Posted on 03.08.10 by Executive Vice President Susan Hogeland, CAE

The great big helium-filled balloon that was health care reform as presented by then-AAFP President Ted Epperly, MD may have deflated a little over the past year, but delegates, alternates and others at CAFP's 2010 Congress of Delegates were more than ready to continue to fight after hearing a practical analysis of the legislation's chances from now-AAFP President, Lori Heim, MD. 

The 80 or more family physicians, residents and students at the meeting in Sacramento may be battle-scarred, and more than a little weary, nonetheless, they're still looking for the reform "pony in the manure" in both Sacramento and Washington, DC.  They're still willing to work hard to convince their legislators that reform is worth the political risk and that ignoring primary and preventive care has to stop sometime; now is a good time.

Dr. Heim updated the Congress on health care reform's possible form following a tumultuous political year, with some strange and surprising twists and turns.  She also reported on the recent machinations in the US Senate that resulted in holding back the anticipated 21.2 percent cut in Medicare payment to physicians necessitated by the Sustained Growth Rate rule - but only until March 31. 

The attendees also heard Dr. Heim present a further legislative update in collaboration with CAFP Legislative Advocate Tom Riley, as well as additional presentations by Drs. Carla Kakutani, Bo Greaves and Walt Mills on the realities of implementing the Patient Centered Medical Home and by staffer Sandy Newman, MPH on health information technology and meaningful use draft regulations.  Two alternate delegates were tapped to act as "reporters" on behalf of the Congress on each of these Town Hall sessions to suggest what might be of use in as the Academy works to implement its 2010-12 strategic plan. 

Eight resolutions were adopted by the Delegates who came, saw and debated - and made Academy policy on issues ranging from the calling on AAFP to rescind its contract with The Coca Cola Company for support of its patient-facing Web site, to the single-payer health plan pending in the California State Senate to help for family medicine residency programs whose accreditation is threatened and patients lose continuity of care when they lose Medi-Cal managed care contracts because of the cost of providing full service care to needy patients.  A complete listing of the resolutions, as passed by the Congress, will be up on our Web site shortly.

Following the conclusion of the Congress, we were treated to a talk by Senate President Pro Tem Darrell Steinberg (D-Sacramento) which put everyone in the mood for the legislative and media training sessions that followed.  The piece de resistance took place Monday morning, when nearly 30 family physicians in all types of practice spent the morning being further briefed on CAFP's key issues (the BUDGET, Patient Centered Medical Home and vaccines legislation) before going to the Capitol to meet with their legislators.  It was a very full weekend. 

Lots of good things came out of the meeting - new officers were elected and sworn in (they take office officially on May 14 at the Annual Scientific Assembly); students and residents and many new delegates and alternates saw CAFP policymaking in action.  Then they observed policymaking in action as CAFP positions on legislation, the budget, etc. was translated into:  what this means to you and your patients and how you should talk about these issues with your legislators and the media.  Telling the tale of family medicine and the impact of pending draconian cuts on real people makes a difference.

The Congress of Delegates is THE place to get the training and information needed to turn you into a skilled advocate for family medicine and your patients.  We are developing a cadre of such individuals to make the greatest impact possible on elected officials at the state and federal levels. 

How about you, next year?

We're putting the finishing touches on the upcoming Congress of Delegates meeting, which will be held this weekend in Sacramento at the Holiday Inn Capitol Plaza starting at 12:30 pm on Saturday.  We'll get a jump start on the weekend on Friday the 5^th when we hold meetings with legislative aides and Paul Grundy, MD, MPH, Director of Health Care Transformation for IBM about the Patient Centered Medical Home and the business perspective on PCMH.  That will be followed by a meeting with folks with Sutter Health, Catholic Healthcare West and Mercy on the same topic.

Dr. Grundy will also be a featured speaker, along with Lori Heim, MD, AAFP President, during the Town Hall portion of the Congress of Delegates on Saturday afternoon.  Dr. Heim will discuss federal legislative activities, including updates to the SGR, and Dr. Grundy will speak about the Patient Centered Medical Home.  Tom Riley, our legislative advocate, will provide an update on state legislative activities, especially the mess that we call the state budget, and Sandy Newman, Director of Health Care Policy, will update the Congress on Regional Extension Centers and meaningful use draft regulations.  Dr. Heim will also be meeting with a group of residents from UC Davis for an in-depth discussion about health care policy on Saturday morning.

