martin, M.D., to speak up, too. Increase the power of your voice by donating to Scholarship, I was ecstatic. March 2013 arrived and I made my way the TAFP Political Action Committee. down to Austin, where my stint began at the C. Frank Webber LecAs I settle back down into resident-life mode, I will always look tureship and Interim Session. At the Committee on Legislative and back fondly on my two weeks with the TAFP staff. For those who Public Affairs meeting and later at the Board of Directors meeting, have not met them, they are very passionate and dedicated to supmembers voted unanimously to support Medicaid expansion with no porting our members and I would like to thank each one of them for strings attached, setting the tone for the next two weeks. their guidance on my journey. And a special thank you to Dr. James TAFP wasn’t the first to publicly support Medicaid expansion, Martin and his scholarship fund, as it afforded me this amazing opnor will it be the last, but our support could not have come at a more portunity to learn the behind-the-scenes of what our organization opportune time. Over the next few days, Sen. Bob Deuell, M.D., does for its members and how health policy shapes our profession R-Greenville, wrote a letter to Gov. Rick Perry with his thoughts on and our community from the perspective of the trenches beneath the Medicaid reform, followed shortly by Senate Bill 1477, outlining his pink granite dome. TAFP scholarships such as this one are funded ideas. Supporters of Medicaid expansion marched to the steps of through the TAFP Foundation, and they help provide new experithe Capitol, where former AAFP President Roland Goertz, M.D., of ences to its younger members, developing leaders for the future. Waco, addressed the masses along with lawmakers and other speakHealth policy is the art of the possible; and in the future of medicine, ers. Then the agency heads and state representatives discussed the all is possible. Now is the time to make your mark on family medicine. financial ramifications of expanding the program at a hearing of the 18
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TEXAS FAMILY PHYSICIAN
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Severe budget cuts from the 82nd Texas Legislature left the women’s health care safety net in tatters, but supported by a strong fiscal and public health policy argument, a bipartisan coalition is working to restore funding for wellness, preventive, and family planning services.
DAMAGE CONTROL Mending The Women’s Health Care Safety Net In Texas BY KATE ALFANO
beneath a grand, wooden replica of the Texas state seal, Anavi Cantu timidly looked out at the large group of news reporters, legislators, and legislative staffers gathered in a Capitol press room and, with a little encouragement from her family physician sitting beside her, spoke a simple message: the family planning and preventive services provided by the state are “really important” to women like her. She and her husband each have two jobs, Cantu explained, and she’s a full-time student; they have two kids. “Without the clinic, without any funding, it would be really hard for people like me and my husband in Robstown,” she said, her voice wavering. “We’re just trying to make it even if we have to have two jobs. We couldn’t afford to have another child. Without [these services], I don’t know where we’d be.” Her family physician, TAFP member Janet Realini, M.D., M.P.H., is a leading advocate for women’s health care in Texas and chair of a new coalition created in the wake of severe cuts to the women’s health care safety net following the 82nd Texas Legislature in 2011. The Texas Women’s Healthcare Coalition—comprised of a growing group of public policy, faith-based, and health care organizations, including TAFP—held the press conference in mid-February to present their platform and build support for their cause. “This is what it’s about,” Realini said after Anavi sat down. “It’s about real people who need services so their families can be healthy, so they can be healthy to take care of their children, to make their way in life, to improve their life.” Texas has two programs that provide low-income women access to basic preventive, wellness, and preconception health care like wellwoman examinations, diabetes screening, breast and cervical cancer 20
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SAMANTHA WHITE
Anavi Cantu addresses members of the Capitol press corps flanked on the left by Janet Realini, M.D., M.P.H., chair of the Texas Women’s Healthcare Coalition, and on the right by Rep. Donna Howard at a TWHC press conference.
screening, contraceptive counseling, and a variety of FDA-approved birth control methods: the Department of State Health Services Family Planning Program and the Texas Women’s Health Program. Once pregnant, low-income women are eligible for Medicaid but non-pregnant women are generally not eligible. The DSHS Family Planning Program is supported mostly by federal dollars from Title X (Family Planning), Title XX (Social Services Block Grant), and Title V (Maternal and Child Health Block Grant), according to TWHC. In the 2010-2011 biennium, 80 percent of its funding came from the federal government. The Women’s Health Program, authorized by the Texas Legislature in 2005 and implemented in 2007 as a five-year Medicaid waiver demonstration project, received 90 percent of its funding from the federal government. From its inception, the legislation authorizing WHP contained explicit language prohibiting qualifying clinics from performing elective abortions, relevant to note for the budget battle of the 82nd Legislature. In May 2011, capping a contentious budget session that pitted each high priority against another, family planning advocates watched in dismay as lawmakers openly attacked this funding—politicized by the abortion debate and, some say, fueled by an ongoing feud between conservative lawmakers and Planned Parenthood—and amended the budget from the floor to appropriate these dollars elsewhere. By the time the dust had settled, lawmakers approved a state budget that cut funding for the DSHS Family Planning Program by 66 percent, from $55.6 million to $19 million. Additionally, a tier system was enacted to prioritize funding for public clinics and hospitals over family planning clinics. And while
“The safety net for women’s health care is in tatters. We need to put funding back, put the resources back, rebuild our safety net as quickly as possible so that Anavi and her family, and so many other women, men, and families around the state have access to preventive care so their families can improve their lives.” Janet Realini, M.D., M.P.H. Chair, Texas Women’s Healthcare Coalition
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During a TWHC press conference Rep. Donna Howard, D-Austin, speaks to the press on the importance of the family planning and women’s health programs and stresses the need for a restoration of the funds cut during the 82nd Legislature to keep clinics open.
“I am encouraged from the response we’re getting that even those who had an ideological reason for wanting the cuts recognize that this went beyond what some of them had anticipated,” Howard said. “They recognize that we have to restore these funds and get these services back in place.” Rep. Donna Howard
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lawmakers authorized renewal of the federal waiver supporting WHP, a rule created earlier in the session by the Texas Health and Human Services Commission excluded Planned Parenthood—which formerly provided more than 40 percent of preventive health and family planning services—from participating as a provider in the program. TWHC estimates that more than 1 million Texas women ages 2044 need publicly supported health care and contraception, and even when Texas’ two family planning programs were fully functioning, they could only provide services to about one-third of the women who needed care, or roughly 340,000. Because of the cuts and the funding tiers enacted by the 82nd Legislature, the number of women the DSHS program will serve is expected to drop to 65,000 per year in 2014 and 2015, down from the 212,000 served in fiscal year 2010. Also, 167 clinics across the state lost funding and at least 53 have closed, two-thirds of which were run by entities unrelated to Planned Parenthood. Many more have reduced hours or the number of family planning appointments they can provide. Public health consequences aside, the fiscal consequences to the state are receiving renewed attention. “We’ve had estimates from DSHS and HHSC that we could anticipate having 24,000 additional unplanned pregnancies in the upcoming biennium, and that will actually cost Texas taxpayers $103 million in Medicaid care for these births that were not planned rather than paying much less up front for the
SAMANTHA WHITE
Poll reveals Texans broadly support women’s access to health care and state funding for programs
preventive services,” State Rep. Donna Howard, DTexans believe that access to family planning and birth control is important and Austin, said at the press conference. should not be limited by a woman’s income level, employer, or medical provider, “On top of this, there have actually been increased according to results from a recent survey. Respondents crossing broad demographic costs in the current fiscal year of approximately $33 categories—political, racial, generational, and the religiously observant—expressed million for the additional births caused as a result of support for the right for women to make their own decisions about family planning those cuts. I think it’s very clear that this is a program and support state funding for family planning programs in the state. that makes a huge difference in cost containment. Additionally, respondents oppose allowing employers to deny their employees health And as I’ve said multiple times, it makes good pubcare coverage for family planning services and birth control, and want to ensure that lic policy and good fiscal policy to refund and restore state funding for family planning goes to medical providers who offer a full range of this program for the women in Texas.” family planning services, including birth control. State Rep. Sarah Davis, R-West University When asked how important it is for Texas women to have access to family planning Place, a breast cancer survivor who supports rouand birth control, regardless of income barriers, more than two-thirds, or 68 percent, tine screening, spoke at the press conference of responded that they felt it was extremely or very important while 30 percent said “just her concern for the Women’s Health Program. As a little important” or “not important at all.” Support for access to family planning and a result of the provider exclusion, the federal Cenbirth control increases dramatically in the Hispanic population (with 81 percent feeling ters for Medicare and Medicaid Services declined it’s extremely or very important versus 16 percent feeling it’s a little or not important), to renew Texas’ WHP waiver. Texas Gov. Rick among women (73 percent versus 24 percent), and among respondents under 30 (84 Perry has pledged that WHP will continue, but percent versus 16 percent). as a state-run program without federal support Seventy-three percent of respondents favor providing state-funded family planning and not a federal-state partnership. To maintain services including birth control for low-income women, with 25 percent opposed. WHP at its current level, Texas must replace more Support greatly increases among black respondents (97 percent in support versus 3 than $30 million annually in lost federal funding, percent opposed), Democrats (95 percent versus 4 percent), and respondents under TWHC estimates. 