Tag Archives: AAFP

Help Is on the Way for Primary Care Doctors (Wink, Wink)

Help is on the way “very soon” for family physicians, internists, and pediatricians in the form of a final rule for accountable care organizations (ACOs).

Based on extensive feedback on the proposed ACO rule, changes are coming that primary care physicians are going to like, Dr. Nancy Nielsen said.

The preliminary  rule  “was met with – how shall I say? – an underwhelming response by the medical community,” said Dr. Nielsen, Senior Advisor of the Center for Medicare & Medicaid Innovation established as part of Centers for Medicare and Medicaid Services (CMS) by the Affordable Care Act.

“We have a few code words we have to work out here so I don’t get into trouble, but you get what I am trying to say,” Dr. Nielsen said at the American Academy of Family Physicians Congress of Delegates. For example, if I tell you ‘it has been suggested to us,’ that is REALLY important and it may be coming out, but I can’t announce anything yet,” said Dr. Nielsen, an internist and former president of the American Medical Association.

Regarding ACOs, Dr. Nielsen said, “Very soon the final rule will come out. Very soon. CMS has listened to the feedback:”

“It has been suggested to us that 65 quality measures are way too many.”

“It has been suggested to us that the mechanism for the shared savings ought to be done differently.”

“And it clearly has been suggested to us that hospitals have the ability to come up with the capital to start an ACO, but it’s really tough for doctors. So it has been suggested to us that we give advanced payment. I am here to say that very soon you will see that, and very soon you will like what you see.”

Although doctors have always been accountable for the care of patients, now they also will be accountable for resource expenditures, and the Center for Medicare & Medicaid Innovation plans to help, Dr. Nielsen said. There will be new expectations and new tools given to primary care physicians. “I will tell you that never once in my 23 years of practice did I see data showing me what it cost when I ordered an x-ray. Do you know what it costs when you write a prescription for an antibiotic? Do you get that data? No, you have never seen that.”

“But you must help us achieve this … when the [internal] warfare within the house of medicine begins,” Dr. Nielsen said. “I have a pet peeve. It really makes me crazy when people talk about people who do primary care as ‘primary care physicians’ and all the other docs as ‘specialists.’” She said that family physicians, internists, and pediatricians should stand together and say ‘We are specialists, just like you are specialists. We have a critical role to play and we need to have the tools to help us play that role.”

“Stay tuned. A lot of things you are going to, like, have been suggested to us.”

Dr. Nielsen’s comments were streamed live on the Internet during the congress and are available as archived video.

–Damian McNamara

@MedReporter on Twitter

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Filed under Blognosis, Family Medicine, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends

Here Comes the Super Committee: The Policy & Practice Podcast

photo courtesy of iStock

The names are in and the lobbying has begun. Physicians — and others — are weighing in with their priorities for the Joint Select Committee on Deficit Reduction — better known as the Super Committee. The group is charged with cutting $1.5 trillion of federal spending by Thanksgiving.

At the top of most doctors’ list: A permanent fix to the Sustainable Growth Rate (SGR) formula, which could lead to a 30% pay cut on Jan. 1. But physicians from several specialties have other concerns they want addressed as well.

Meanwhile, a federal appeals court in Atlanta ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional, pushing the law one step close to its much-predicted airing in front of the Supreme Court.

Regardless of legal wranglings, the feds are busy pushing ACA programs along, with announcements of more than $200 million worth of programs last week.

LISTEN:  For details, check out this week’s Policy & Practice Podcast. Let us know what you think.

—Frances Correa (@FMCReporting on Twitter)

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Filed under Blognosis, Health Policy, health reform, IMNG, Podcast

Video of the Week: Celebrating 40 Years of Family Practice, Part I

Family Practice News is celebrating 40 years of covering this primary care medical specialty. Family Practice News was there when the American Academy of General Practice became the American Academy of Family Physicians in 1971.

As family medicine was being formally recognized as a medical specialty in 1971, three young physicians were preparing to enter the field. Family Practice News sat down with the 2nd-year family practice residents at that time to find out what they thought of their training, their newly recognized specialty, and what their careers would hold.

Now, 40 years later, we invited them to look back on how their expectations stacked up to the reality of clinical practice. We’re going to feature their video interviews over the next few weeks. This week, get to know Dr. Alva S. “Buzz” Baker.

The most valuable life lesson from medicine has really been  don’t sweat the small stuff.

Check back weekly to hear more wisdom from the FP class of 1971 and don’t miss our 40th anniversary coverage.

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Filed under Family Medicine, Primary care, Video

I’m Not Just a Doctor, I’m Also a Candidate


Nothing is more American than winning. It’s so central to the American ethos that the Founding Fathers didn’t even bother to scribble it into the Bill of Rights. An amendment enshrining our right to strive for victory likely would’ve elicited a collective “Well, duh” by our bewigged forefathers. You might as well have guaranteed 18th-century citizens the right to breathe air or to wear jaunty tricornered hats. Thomas Jefferson didn’t begin the Declaration of Independence by announcing to King George III that “We hold this truth to be self-evident: Just win, baby.” He didn’t need to – Lexington, Concord, and Bunker Hill had demonstrated that the ancestors of future Boston Red Sox fans were in it to win it.

photo courtesy of Terry Rudd

Despite our national addiction to sports, it’s victory within the arena of politics – those recurring, well-funded bar brawls to decide who’s in charge – that most enthralls, unifies, and divides the nation. And even the shrine to the faith of apolitical science, the House of Medicine, enjoys intramural bouts of political pugilism.