Another highlight at the Congress will be our luncheon speaker on Sunday - State Senate President Pro Tem Darrell Steinberg (D-Sacramento).  We're very excited to have Senator Steinberg with us to share his insight about the budget crisis.

The Congress weekend is jam-packed.  We've tried to add value to the Congress of Delegates governance functions by combining them with advocacy and media training as well as issues briefings.  All that training and orientation better prepares the 40 or more delegates and alternates who stay over for our legislative visits to the Capitol on Monday, March 8.  Our plan over the past three years has been to educate and mobilize a cadre of family physicians who will advocate for family medicine's key issues at the local, state and national levels, but especially at the state level, which is why we separated the Congress from the Annual Scientific Assembly and moved it to Sacramento. 

It has been regrettable that the recession intervened in health care reform at the state level, and the recession and politics have intervened at the federal level, although the jury is still out about the possibility of federal reform.  As a recent article in the New York Times pointed out, health care costs must be dealt with soon, whether in reform legislation or not, as the cost of health insurance premiums otherwise is expected to more than double in the next 10 years, taking a family of four's coverage to $24,000 by 2020.  Last year, one of the plans we offer employees here at CAFP jumped 18%.  One plan's announced increase of up to 38% for individual policyholders got quite a bit of national attention recently.  One challenge with mandating that insurance companies take all comers is it fails to address the fact that the plans may charge pretty much what they wish.  So, you CAN get coverage, but can you PAY for it? 

EDITOR'S NOTE: CAFP member Michelle Look, MD was in Vancouver as a member of the US Olympic International Medical Staff and spent the last two weeks providing a first-person perspective of the Winter Olympics as well as her duties. We thank Dr. Look for sharing her stories.

Posted on 02.27.10 by Michelle Look, MD    

Great day at four-man bobsled. The course is fast as seen by the number of crashes at turns 10, 11, and 12 amongst the world's best bobsledders. I was at the start house, infact you might have caught a glimpse of me at the start of Steve Holcomb's run. It was snowing so hard, it accumulated on the track within seconds. After each run, a team of 10 VANOC cleaners (or smurfs as they are affectionately called), sweep and shovel the track. Our team watched as the smurfs would finish as much as 40 seconds faster before the US sled than before the Canadian sleds, allowing  less snow to fall and a cleaner track for the home team. Very sneaky. There were I about seven crashes. When they crash, it is so violent, you just hold your breath until everyone climbs out of the sled.

Their suits are shredded and the abrasions are impressive. There are steering maneuvers for the pilot to attempt when they are tipping, but if a sled is having trouble before the 50-50 curve, they have no chance of recovering in time. When hundredths of a second on the top of the hill translates to a medal or not, the pilot has no choice but to take it to the edge. Go big or go home.

The strategy worked for Jeret Peterson in freestyle aerials.

After a less-than-perfect first jump, our team said time for the "Hurricane." With a 4.90 degree of difficulty compared to everyone else at 4.50, he pulled it out to take the silver medal.

Our high-performance team's proudest moment of the day though was the amazing race in Nordic Combined. Our skiers have been entering cycling races in the offseason to develop their skill in racing strategies. If you watched the race, it felt like the Tour de France. Back and forth our two skiers challenged the Austrian skier until the last 800 meters when Bill Demong put down the hammer. A gold and silver medal in Nordic. Amazing.

Here are some pictures of the day with Elana Mayer, our bronze medal winner from two-man women's bobsled. The medal is as heavy as it looks. More bobsled tommorrow. Steve Holcomb has a 0.40 second lead, let's hope it's enough. One more medal and we are guarnteed to beat the all time record of 36 medals. A huge success for the US Olympic team and staff.

EDITOR'S NOTE: CAFP member Michelle Look, MD is in Vancouver as a member of the US Olympic International Medical Staff and is providing a first-person perspective of the Winter Olympics as well as her duties.    