30 (85 percent versus 15 percent). Davis said at the press conference that legislaNearly half, or 49 percent, of respondents say that they feel that women’s access to tors have found the funding for the program, but family planning and birth control is being threatened in Texas, compared to 34 perthe most significant challenge will be ensuring the cent not acknowledging a threat. delivery system has the providers to care for the The survey was conducted by Greenberg Quinlan Rosner and Chesapeake Beach patients the program serves. The state will be on Consulting for the Texas Freedom Network Education Fund. It reached a total of 604 the hook for additional Medicaid costs for materregistered voters in Texas and was conducted in February 2013. nity and infant care if provider capacity is not sufficient to maintain the number of women served. “We’re in this era where we want to minimize the cost to the state, we want to minimize the taxpayer dollars that we spend, and really it’s fortunate that we have women’s preventive health care because it’s one cal reason for wanting the cuts recognize that this went beyond what of the most cost-effective ways to help lessen the cost to Medicaid,” some of them had anticipated,” Howard said. “They recognize that we Realini said. For every dollar the state spends on family planning care, have to restore these funds and get these services back in place.” including contraceptive care and preventive screenings, we save at And there’s similar sentiment on the Senate side. State Sen. Jane least $3.74 by helping women avoid unplanned pregnancy, and avoidNelson, R-Flower Mound, who chairs the Senate Finance Committee’s ing the Medicaid costs for pregnancy, birth, and infant health care, Article II Workgroup, announced her support for adding $100 million she explained. “More recent estimates have it even higher, so that’s a to the base budget for women’s health services. conservative estimate.” “It’s time for us to unite behind solutions we can all agree are in the TWHC is asking lawmakers to restore DSHS family planning fundbest interest of keeping Texas women healthy,” she said in a February ing to 2010-2011 levels, back to $55.6 million per year to restore access press release. “I believe in the power of prevention, and our plan will for the 147,000 women cut from the program; fully fund the Texas ensure that Texas women have access to the best possible preventive Women’s Health Program at a cost of $36 million per year to maintain services, such as cancer screenings. In addition to making this investservices for 130,000 women; and ensure ample provider capacity for ment, it is important that we grow our network of providers, expand the Women’s Health Program with active monitoring and aggressive access for women in rural communities, and recognize that family action to expand provider capacity. planning is a critical component of our efforts to support the health “The safety net for women’s health care is in tatters,” Realini said. of Texas women.” “We need to put funding back, put the resources back, rebuild our But, restoring funding is just the first step, Howard said. “Even safety net as quickly as possible so that Anavi and her family and so with restoring the funds, I think we’re going to be struggling to get many other women, men, and families around the state have access to these programs up and running. Over 53 clinics were closed; they don’t preventive care so their families can improve their lives.” exist anymore. We have to create more. And then of course if Planned Both Davis and Howard expressed optimism that their colleagues Parenthood is not a part of this and they were providing a number of in the House will address these funding concerns. “I am encouraged services here, that exacerbates the issue. We have challenges ahead, from the response we’re getting that even those who had an ideologieven with the funding, but we must restore the funding.”
www.tafp.org
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minutes in brief
Highlights from TAFP’s Interim Session, March 1-2, 2013 The committees, commissions, and sections of the Texas Academy of Family Physicians met in Austin on March 1-2, 2013. The Board of Directors met on Saturday, March 2 to hear reports and recommendations. Below are the highlights of the meeting.
by mid-level providers and contracted providers. They also heard from Dr. Charles Stern on family medicine redesign efforts at Scott & White. Dr. Michael Sills from Baylor Health Systems gave a presentation to the commission on the evolving state of the health care delivery system in Texas, the effects of consolidation among providers, and the role of family physicians over the next several years. Commission on Legislative and Public Affairs
Bylaws Committee The Bylaws Committee had one recommendation for the Board of Directors to review. At the request of the Executive Committee, the Bylaws Committee drafted amendments to implement recommendations from the Task Force on Governance to alter TAFP’s governance model. The TAFP Board recommended adoption of the proposed bylaws changes. You can see the full bylaws with proposed changes starting on page 27. These amendments will be voted on by the membership at the Business and Awards Lunch during the TAFP Annual Session in Fort Worth, Saturday, Aug. 3, 2013. Executive Committee The Executive Committee reviewed the TAFP and NPI Budgets. Dr. Troy Fiesinger discussed the legislative session. Tom Banning provided an update on GME funding, Medicaid expansion, and scope of practice. Finance Committee The Finance Committee reviewed the combined 2012 audit for TAFP and NPI. There were no major findings. The committee decided to request proposals from other CPA firms for the 2013 audit. The committee will review the bids and decide whether to switch accounting firms or stay with Glass & Co. Nominating Committee The Nominating Committee proposed the following slate of officers for 2013-2014: Dale Ragle, M.D., president-elect; Tricia Elliott, M.D., vice president; Ajay Gupta, M.D., treasurer; Janet Hurley, M.D., parliamentarian; Linda Siy, M.D., delegate to AAFP; and Troy Fiesinger, M.D., alternate delegate to AAFP. 24
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Commission on Academic Affairs The Commission on Academic Affairs found that the current Goals and Objectives do not accurately reflect their activities. They are undergoing a major revision to be reviewed at Annual Session. The group started a prioritization process and will continue this via e-mail over the next few weeks. Goals and Objectives will be combined and condensed with measurable objectives for a more efficient commission. Commission on Continuing Professional Development The Commission on Continuing Professional Development approved program chairs for TAFP’s educational programs for the next year. Program chairs include Rebecca Hart, M.D., for the 2013 Primary Care Summit in Houston; Clare Hawkins, M.D., for the 2013 Primary Care Summit in Dallas; Stephanie Roth, M.D., for the 2014 C. Frank Webber Lectureship; and Dale Allison, M.D. and Robert Shields, D.O., for the 2014 Annual Session & Scientific Assembly. Commission on Core Delegation The Commission on Core Delegation discussed the work of the various AAFP Commissions. There are TAFP members on all but one AAFP commission. The commission also heard from TMA presidential candidates. Commission on Health Care Services and Managed Care The Commission on Health Care Services and Managed Care heard from TAFP’s practice management consultant, Bradley Reiner, about recent developments in third-party billing practices for services delivered
TEXAS FAMILY PHYSICIAN
The Commission on Legislative and Public Affairs had one recommendation for the Board of Directors to review. The board approved their recommendation that TAFP support Medicaid expansion to meet the health care needs of Texans. Under the Patient Protection and Affordable Care Act, states can expand Medicaid coverage to uncovered populations including working-age adults below 133 percent of the federal poverty level. The federal government will cover the costs of the expansion through 2016, and a substantial portion of the cost in subsequent years. States can opt in or opt out of the Medicaid expansion at any time. The commission voted unanimously to recommend this policy statement. Commission on Membership and Member Services The Commission on Membership and Member Services discussed membership statistics, the reelection report, and resident and student recruiting. The commission also selected several award and scholarship recipients.
The second recommendation was that TAFP request DPS clarify the meaning of “anybody” in the DPS medication list release. According to release documents on the DPS site, physicians agree to not disclose information to “anybody.” This should be clarified as the term “anybody” is quite vague, and makes it appear that the information is not supposed to be discussed with the patient. The Board of Directors voted to approve both motions. Section on Special Constituencies The Section on Special Constituencies discussed the National Conference of Special Constituencies and acknowledged the official representatives from TAFP for 2013: Lindsay Botsford, M.D., as the women’s delegate; Bruce Echols, M.D., as the GLBT delegate; Emily Briggs, M.D., as the new physicians’ delegate; Edward Chieke Nwanegbo, M.D., as the minority delegate; and Manjula Cherukuri, M.D., as the IMG delegate. The section selected Bruce Echols, M.D., as the recipient of the TAFP Special Constituency Leadership Award. Section on Medical Students The Section on Medical Students held their elections for the 201314 student officer positions. The new officers are: Jerry Abraham, M.P.H., chair; Brittant Taute, chair-elect; Jacklyn Chang, TAFP Board of Directors; Evan Perez, TAFP Board of Directors alternate; Matt Mullane, National Conference delegate; Anna Gamwell, National Conference alternate delegate; and Sharon Gilkey, FMIG coordinator.