Case in point: the campaign for leadership posts – particularly the job of president ‑ during last week’s American Academy of Family Physicians’ Congress of Delegates in Denver.

All the signs and symptoms of the American obsession with political victory were there – the ardent campaign supporters, the Technicolor campaign buttons, the sea of slick, sophisticated campaign brochures and origami-esque candidate cards that likely denuded many an Oregon hillside. The three-way race to be AAFP President-Elect even spawned a cliffhanger runoff election that ended in victory for a family physician from the state of Washington. And the aftermath of the presidential election featured the requisite shock, disappointment, and grumbling failure analysis within the ranks of the politically defeated.

But what came next were phenomena all too rare in America’s favorite blood sport: graciousness and a unifying patriotism.

 The magnanimous winners were almost literally overcome with emotion. They offered up acceptance speeches seasoned with the type of teary-eyed anecdotes usually served up by scenery-chewing Oscar winners right before the music cuts short their pathos and cues a commercial. The losers were no less generous and prone to edge-of-weepy acknowledgements during an open-mic session. And each and every one professed a shared love of their career country: family medicine.

 In victory and defeat, the AAFP political competitors’ push for victory was tempered by Abraham Lincoln’s “better angels of our nature.” At that moment, those better angels of American medicine, family physicians, embodied Abe’s selfless ideal of political healing.

At least at that moment.

During a postelection stroll through a chic Denver dining district, one family physician was overheard declaring to his dinner companions, “They kicked him to the curb in favor of some slacker from Washington.”

 Apparently, even America’s better angels prefer winning.

 –Terry Rudd (on twitter @FamilyPracNews)

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Filed under Family Medicine, Health Policy, health reform, IMNG

Give Me a (Medical) Home: The Policy & Practice Podcast

While doctors are still peeved that there’s been no action to avoid the deep cuts in Medicare pay necessitated by the Sustainable Growth Rate formula, or SGR, the Obama administration has delivered some good news regarding a test of the Advanced Primary Care Practice concept, better known as the medical home.

For more on those stories, listen to this week’s Policy & Practice Podcast.

Not up to speed on the medical home? My colleague Mary Ellen Schneider can help you with that. As the medical home beat reporter for Elsevier Global Medical News—Notes From the Road’s sister news outlet—she’s covered the topic from most angles.

Image courtesy flickr user J. Steven Conn (CC)

Today, she wrote about an extensive test of the concept sponsored by the American Academy of Family Physicians; last week, she took a look at how specialists might lead the medical home for some of their patients.

See how much you can learn by reading Notes From the Road?

—Denise Fulton (@denisefulton on Twitter)
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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Podcast, Practice Trends, Primary care, Rheumatology

I See What You Mean

From the annual meeting of the Heart Rhythm Society, Denver:

Physicians planning to attend the upcoming annual meetings of the American Academy of Family Physicians, Society of Diagnostic Medical Ultrasound, or American Public Health Association at Denver’s Colorado Convention Center should prepare themselves for Shock and Awww when they encounter the big blue bear, a whimsical 40-foot tall sculpture peering through the glass to see what’s going on inside.

The sculpture by British-born University of Denver artist Lawrence Argent  is titled, “I See What You Mean.” Commissioned under the city’s 1%-for-public-art program, the big blue bear weighs 10,000 pounds and is composed of more than 4,000 polymer and concrete interlocking triangles over a steel frame. Argent began with a small plastic toy he scanned and converted into a digital computer file, which he then sculpted electronically.

The big blue bear has become a popular, feel-good tourist attraction. It also serves as a convenient meeting point for conventioneers who become disoriented by the conference center’s long, white, largely unmarked corridors.

— Bruce Jancin

Photo by Bruce Jancin

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Filed under Allergy and Immunology, Cardiovascular Medicine, Dermatology, Emergency Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Genomic medicine, Geriatric Medicine, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Nephrology, Neurology and Neurological Surgery, Obstetrics and Gynecology, Oncology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry, Pulmonary Diseases and Sleep Medicine, Radiology, Rheumatology, Sports Medicine, Surgery, Thoracic Surgery, Uncategorized

To Cut or Not to Cut

from the American Academy of Pediatrics National Conference and Exhibition in Washington, D.C.

Photo by K. Wachter

Photo by K. Wachter

We had protesters today here at the AAP meeting.  Three of them.  They were urging pediatricians not to perform circumcisions, likening the procedure to torture.  Given my gender (that’s Ms. Wachter, thank you very much) and my lack of male offspring, it’s not a subject that I had ever given much thought. 

So I did a little research.  Both AAP and the American Academy of Family Physicians seem to take the path of least resistance: the potential health benefits of circumcision–reduced rates of STDs and urinary tract infections, prevention of certain penile problems, and reduced risk of penile cancer–are not sufficient to recommend routine circumcision.  Instead, parents should make this decision in light of available information and cultural/religious considerations. 

Opponents of circumcision argue that the procedure inflicts unnecessary pain on newborn boys and may result in surgical complications.  And then there’s the sexual pleasure argument.  Purportedly, uncircumcised men enjoy greater sexual sensation than their clipped comrades.  At a purely scientific level, a more definitive answer would require studying men who have experienced both conditions.  A quick search on PubMed confirmed my suspicion that this sample size is fairly small.  But I defer to the medical professionals–yea or nay on circumcision?

—Kerri Wachter, @knwachter on Twitter

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Filed under Family Medicine, Pediatrics, Polls, Primary care, Urology