Posted on 02.25.10 by Michelle Look, MD  

With apologies to my husband Tor, an 8x10 of Petter Northug of Norway may be the new addition to my office. I went to Scandanavia today. At least it seemed like I was in Scandanavia at the Whistler Olympic Park. English was not the most common language spoken. The stadium was filled with flags from Norway, Sweden, and Finland which dominate the Nordic ski world. My friends from Switzerland were heavily represented with their four-foot cowbells and Alpine horns (Ricola horns as we call them). We watched as Northug bridged an insurmountable 27-second gap on his own in the last leg of the 4x10km cross-country relay and passed the Czech Republic and France to win the silver medal. Too exciting.

If you watched the women's two-man bobsled, you saw the difficulty that every country (except Canada) was having with turns 11-12. Right after our first run, coach called our center for footage of Canada1 and USA2 going through just that turn to be sent to his netbook at the sliding center start house. In the second run, pilot Erin navigates the turn perfectly. Enough to give USA2 the bronze and put smiles on our crew here at the high performance center. While our team has been studying the Canadians and video of the track for months, perhaps seeing the video at that moment may have had an influence on the positive outcome. What we do know is that four countries crashed at that portion of the track including world champions Nicola Minichiello and Gillian Cooke from Great Britain (who jettisoned out of the bobsled, so scary), and favorite Cathleen Martini and Romy Logsch from Germany. My favorite sled was the beautiful Japanese bobsled with the Geisha girl painted on it. Their pink helmets reminded me of Dr. Becca Rodriguez's pink power ranger costume from Disneyland. They also crashed spectaculary but fortunately everyone was OK.

If last week belonged to the USA, then this week has been for Germany. With less than 20 events left, it is going to be close. Each morning, I listen to the analysis by our sports performance team. I have seen first hand the ups and downs of high expectations. The pressure on these athletes and their support team is incredible. Like a fund manager, each team's performance is analyzed for the value of  their investment. Everything from the talent assets both now and in development, to the coaches, to the equipment technicians and even the sports medicine team is under the microscope. This is not a job for the faint of heart. Mistakes like the Norwegian longtrack speed skating coach made will live with you forever. 

Nordic combined Individual large hill is today. We'll see if going home to practice in Park City for the week was the right move. I'll be covering the four-man bobsled tommorrow night. Steve Holcom's best event. Think good thoughts. They call the Olympic games a marathon, not a sprint. We hope to build on our medal count today and keep them coming through the Gold Medal round of ice hockey.

Go Oohsa!

EDITOR'S NOTE: CAFP member Michelle Look, MD is in Vancouver as a member of the US Olympic International Medical Staff and is providing a first-person perspective of the Winter Olympics as well as her duties.    

Posted on 02.23.10 by Michelle Look, MD

I spent the day in the Whistler Village Medical Clinic yesterday. Yes, it's true, the McDonald's in the athlete cafeteria is very popular. McCafe is awesome.  This is the Green games and when I went to dispose of my rubbish, the VANOC volunteer said everything goes into recyclable except McDonald's which goes into other. How embarassing.

I was given a tour of the VANOC polyclinic and it was amazing. Not only do they have a full GE-sponsored MRI, CT, digital X-ray and diagnostic ultrasound, but their pride and joy is their Mobile Medical Hospital built just for the games. They took two double wide trailers and took out the wall in between them. It has six ICU beds, a fluoroscope, portable X-ray and an entire sterile operating room in the back. On a coffee cart sits a hematology lab to type and cross blood for transfusion. This MMH is manned by four ICU nurses, two orthopedic surgeons, two trauma surgeons, and two anestheisologists 24 hours a day. When an athlete goes down on the hill at Creekside, which unfortunately has been more than a few times, they can be longlined down the slope to a waiting helicopter and flown to the polyclinic in the athlete village about five kilometers away. There, they can be stabilized and flown down to a Vancouver trauma hospital or (if the weather is bad or the sea-to sky-highway is blocked, operated on in the MMH. Pretty impressive for a remote site. 