Commission on Public Health, Clinical Affairs, and Research
Section on Resident Physicians
The Commission on Public Health, Clinical Affairs, and Research had two recommendations for the board. The first was asking TAFP to work with the DEA to create a marketing campaign for National Prescription Drug Take-Back Day to help remove dangerous drugs and promote appropriate medication disposal. Trace amounts of multiple medications have been found in the water supply, due to lack of educational materials on proper disposal of medications. The DEA National Prescription Drug Take-Back Day exists, but is not widely marketed.
The Section on Resident Physicians held their elections for the resident officer positions. The new officers are: Linda May, M.D., chair; Amir Hendiani, M.D., vice chair; Laura Adams, M.D., secretary; Kassie Soefje, M.D., National Conference delegate; Hsin- Yi- Janey Wang, M.D., National Conference alternate delegate; Joshua Splinter, M.D., and Mike Leasure, M.D., delegates to the TAFP Board of Directors; Cesar Maldonado, M.D., and Tarina Desai, M.D., alternate delegates to the TAFP Board of Directors.
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201 3 PROPOSE D AMENDMENTS TO TAFP BYLAW S
A proposed change to TAFP’s governance By Linda Siy, M.D., chair of the Academy’s Task Force on Governance At the March 2, 2013, meeting of the TAFP Board of Directors, the board voted to recommend adoption of a set of substantial bylaws amendments. There are a few minor wording changes and a simplification of membership requirements by referring to the AAFP bylaws for the classes, qualifications, and conditions of membership, but the majority of the proposed changes come as the result of over two years of work by the Task Force on Governance. The task force was convened by then President Melissa Gerdes, M.D., to study TAFP’s governance model and I was asked to serve as chair. After discussing ideas with the board over the last two years, the task force completed its final report in December 2012. The goal was to ensure that the governing body is appropriately executing the legal and fiscal responsibilities associated with a board of directors, and to improve efficiency in the use of Academy resources – both fiscal resources and the time donated by volunteer leaders. We also wanted to maintain a grass-roots body to keep the voices of members alive in the governance structure. Under the proposed structure, a member assembly composed primarily of chapter representatives would elect leaders and discuss issues of importance to the organization. The assembly would meet at TAFP’s Annual
Session and all members would be welcome to attend. The proposal also establishes a fifteen-member Board of Directors and a seven-member Executive Committee. To obtain a copy of the final report of the task force, contact Kathy McCarthy at kmccarthy@tafp.org. If you have served in leadership with TAFP, you know this is a significant change. Our current board is quite large with representatives from each local chapter. The average non-profit board has 19 members, while our board has over 90. We all agreed that a smaller, more nimble board would be more appropriate. The task force discussed the idea of geographic representation on the new board but ultimately decided that the focus should be on finding members with the appropriate competencies to lead our organization with a secondary goal of finding members with diversity in geography, practice type, and years in practice. Following is the entire bylaws of TAFP with the proposed changes marked throughout. In accordance with our bylaws, the membership present at the TAFP business meeting on Saturday, Aug. 3, 2013, during the TAFP Annual Session and Scientific Assembly will have the opportunity to vote on these proposed bylaws amendments. An affirmative vote of at least two-thirds of the members present shall constitute adoption.
Chapter I. Name
Chapter V. Goals and Purposes
The name of this organization shall be the Texas Academy of Family Physicians (TAFP) hereinafter referred to as the Academy. The Academy is chartered under the laws of the State of Texas.
To support the vision and mission statement the goals of this organization include:
Chapter II. Affiliation The Academy is a constituent chapter of the American Academy of Family Physicians (AAFP). No rules, regulations, or policies of this organization shall be in conflict with those of the American Academy of Family Physicians. In the event of conflict, the Bylaws of the AAFP shall prevail.
Chapter III. Vision Statement The Texas Academy of Family Physicians is dedicated to the promotion of a healthcare environment that values the vital role of family physicians in providing quality, comprehensive care to all Texans.
Chapter IV. Mission Statement The Texas Academy of Family Physicians unites the family physicians of Texas through advocacy, education and member services, and to empowers them to provide a medical home for all patients of all ages.
1. To establish, maintain and promote an organization of family physicians. 2. To promote and maintain the highest professional standards of family medicine. 3. To promote public awareness of family medicine. 4. To promote the science and art of medicine and surgery. 5. To preserve the right of the patient to choose a physician. 6. To preserve the right of the family physician to engage in medical and surgical procedures for which he/she is qualified by training, expertise, and/or demonstrated ability. 7. To provide and assist in providing CME courses for family physicians and general practitioners, and to encourage participation in such training. 8. To ensure promote the availability of high quality family medicine residency programs to provide competent family physicians for every Texas citizen.
9. To encourage men and women to choose family medicine as a career and assist them in achieving this goal. 10. To assure the responsibility of public advocacy in health related matters. 11. To promote and improve the public health. 12. To serve as a public advocate for our members.
Chapter VI. Classes of Membership and Election The classes of membership and the regulations governing re-election to membership as described in this chapter shall be the same as these of the AAFP. In the event of conflict, the Bylaws of the AAFP shall prevail. The qualifications, classes and conditions of membership shall be the same as provided in the Bylaws of the AAFP. All active members of this organization shall be members of the AAFP and their local chapter. In the event of conflict, the Bylaws of the AAFP shall prevail. section 1. active members Any active member in good standing shall be eligible to vote and hold office. Election to active membership shall be for a
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2013 PROPOSED AMENDMENTS TO TAFP BYLAWS maximum period of three (3) years, at the expiration of which term the member shall be eligible for re-election. No member shall be re-elected to membership who is not in good standing at the time of their re-election and has not fulfilled the continuing medical education requirements. Former active members who apply for membership less than two years after having ceased to be an active member must provide evidence they have earned the requisite 100 credits of continuing medical education acceptable to the Board; except that such an applicant who was a resident member in good standing and automatically upgraded to active status upon completion of residency training but never paid dues as an active member shall not be required to satisfy this continuing medical education requirement upon reapplication within two years of completion of residency training. Members of this Academy shall be in good standing in their component chapter and shall have paid all appropriate dues and fees. A member may join or transfer his/her membership to another component chapter that offers a closer community of interest. Initial application for membership may be made directly to the component chapter with which the member desires affiliation. Transfer of existing membership, however, must be approved first by the member’s current chapter before the application for transfer may be considered. SECTION 2. Resident Members Membership election shall be limited to the duration of one’s residency or extended training upon completion of their residency training and upon verification of eligibility for active membership resident members automatically shall be transferred to active membership. A Resident member may vote in Academy and component chapter affairs, may hold component chapter office under provisions of individual constituent component chapter bylaws, and may address the membership but may not hold state office. At the option of the resident and the component chapter where the resident resides, he/she may become a member of the component chapter. However, membership in a component chapter shall not be required. SECTION 3. Inactive Members Members who are incapacitated or retired from the practice of medicine with less than twenty (20) years continued membership in the Academy, and who are unable to engage in active practice may be elected to Inactive membership by a majority vote of the Board of Directors. Election to Inactive membership shall be for a maximum of one (1) year, provided, that the Inactive members be re-elected to this classification annually by the Board of Directors, unless the member is totally retired. An Inactive member shall be relieved of the require ment for postgraduate education and shall not vote or hold office in the Academy but may address the membership and serve on
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committees and commissions. shall have the privilege of the floor of the Assembly. SECTION 4. Honorary Members A person who has rendered outstanding service to the AAFP or to the medical profes sion, or has been a distinguished member of the AAFP and has retired from practice, may be elected by the Congress of Delegates to Honorary membership. An Honorary Member shall be entitled to the privilege of the floor of the Assembly but may not vote. He/she shall pay no dues or admission fees and shall have no right, title, or interest in any Academy property. Constituent chapters may not confer honorary membership but may propose candidates to the AAFP. SECTION 5. Supporting Members Duly licensed physicians may be elected to supporting membership. Supporting membership shall consist of two types (1) those physicians in specialties other than family medicine but not including those in emergency medicine otherwise eligible for some other category of membership; and (2) those physicians actively engaged in family medicine or teaching of family medicine or medical administration for the previous six years, but do not qualify for active membership because they have not completed the necessary residency training. With respect to physicians practicing in a specialty other than family medicine, such physicians may become Supporting Members provided they meet the criteria established by the Board of Directors and are licensed to practice in Texas. Such criteria shall be based on activities which support and enhance the specialty of family medicine. Supporting Members actively engaged in a specialty other than family medicine shall be relieved of the requirements for postgraduate education. With respect to those physicians who are eligible for Supporting Membership by virtue of being actively engaged in family medicine, the teaching of family medicine or medical administration for the previous six years, such physicians must have earned 100 credits of postgraduate study acceptable to the Board of Directors during the two years immediately preceding their application for supporting membership only if they previously held supporting membership and ceased to be a supporting member less than two years prior to reapplying for supporting membership. This type of supporting members also must earn 150 credits of acceptable postgraduate study every three years in order to retain Supporting Membership. A Supporting Member shall not vote or hold office in the Academy, but may address the membership and serve on committees and commissions. shall have the privilege of the floor of the assembly. SECTION 6. Life Members Any person who has continued membership in the Academy for a minimum of twenty (20) years, has reached age seventy (70), or
is totally retired from the medical practice may, on application to the Board of Directors, be classified as a Life Member. Life members are relieved of the postgraduate study requirements. Life members may vote, serve on committees and commissions and address the membership and have the privilege of the floor of the Assembly but shall not hold office. SECTION 7. Student Members Any student enrolled in a Texas school of medicine or osteopathy, approved by an appropriate United States accrediting institution as defined by the AAFP’s Commission on Education, may be elected to Student membership in the same manner as an active member. Election to Student membership shall terminate upon graduation from medical school. Student members may not hold office in the Academy, but shall have the privilege of addressing the membership and serving on committees and commissions the floor of the Assembly. However, one student may be elected to the Board of Directors. SECTION 8. Uniformed Services Adjunct Members Members of the Uniformed Services Constituent Chapter of the AAFP may be designated Uniformed Services Adjunct Members of the Texas Academy, without the right to vote or hold office, upon application to the Board of Directors. SECTION 9. Any member who changes his or her occupation or status in such a manner as to render him or her ineligible for membership in the Academy, may, unless he or she resigns, be stricken from the roll of members by action of the Board of Directors. Under unusual circumstances approved by the Board of Directors, exceptions may be made to the membership rules and requirements on an individual basis by a two-thirds (2/3) vote of the Board of Directors. SECTION 10 9. Membership Agreement Acceptance of membership in this Academy shall constitute an agreement by each member to comply with the Bylaws and to recognize the Board of Directors as the sole judge of the right to be or remain a member, provided, however, that the membership in this Academy is conferred by virtue of membership in a component chapter. The Board of Directors shall be the judge of the member’s right to be or remain a member of the Academy. All right, title, and interest, both legal and equitable, of the members in and to the property of this organization shall terminate in the event of any or either of the following: (a) expulsion of the member; (b) striking the name from the roll of members; (c) death; (d) resignation. SECTION 10. Good Standing A member in good standing shall be one whose current dues and assessments, if any, have been paid in accordance with the provision of these Bylaws, who is not under disciplinary action, and who has met the
applicable CME requirements during the period of the preceding three (3) years as set forth in the AAFP Bylaws.
Chapter VII. Ethics SECTION 1. Principles The principles of ethics of this organization shall be those of the American Academy of Family Physicians and the American Medical Association. The American Academy of Family Physicians’ Congress of Delegates, on a two-thirds (2/3) vote, may adopt policies or positions relating to ethical issues even though such policies or positions are in addition to or contrary to the Principles of Medical Ethics of the American Medical Association. Absent such specific action by the Congress of Delegates, the Principles of Medical Ethics of the American Medical Association, as they now or hereafter may provide, shall be the principles of ethics of this organization. SECTION 2. Violation of Principles If any member has violated the principles of Medical Ethics or the Bylaws of this Academy, or is otherwise guilty of conduct justifying censure, suspension or expulsion from this organization, any member may bring charges against him/her. Charges must be in writing and signed by the accuser(s) and must specify the acts and/or conduct. Charges must be filed with the Chief Executive Officer/Executive Vice President of the TAFP. At the first meeting of the TAFP Board of Directors held after the filing of charges, the charges must be presented to the Board. The Board shall consider the charges and shall either dismiss them or proceed within thirty (30) days. If the Board fails to dismiss the charges, it shall, within fifteen (15) days, serve the charges to the accused through registered mail to the last known address of the accused. The Board shall also fix a time and place for hearing the charges and the accused shall be notified of the time and place in the same manner as the serving of the charges. The hearing shall not be less than fifteen (15) days or more than six (6) months after serving of charges. The accused may answer in writing but failure to do so shall not be an admission of guilt or a waiver of the accused right to a hearing. The Board shall give the accuser and the accused opportunity to be heard, including oral arguments, and the filing and consideration of written briefs, conclude the hearing and within thirty (30) days render a decision. The affirmative votes of the majority of the Board members present and voting shall constitute the verdict of the Board which by such vote may exonerate, censure, suspend, or expel the accused member. The decision of the Board shall be signed by the President and Secretary of the Academy. No member of the Board not present for the entire time of the hearing shall be entitled to vote.
Censure shall mean a reprimand by the chairman of the Board of Directors administered to the accused in the presence of the Board. No member shall be suspended for more than one year and at the expiration of the period of suspension shall be reinstated to membership upon application and the payment of dues accrued during the period of suspension. The decision of the Board of Directors shall be final, except as provided hereafter. SECTION 3. Appeals Any member of the TAFP Chapter who has been censured, suspended, or expelled may appeal such action within six (6) months after notice is given by their chapter to the Board of Directors of the AAFP.
Chapter VIII. Component Chapters SECTION 1. Component chapters consisting of counties or regional areas may be chartered by the Academy, and their bylaws shall not be in conflict with the Bylaws of the Texas or American Academies of Family Physicians. One Uniformed Services Component chapter and one Resident Component chapter may be established for the State, subject to the same rules as other component chapters. SECTION 2. Upon petition of ten (10) or more members of the Academy residing in a county or regional area, the Board of Directors may issue a charter for a component chapter. Such charters shall be in a form approved by the Board of Directors. SECTION 3. Petitions for a component chapter shall be accompanied by the proposed bylaws for the chapter. No charter shall be issued until bylaws are approved by the Board of Directors of the Academy. The members of the component chapter shall be those to whom a charter is issued and such addition al people who are elected to membership thereafter. SECTION 4. Approval by the Board of Directors of the TAFP is necessary for expansion of an existing component chapter to include a con tiguous county in such chapter. SECTION 5. Any component chapter chartered by the TAFP may be suspended or revoked by the Board of Directors: (1) in the event of any action deemed to be in conflict with the Bylaws, (2) in the event of its failure to comply with all of the requirements of these Bylaws, or; (3) with any failure to comply with any lawful requirement of the Board of Directors or officers of this Academy, or of the AAFP. Procedures shall be in accordance with Chapter VI, Section 6, of the AAFP Bylaws. Component chapters are separate incorporated or unincorporated associations and unless there is a properly executed agreement, TAFP is neither explicitly nor by implication the guarantor of the debts of a component chapter. TAFP does not have
the authority to approve, disapprove or veto any actions of a component chapter unless such action violates the provisions of the TAFP or AAFP Bylaws. SECTION 6. Component Chapter Inactivity. When a component chapter exhibits evidence of inactivity such as failure to hold meetings, failure to send Delegates to the Member Assembly a director to the meetings of the board of directors, or failure to elect officers or a director for a period of three (3) years, the board of directors may request that a contiguous component chapter annex all or part of the inactive chapter to produce a larger, consolidated chapter. Such action is not to be considered as penalizing the inactive chapter, but to allow the membership in such chapter a voice and representation in the affairs of the Texas Academy of Family Physicians. Should component chapter request dissolution, each member will be polled for their approval. If there is a majority, each member will be assigned to the selected component chapter of their closest community interest.
Chapter IX. Dues and Admission Fees SECTION 1. Dues of the TAFP will be set by the Board of Directors with the approval of the members present and voting at the annual business meeting. The dues may be changed by a two thirds (2/3) vote of the Board of Directors and a majority vote of the membership present and voting at the next annual business meeting. The Board of Directors is empowered to levy an admission fee that shall accompany any new applications for membership. SECTION 2. It is mandatory that dues and fees to the AAFP be current to be qualified for membership in the TAFP. SECTION 3. Membership dues shall be payable in advance on January 1 each year. Dues of the new members shall be prorated as follows: If he/she is enrolled on or after July 1, but prior to November 1, his/her dues shall amount to one half (1/2) the annual dues; if he/she is enrolled on or after November 1, his/her dues shall be waived, but his/her annual dues for the ensuing calendar year shall immediately become due and payable, in addition to any admission fees. SECTION 4. Any member whose dues are unpaid at the time of any annual business meeting shall be ineligible to vote or hold office. Any member who pays dues on a calendar year basis shall be considered delinquent if his/ her dues are unpaid as of July 1 and shall be removed from membership thirty (30) days after notice from the Treasurer. Any member who pays dues on an academic year basis, such as a student or resident member, shall be considered delinquent if his/her dues are unpaid as of December 31 and shall be removed from membership thirty (30)
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2013 PROPOSED AMENDMENTS TO TAFP BYLAWS days after notice from the Treasurer. Upon completion of residency or extended training, such a member may apply for active membership and may hold such membership for the remainder of the calendar year without paying the standard dues for this category, but he/she must pay the usual and customary admission fees.
Chapter X. Annual Business Meeting SECTION 1. A business meeting of this organization shall be held annually at a time and place to be determined by the Board of Directors and shall be announced at least sixty (60) days prior to the date. This meeting shall be presided over by the President, and the Chief Executive Officer/Executive Vice President of the association shall be the secretary of the meeting. SECTION 2. Functions of the annual business meeting shall be: (1) to adopt or reject proposed changes in the Bylaws; (2) to act upon annual reports by officers and committees which are summarized and given by the President; (3) to act on business specifically referred by the Board of Directors; and (4) to make available the power of referendum. SECTION 3. Any member of the Academy in good standing may submit a resolution to the Board of Directors for consideration at the annual business meeting and to be published in the official journal prior to the annual meeting, provided: (1) the resolution is signed by five other members in good standing, and; (2) it is sent by registered mail to Academy headquarters at least sixty (60) days prior to the annual business meeting. SECTION 4. Resolutions not meeting the requirements specified will be introduced only if a copy is submitted in writing to the presiding officer, and only if consent to consider the resolu tion is voted by a majority of the members present and voting. SECTION 5. Fifty (50) members shall constitute a quorum at the annual business meeting or any special meeting. Active members in good standing whose dues are paid in full for the calendar year shall be eligible to vote.
Chapter XI. Member Assembly SECTION 1. A Member Assembly shall convene at least annually to review policy and direction implemented by the Board of Directors, Executive Committee and committees of the Board. The Assembly, composed of delegates from TAFP local chapters, shall elect officers, Delegates to the AAFP and the TAFP Board of Directors and act on business specifically referred by the Board of Directors. In addition, the Delegates to the Assembly may, by majority vote, approve a referendum for submission to the members of TAFP on questions affecting the policy
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or recommendations of the Academy. Any member in good standing may attend the Member Assembly. Voting shall be limited to the members specified in Section 2.
SECTION 8. Thirty voting members of the Member Assembly shall constitute a quorum at any convening.
SECTION 2. The Member Assembly shall be composed of all members of the TAFP Board of Directors, delegates from local chapters, delegates selected by the Section on Special Constituencies, Section on Resident Physicians and Section on Medical Students.
SECTION 9. Each delegate to the Member Assembly shall have one vote. Should a TAFP member in good standing not serving on the Assembly wish to have the privilege of the floor, they must petition the presiding officer and obtain permission to address the Assembly but they shall have no right to vote.
SECTION 3. Local chapters having between one and 49 active members shall be entitled to one delegate and one alternate. Local chapters having between 50 and 99 active members shall have two delegates and two alternates. Chapters with 100 to 199 active members shall have three delegates and three alternates, and for each additional 100 active members, chapters shall be entitled to one additional delegate and alternate. The actual number of delegates and alternates shall be based on the official membership rolls for TAFP as of June 1 each year. Chapters shall elect their own delegates in a method of their choosing. Chapters must submit their names for delegates and alternates six weeks prior to the Annual Session. After the chapter deadline, a call for representatives shall be sent electronically to members in chapters with unfilled delegate or alternate positions. A member wishing to fill an open seat must notify TAFP in writing four weeks prior to the meeting and be properly credentialed. If more members are interested in representing a chapter than there are delegate seats, the date that TAFP receives notification from the member shall determine the representatives. The term of office of each delegate and alternate shall be one year and they can succeed themselves. SECTION 4. The Section on Special Constituencies shall select two delegates and two alternates at the Interim Session to serve in the next Member Assembly. The term of office of each delegate and alternate shall be one year and they can succeed themselves. SECTION 5. The Section on Resident Physicians shall select two delegates and two alternates at the Interim Session to serve in the next Member Assembly. The term of office of each delegate and alternate shall be one year and they can succeed themselves. SECTION 6. The Section on Medical Students shall select two delegates and two alternates at the Interim Session to serve in the next Member Assembly. The term of office of each delegate and alternate shall be one year and they can succeed themselves. SECTION 7. To be seated, a delegate must be in good standing in the Academy.
Chapter XII. Board of Directors Subchapter I. Policy and Procedure SECTION 1. The control and administration of the Academy shall be vested in a Board of Directors, hereinafter called the Board. The Board shall be composed of the Academy President, Vice President, President-Elect, Treasurer, Parliamentarian, Immediate Past President, Delegates and Alternate Delegates to the AAFP, three at-large directors, one new physician director, one special constituency director, one resident director, and one medical student director. Coordinator of Preceptorship Programs, and a representative/s from each component chapter, depending on the component chapter size. Past Presidents of the Academy may serve as ex-officio, non-voting members of the Board. The component representative/s shall be the Director or in his/her absence the Alternate Director or in their absence a credentialed member from the component chapter. The Nominating Committee may nominate one (1) Student Director and one (1) Student Alternate Director as well as two (2) Resident Directors and two (2) Resident Alternate Directors, and one (1) Special Constituency member to serve on the Board. They shall be nominated to serve a one (1) year term and may be renominated to serve additional terms; however, their term shall terminate upon graduation from medical school or completion of residency or extended training. They shall be nominated from among the student and resident membership of the Academy, respectively. A duly elected student or resident director may vote and have the privilege of the floor similar to the Directors from component chapters, but may not be named chair of a committee or hold office in the Academy. SECTION 2. The student, resident and special constituency directors shall be nominated from among the student, resident and special constituency membership of the Academy, respectively. The Section on Medical Students, Section on Resident Physicians and Section on Special Constituencies shall select members in good standing at their Interim Session meeting to recommend for those director positions. They shall be elected by the annual Member Assembly
and begin serving at the conclusion of the Annual Session. The term of office shall be one year and they may succeed themselves. SECTION 3. The New Physician Director must be an active member in good standing who is less than seven years out of residency training. The Nominating Committee shall recommend a New Physician Director at their Interim Session meeting and they shall be elected by the annual Member Assembly and begin serving at the conclusion of the Annual Session. The term of office shall be one year and they may succeed themselves. SECTION 4. The three at-large directors shall serve three-year terms with one director elected each year. All at-large directors must be active members in good standing. The Nominating Committee shall nominate them at their Interim Session meeting and they shall be elected by the annual Member Assembly and begin serving at the conclusion of the Annual Session. They may serve up to two consecutive terms. SECTION 2 5. Seven (7)Twenty (20) members of the Board of Directors shall constitute a quorum. An excused absence of a director, submitted in writing, shall count toward the quorum. SECTION 6. The Board shall meet at the time of the Interim and Annual meeting and at such other times as may be set by the Board of Directors. SECTION 3 7. Each member of the Board of Directors shall have one (1) vote. SECTION 4 8. Members of the Board of Directors who are absent from two (2) consecutive Board Meetings shall may be dropped from the Board unless excused for a reason accep table to the Board. SECTION 5 9. The officers of the Academy shall be President, Vice President, Treasurer, PresidentElect, Immediate Past President, and Parliamentarian. The Immediate Past President shall serve as Chairman of the Board and shall not be eligible to succeed himself/herself. The powers, duties, terms of office, and method of election of officers shall be set forth in these Bylaws. SECTION 6 10. At the Interim Session Meeting of the Board of Directors, the Nominating Committee shall present nominations for Officers, Directors, and Alternate Directors of the TAFP, and Delegate and Alternate Delegate to the AAFP Congress of Delegates. Nominations may be made The Bylaws shall not prevent nominations from the floor at the Annual Ssession Member Assembly Board of Directors meeting. The Bylaws shall not prevent Aa Delegate or Alternate to
the Congress of Delegates of the AAFP may hold from holding another elected or appointed office; and provide further that any additional Delegates from the Texas Chapter to the AAFP may be elected at the Annual Session Board of Directors meeting without further amendment of the Bylaws. SECTION 7 11. Component Chapter Nominations – A component chapter may nominate any active member for the elected positions of the Academy. This nomination must be submitted in writing to the President at least ninety (90) days prior to the beginning of the Annual Session. If a component chapter is inactive, five (5) members in good standing of that component chapter may submit a nomination. The President will notify the Board of Directors of all nominations for all elected positions at least sixty (60) days prior to the beginning of the Annual Session. SECTION 8 12. Board Elections shall be by majority vote of the credentialed Delegates to the Annual Member Assembly Board members present and voting at the Annual Session Board of Directors Meeting. SECTION 9 13. All candidates for office in this Academy shall be active members in good standing. SECTION 10 14. Vacancies on the Board shall be filled by the Alternate Director and such appointment shall terminate at the next annual Member Assembly Board of Directors meeting, at which time the Nominating Committee shall present a nominee for the unexpired term, if any. A vacancy shall exist on the Board when an elected member for any reason terminates his/her membership in the chapter which he/she represents. SECTION 11 15. If the office of the President becomes vacant, he/she shall be succeeded by the Vice President. In the event the Vice President is unable to serve, the office shall be filled by an appointment of the Executive Committee until the next annual Session Board of Directors meeting. In the event of the death, resignation, or removal from office of the President-Elect, the Executive Committee shall nominate one or more members for that office and election of the successor to the President-Elect shall take place by voting on those candidates by the Board of Directors at the next Annual Session, provided that nothing shall prevent additional nominations for this office. If the death, resignation, or removal of the PresidentElect occurs more than ninety (90) days before the next Annual Session Board of Directors meeting, the Executive Committee in a special meeting shall nominate two (2) members and distribute mail ballots to the Board of Directors. Election of the new President-Elect shall be by a majority of those ballots returned to the TAFP office within fifteen (15) days of the mailing date.
SECTION 12 16. The Board shall control all properties and monies of the Academy, and shall manage its financial affairs after the manner and with the usual authority of Boards of Directors under Texas state law. The Board will supervise all publications of the Academy. All resolutions or recommendations pertaining to the expenditure of money must be approved by the Board. The Board shall fix the salaries of the Academy’s salaried employees. The Board may appoint special committees to aid in the discharge of its duties. SECTION 13 17. The Board may delegate any of its duties and authority to the Executive Committee as provided in Sub-Chapter II.
Subchapter II. Executive Committee Duties and Terms of Office SECTION 1. Members of Executive Committee There shall be an a seven-member Executive Committee of the Board composed of thirteen (13) members: the President - who also serves as Chair; Vice President; PresidentElect; Treasurer; Immediate Past President; the Parliamentarian; two (2) members selected by the President; two (2) other members and one at-large director elected by the Board of Directors. from nominations made by component chapters or from the floor of the Board of Directors at the Annual Session Board of Directors meeting. There will be a resident member, selected by the Section of Resident Physicians, and a Special Constituency member selected by the Section on Special Constituencies. There will also be a non-voting student member selected by the Section of Medical Students. Terms shall be in conjunction with the elected position terms for President, Vice President, President-elect, Treasurer, Immediate Past President, and the Parliamentarian. The atlarge director shall be elected by the Board at the Annual Session and shall serve until the next Annual Session. Terms of the five (5) additional members (two selected by the President, two elected by the Board, and one selected by the Section on Special Constituencies) shall be for one year. The Resident and Student members will be appointed to serve a one-year term and may be appointed for an additional (1) one year term. SECTION 2. Purposes of the Executive Committee The Executive Committee, by a vote of its members, shall have full authority to act for and in behalf of the Board of Directors on such matters as determined by the Board or whenever the business of the Academy demands prompt action in the interim between meetings of the Board or when it is impracticable or impossible to convene the Board of Directors. The Executive Committee will also be responsible for evaluating and making
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2013 PROPOSED AMENDMENTS TO TAFP BYLAWS recommendations to the Board concerning the internal affairs of the Academy. These affairs include among other items: personnel problems, major staffing selections and changes, performance reviews, annual salary review of the Chief Executive Officer/Executive Vice President and review of employee benefit plans. The Executive committee will be available to the CEO/EVP to discuss any items necessary. The Executive committee will decide at any time when the expertise of an Internal Affairs Commission is necessary and call that commission in at that time. SECTION 3. Executive Committee Meetings Meetings of the Executive Committee shall be held at the call of the chair. A report of its actions shall be given by the Executive Committee to the Board of Directors at the following Board meeting for approval. The resident member shall be a voting member of this committee. A majority shall con stitute a quorum.
Subchapter III. Elected Positions SECTION 1. President The President shall be the chief executive elected officer and shall have the general supervision and will also control the business affairs of the organization subject to the approval of the Board or the Executive Committee. The President shall preside at all meetings of the Academy and shall be the Chairman of the Board. The President shall be an ex-officio member of all commit tees and commissions and shall appoint all standing committees and commissions, subject to Board approval and by authority of the Board shall appoint all special committees. His or her term of office shall begin at the conclusion of the first ensuing annual meeting following the annual meeting at which his/her election occurs as President-elect and expires at the conclusion of the next annual session meeting, when his/ her successor is seated. He/she shall not be eligible to succeed himself/herself. SECTION 2. President-Elect The President-Elect shall be a member of the Board and ex-officio member of all commit tees and shall preside at meetings of the Academy in the absence of the President and Vice President. He/she shall succeed to the office of the President at the conclusion of the first annual session meeting following the annual session meeting at which his/ her election occurred, and shall expire at the conclusion of the next annual session meeting, or when his/her successor is elected. SECTION 3. Vice President The Vice President shall become upon election a member of the Board and shall preside at meetings of the Academy and of the Board in the absence of the President. His/her term of office shall begin at the conclusion of the Annual Session Board of Directors meeting at which his/her election occurs, and shall expire at the conclusion of the next Annual Session Board of Direc-
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tors meeting, or when his/her successor is elected. He/she shall be able to succeed himself/herself. SECTION 4. Immediate Past President The Immediate Past President shall serve as Chair be a member of the Board of Directors for a period of one year following his/ her term as president; such term is to begin at the conclusion of his/her term of office and end at the conclusion of the following Annual Session Board of Directors meeting. SECTION 5. Treasurer The Treasurer shall become upon election a member of the Board and Chairman of the Finance Committee. He/she shall be the custodian of all Academy funds and shall, in such amounts as the Board may require furnish bond, the premium of which shall be paid by the Academy. He/she shall perform the duties which the office ordinarily connotes. He/she will meet with the Chief Executive Officer/Executive Vice President and the financial manager as a Financial Oversight Committee at least four times annually. He/she shall be elected for a one (1) year term beginning at the conclusion of the annual session Board of Directors meeting at which he/she is elected and may succeed himself/herself. In the event of a vacancy in the office of Treasurer, the Executive Committee, by majority vote, shall appoint a successor to serve until the next Annual Session Board of Directors meeting. SECTION 6. Parliamentarian The Parliamentarian shall be elected by the Board of Directors. He/she shall upon election become a voting member of the Board of Directors. His/her duties shall be to inform the officers of proper parliamentary procedures, according to Sturgis the current edition of the “American Institute of Parliamentarians Standard Code of Parliamentary Procedure.” (current edition). He/she shall be elected for a one (1) year term and may succeed himself/herself. SECTION 7. AAFP Delegates The term of office of a Delegate to AAFP shall not exceed three (3) consecutive two (2) year terms. The term of the office of Alternate Delegate to AAFP shall not exceed three (3), consecutive two (2) year terms. Nothing shall prevent an Alternate Delegate from advancing to serve as Delegate. The terms of the TAFP Delegates and Alternate Delegates to the AAFP will begin and end at the end of the AAFP Congress of Delegates. SECTION 8. Directors and Alternate Directors The term of office of a Director and Alternate Director, with the exception of the Student, Resident, and Special Constituency members, shall be three (3) years, and shall begin at the conclusion of the annual session Board of Directors meeting at which he/she was elected. No Director or Alternate Director may serve two (2) consecutive terms.
The nomination of members to the Board will follow the rotation schedule outlined below, and be repeated every three (3) years thereafter. Each component chapter will nominate Directors and Alternate Directors based on the numbers of active members within that chapter, i.e., less than 200 active members, one Director and one Alternate Director; 201-400, two Directors and two Alternate Directors; 401-600 active members, three Directors and three Alternate Directors; and 601 and over active members, four Directors and four Alternate Directors. The additional Directors and Alternate Directors will be added on a staggered rotating schedule as determined by the Board of Directors and consistent with the outline below: 1962 - Nominations for three (3) year terms: El Paso, Permian Basin, West Texas, Gulf Coast, Valley, Travis County, East Texas, Sam Houston, Colorado Valley, Rose, Henderson County 1963 - Nominations for three (3) year terms: South Plains, Midwest, Panhandle, Harris County, Central Texas, Tarrant County, North Texas, Abilene, Brazos Valley, Three Rivers, San Gabriel 1964 - Nominations for three (3) year terms: Alamo, Galveston, South Texas, Southeast Texas, Dallas, Red River, Northeast Texas, Southwest Texas, Northwoods
Subchapter IV. Appointed Positions SECTION 1. Coordinator of Preceptorship Programs The Coordinator of Preceptorship Programs shall be appointed by the President and confirmed by the Board. He/she shall upon appoint ment and confirmation become an ex-officio non-voting member of the Board and shall be a member of the Commission on Academic Affairs. He/she shall have the responsibility of supervising student preceptorships with members. He/she shall be appointed for a three (3) year term and may succeed himself/herself. SECTION 2. Inter-Specialty Society Committee Appointment The Academy’s representative and alternate representative to the Inter-Specialty Society Committee of the Texas Medical Association shall be recommended by the Nominating Committee and confirmed by the Board. He/she shall upon appointment and confirmation become an ex-officio non-voting member of the Board. He/she shall have the responsibility of reporting the activities of the Inter-specialty Society Committee of the Texas Medical Association to the Board. He/she shall be appointed for a term not to exceed three (3) years. However, he/she may succeed himself/herself without limits. SECTION 3. Chief Executive Officer/ Executive Vice President The Board of Directors shall appoint a Chief Executive Officer/Executive Vice President www.tafp.org for a term and stipend to be fixed by the
PROPOSE D G OVERNANCE ST RUCT URE
Board of Directors – (15 voting members) • Officers (6) • Delegates to the AAFP (2) • Three at-large members elected to three-year terms by the Member Assembly (3) • New Physicians (1 director) • Special Constituencies (1 director) • Residents (1 director) • Students (1 director) The role of the board will stay the same except for elections. They will remain the governing body of TAFP and will control all properties and monies, manage financial affairs, supervise all publications, etc. Committees will report to the board after each meeting with their recommendations.
Member Assembly – (100+ voting members) The Member Assembly shall be an annual meeting of delegates from the various local chapters as well as a few other defined members. The meeting will be open to all members, but only those designated delegates will have the power to vote. Local chapters will have proportional representation based on their number of members. All members of the Board of Directors shall also be voting members of the Assembly. This body will elect officers and board members, review policy and direction implemented by the Board of Directors, and have the power of referendum.
Board. He/she shall under the direction of the Board of Directors perform such duties as the title of office ordinarily connotes, and such duties of the Treasurer may be assigned to him/her by the Board. He/she shall keep an accurate record of meetings and transac tions of the annual business meetings and the meetings of the Board. He/she shall serve as secretary to these bodies. He/she may or may not be a member of the Academy and shall not be entitled to vote.
Chapter XIII. Standing Committees SECTION 1. General Definition The President will appoint, subject to the approval of the Board, a Bylaws Committee, a Nominating Committee, and a Finance Committee. The Board of Directors shall
determine the composition of these bodies and their function shall be established in other sections of these bylaws, and shall be determined by the Board of Directors and published in the “Manual of Duties and Responsibilities.” In addition, the Board of Directors may appoint such additional committees, or similar organizational entities known as commissions/committees to assist the Board of Directors as it deems appropriate. The composition and functions of such additional committees, or organizational entities shall be as determined by the Board of Directors and published. Three active members of the committee/ commission will constitute a quorum for any Committees/Commission.
Executive Committee (7 voting members) Six officers plus one member of the board elected annually. The Executive Committee will have the full authority to conduct business between full meetings of the board when prompt action is needed or when it is impractical or impossible to convene the board, or when the board authorizes or directs the Executive Committee to act for and on behalf of the board.
All other Committees, Commissions, and Sections The proposed governance changes do not affect the membership, responsibilities, nor meeting times of TAFP committees, commissions, and sections.
The President subject to Board approval shall appoint the chair of the committee. No member may serve as chair of any specific committee for more than three (3) years and members of committees are not considered officers. Resident or student members may be appointed to committee membership for a one (1) year term but not to exceed three (3) appointments to the same committee. Any committee chair or member who fails twice in succession to attend meetings of his/her committee shall be dismissed from the committee unless he/she submits an acceptable excuse. A chair must submit his/ her excuse to the President and a member must submit his/her excuse to the chair of that committee.
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2013 PROPOSED AMENDMENTS TO TAFP BYLAWS SECTION 2. Committee descriptions Bylaws Committee a) This Committee shall consist of a Chair and five (5) or more other members. A resident member and a non-voting student member may be appointed for a one-year term. b) One third (1/3) of the members shall be appointed annually, each for a term of three (3) years. c) Duties of this committee shall include studying the Bylaws and making recommendations for changes, dele tions, modifications, and interpreta tions after consideration to submitted proposals. Finance Committee This Committee shall consist of the Treasurer of the Texas Academy, as chair, and four (4) or more other members. A resident and a student member may be appointed for a one-year term. One-third (1/3) of the members shall be appointed annually, each for a term of three (3) years. The Chief Executive Officer/Executive Vice President shall serve as an ex- officio, non-voting member of this Committee. This Committee shall supervise the Academy’s fiscal accounts, submit an annual budget for Board approval and arrange an annual fiscal audit. Nominating Committee a) This committee shall consist of nine (9) members; each with terms of three years. b) One third (1/3) of the members shall be appointed annually. c) Two (2) members will be appointed by the President-Elect and the other elected by the Board of Directors. d) The chair shall be elected by the committee, from the committee’s membership. e) The purpose of this committee shall be to: i) Represent Present nominations for the office of President-Elect, Vice President, Treasurer, one (1) Delegate and one (1) Alternate Delegate to the Congress of the AAFP. ii) Review the Present nominations of Directors and Alternate Directors from component chapters for the Board of Directors. iii) Make suggestions to the President regarding appointments to the AAFP, Texas and American Medical Associations, other state committees and commissions, and any other appointments, which may be requested. iv) Evaluate the job performance and attendance of elected TAFP officers and delegates. Other Committees Special committees or task forces may be appointed by the President. They shall be reviewed annually and when their assigned task is completed and their report is received by the Board, they shall be dissolved.
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Chapter XIII XIV. Notice of Meetings
specified. Amendments shall be subject to review by the AAFP Board of Directors.
SECTION 1. Notice of general or special meetings shall be given by the Chief Executive Officer/ Executive Vice President to all members at least thirty (30) days prior to the date of the meeting, either by letter mailed to each member’s address or by publication.
Chapter XVIII. Conflict of Interest
SECTION 2. Special meetings may be called by the Board or the President. Special meetings shall be called by the Chief Executive Officer/Executive Vice President upon written request of ten (10) or more members, at a place and time determined by the Board.
Addendum to proposed bylaws changes
SECTION 3. Fifty (50) members shall constitute a quorum at any general or special meeting of the Academy.
Chapter XIV. Inspection of Records The minutes of the proceedings of the Board of Directors, the membership registry, and the ledgers of fiscal account shall be open to inspection upon the written demand of any member at any reasonable time, (during regular business hours), for any purpose reasonably related to the member’s interest as a member, and shall be produced at any time when requested by ten percent (10%) of the members present at any general or special meeting. Demand of inspection, other than at a meeting of the members, shall be in writing to the President or to the Chief Executive Officer/Executive Vice President of the Academy.
Chapter XVI. Rules of Order In all matters not covered by the Texas Academy of Family Physicians’ constitution, bylaws, and standing rules, the Texas Academy of Family Physicians shall be governed by the current edition of the “American Institute of Parliamentarians Standard Code of Parliamentary Procedure.” Sturgis Standard Code of Parliamentary Procedure (current edition), except when it is in conflict with the Bylaws, shall cover all parliamentary procedures of the meetings.
Chapter XVII. Amendment of Bylaws Any two or more members may propose Bylaws or amendments to Bylaws. Such proposals or amendments shall be submitted to the Chief Executive Officer/Executive Vice President of the Academy at least 100 days prior to the annual business meeting of the Academy. Notice shall be given by the Chief Executive Officer/Executive Vice President at least 30 days prior to the meeting. Publication of the amendments in the official publication of the Academy shall be considered notice to the members. An affirmative vote of at least two-thirds (2/3) of the members present and voting at the annual business meeting shall constitute adoption. Amendments shall take effect as specified in the bylaws of the AAFP immediately upon adoption unless otherwise
All TAFP officers, directors, commission/ committee members or members of similar organizational entities may be asked to sign a Conflict of Interest Statement approved by the Board of Directors.
The bylaws amendments proposed alter TAFP’s governance structure and due to the timing of events at the Annual Session, a slightly different process for the election of the board of directors is needed for the first year if these amendments are approved. The following transition procedures were proposed by Larry Karrh, M.D., chair of the Bylaws Committee, and Linda Siy, M.D., chair of the Task Force on Governance. This transition procedure will be voted on at the same time as the other bylaws amendments.
Transition Procedures if New Governance Bylaws Are Adopted (If the new governance bylaws are not adopted, selection of board members will follow the existing bylaws and practices of TAFP) Aug. 3, 2013 Nominating Committee meets to recommend directors for terms commencing at the conclusion of Annual Session. Those directors will be: 1. Three at-large directors (staggered terms ending 2014, 2015, and 2016), 2. One new physician director, 3. One director nominated by the Section on Special Constituencies, 4. One director nominated by the Section on Medical Students, and 5. One director nominated by the Section on Residents. Board of Directors meets in second session to vote on the Nominating Committee recommendations for directors for terms commencing at the conclusion of Annual Session. Terms of all board members not otherwise elected by the board expire at the conclusion of Annual Session. Aug. 4, 2013 New Board of Directors takes office. These transition procedures expire on Aug. 5, 2013 and are considered repealed. Please note: Officers and delegates to the AAFP will be elected at the first Board of Directors meeting on Aug. 3 prior to the vote on the new bylaws. This action is not affected by action on the new bylaws and officers and delegates selected will serve whether the bylaws changes are approved or not.
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NUTRITION
The Learning Connection The positive link between nutrition, physical activity, and academic success Katie Barckholtz, M.P.H., R.D., L.D. Director of Health and Wellness, Dairy MAX, Inc.
healthy behaviors support better learning. Poor nutrition, inactivity, and unhealthy weight may not only lead to poor academic achievement in children, but also hard costs for individuals, schools, and society. These costs include spiraling health care expenses, lower productivity, and a workforce unprepared for global competition. It is clear that student nutrition and physical activity must be a priority for our society’s future well-being. Unfortunately, across the United States, schools face tremendous challenges to meet economic, health, and academic demands. Many schools lack the funds to execute school wellness policies or to start breakfast programs or enhance these programs. As pressures mount to improve standardized test scores, many districts are shortening or eliminating opportunities for physical activity, such as recess and physical education classes. Given the nature of these problems and even in light of these barriers, the solution for healthier children certainly starts with schools and with the communities in which they live. The GENYOUth Foundation, National Dairy Council, American College of Sports Medicine, and the American School Health Association have come together to release a report entitled “The Wellness Impact: Enhancing Academic Success Through Healthy School Environments.” The report and the research within help make the case that health is not a competing priority to academic performance; in fact, healthy behaviors, including good nutrition and physical activity, can help students learn better. In essence, healthy students are better students. Research shows that improved nutrition, daily breakfast, and increased physical activity can lead to improved academic performance. Schools are a focal point for action. Apart from home, schools are one of the most important places to impact children’s nutrition and physical activity. Proven school wellness programs like Fuel Up to Play 60, an in-school nutrition and physical activity program funded by National Dairy Council and the National Football League, in collaboration with the U.S. Department of Agriculture, empower students to make positive changes at school and can bring healthy changes to life in the classroom. Some studies suggest that just increasing children’s access to good nutrition and regular physical activity can lead to enhanced classroom achievement. Breakfast matters. Research continues to support the importance of that morning meal. Research shows that those who eat breakfast have better attention and memory than breakfast skippers. Students who are more active during school perform better on standardized 36
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Health is not a competing priority to academic performance. In fact, healthy behaviors, including good nutrition and physical activity, can help students learn better. In essence, healthy students are better students.
tests for reading, math, and spelling. School breakfast programs that offer nutrient-rich foods—such as low-fat and fat-free dairy, whole grains, fruits and vegetables, and lean proteins—are especially important as a simple, cost-effective means to address food security issues and can impact children’s nutrition and readiness to learn. American kids spend more than 2,000 hours in school each year where in-school wellness policies can encourage healthy habits. Schools are an ideal place to promote childhood health and wellness, but they cannot act alone. Parents, schools, health professionals, business leaders, and the larger community must work together to affect change for children’s health and wellness in schools. To learn more about the research and for the full Wellness Impact report and resources, and for ways to support your local school wellness programs, visit www.genyouthfoundation.org/programs/#impact.
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perspective
Shine your light in service to your specialty By Janet Hurley, M.D., chair of the TAFP Commission on Health Care Services and Managed Care
As I look with uncertainty to the future health care landscape and talk with fellow family physicians, I find many of us fearful of what the upcoming years will bring. I admit there are times when I get discouraged too, when it seems like things are too difficult to fix or that the problems are too big to solve. It’s in those moments that I realize we are living in a fallen world and the temptation is strong to just hide or give up. But God does not call us to hide our worries; he calls us to shine our light to the world around us. So I ask you, what does your light look like? We are all called to be leaders to some degree, either in our families, our practice, or our government. Some will move on to state and national leadership realms, but it is okay if not all of us do that. How do you use your gifts and talents? Are you befuddled with frustration and worry? Have you hunkered down in seclusion? To squander our gifts and talents is like burying the best of ourselves in the sand. We’ll look back and wonder where the “good old days” have gone and realize that our health care system is no longer recognizable to us and that we have been left behind, frustrated and broken. Each of us has gifts and talents that should not be left unused. I believe family medicine will play an important role in the establishment of a sustainable health care model for the future because it provides affordable quality care to patients. Family medicine will not lead simply because we have a great lobby team at the state and national levels, nor because we bark the loudest. It will lead because we are the best product out there, and this fact should not be undervalued, hidden under the snobbery of academia, nor belittled by “gatekeeper” terminology. The message we convey and the service we provide should not be buried in the sand because we feel despondent, frustrated, or worried.
The challenges in health care require us to tackle difficult and controversial topics. The cost of health care is the real enemy, and we must learn all we can about reducing redundancies in our health care delivery systems and eliminating excessive procedures and tests, as well as unnecessary ER visits and hospitalizations. We must be willing to cast off old treatment paradigms within our own practices that can no longer be defended by evidence. There will also be an emphasis on patient accountability. We need to embrace elements such as motivational interviewing and patient self-management support tools to empower patients to live healthier lives and embrace healthier living practices. Yet we will also need to respect personal freedoms that sometimes lead to self-destructive patterns of behavior. While we should always treat patients with respect and dignity, there will need to be an acknowledgement that society can no longer bear the responsibility of expensive treatments for the conditions that ensue from some of these behaviors. How our government and our society tackle these difficult ethical issues will be the greatest challenge in this process. And to have our government and our society do so without the expertise of family physicians, who have been at the bedside of these patients, would be a great tragedy. So again, I ask, how are you using your gifts and talents? What does your light look like? If you are looking for ways to make your voice heard, and want to be a part of these big issues that face our society, our nation, and our specialty, then please be a part of what we are doing here at TAFP. Do not bury your gifts and talents, and do not hide your light under a bowl. Do not succumb to doubt, dread, or fear. The future is bright for our specialty, and brighter still if the armies of our members rise up to the challenge with confidence and integrity. I look forward to having you join us along this journey.
The cost of health care is the real enemy, and we must learn all we can about reducing redundancies in our health care delivery systems and eliminating excessive procedures and tests, as well as unnecessary ER visits and hospitalizations. We must be willing to cast off old treatment paradigms within our own practices that can no longer be defended by evidence.
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