This weekend, I was at the bobsled venue. The speeds of the sleds and the crashes were impressive. Affectionately nicknamed the 50-50 (for 50 percent chance of crashing), turns 12 and 13 is heavily on the mind of our bobsled drivers. How does it feel to hit that wall after turn 16? "It hurts" says bobsledder Chris Fogt. And the lugers, skeleton racers and bobsledders all have the bruises to show for it. They tell me the pushers and brakeman can only listen to the pilot to decide whether to duck down further into the sled or bail out. Sometimes out of the bobsled is best but the G forces push their body into the sled and they can't jump.  Look for good things from our fourman bobsled team.

Nordic combined returned yesterday, they went home for the week to practice on their own ski jumping hill in Park City after their impressive finish last Sunday. One of the benefits we won't be able to do in Sochi in 2014.

We are constantly looking at other countries and how they have had reached their success. Especially the small countries who pull out medals. Natural talent may get you to the Games, but it may not be enough to medal. While the ridges on Great Britain's Amy Williams helmet was not what gave her the gold in luge, there were other things our center did add. For instance, a  rubberband attatched from the chin of a luger's helmet to their jersey to help keep their chin down against the 6-10 G forces pushing their cervical spine into hyperextension. Also having their gloves fashioned in a dorsiflexed, position so that when they paddle forward they get a little extra force.  For the record and for the hundredth time, we did not do the research on Austrian, American or can cheese for Lindsey Vonn.

My Hawaiian/Californian skin is perhaps getting thicker as I can now go outside with only three layers instead of five. My husband Tor came to visit for the weekend and I outlasted his Danish shell. That is a first. Standing on the hill for several hours at the sliding center can still chill you to the bone, but hearing the star spangled banner can always warm you up. Looking for our success to continue through the final week.

GO U.S.EH!

Posted on 02.22.10 by Executive Vice President Susan Hogeland, CAE 

CAFP has been thoroughly preoccupied with the budget mess in Sacramento and the impact it will have on health care services.  I don't think we even know the extent of the damage yet, as things such as elimination of Healthy Families and other draconian steps are still on the table.  Legislative Advocate Tom Riley has been attending hearings and briefings, and we've been encouraging family physicians to communicate directly with their Assemblypersons and Senators about the ill effects such cuts will have on real patients.

Meantime, we're soldiering on with efforts to introduce legislators to the precepts of the Patient Centered Medical Home (PCMH).  Today, Tom Riley, Adam Francis, Legislative Assistant, and Sandy Newman, Director of Health Policy will spend the day with Adrienne White of IBM meeting with Assembly members, aides to Governor Schwarzenegger, one state senator, and representatives from the California Chamber of Commerce to promote PCMH.   We continue to be grateful to the folks at IBM for their incredible support of family medicine and primary care on this issue.  This coming Friday, Paul Grundy, MD, MPH, IBM Global Director of Health Care Transformation will be flying into Sacramento to attend similar meetings with us and then to speak to our Congress of Delegates on Saturday, March 6 about the business perspective on PCMH. 

Speaking of the Congress, we're putting finishing touches on the Town Hall presentations (such as Dr. Grundy's), and now AAFP President Lori Heim will help present on the legislative update session, bringing the latest from Washington, DC on such issues as the Sustainable Growth Rate potential cuts, reform, etc.  Our legislative and media training sessions on Sunday afternoon of Congress have really taken shape as well.  Media consultant Catherine Direen has pulled together reporters from the Sacramento Bee, SF Business Times, San Francisco Chronicle, and Capitol Public Radio for the session on what reports want from interviews and how to become a source.  Former Sacramento Bee columnist and blogger Dan Weintraub will participate in our "Lions and Tigers and Blogs, Oh My!" session, which will also feature CAFP members Carla Kakutani and Jay Lee.  Wow!  These sessions are open to all members by prior registration - contact me or Mariah Brooks to get your name on the list.  All members are also welcome to participate in our visits at the Capitol - let Adam Francis on our staff know if you'd like help making appointments with your legislators and would like to attend our breakfast briefing on Monday, March 8. 

Sandy Newman has prepared an excellent summary of the federal draft "meaningful use" regulations currently under comment.  The document can be found on CAFP's Web site and will be handed out at the Congress as part of Sandy's Town Hall presentation on Health Information Technology.  CAFP provided input on these draft regulations to the AAFP, which will submit them by the comment deadline of March 15.

I will be away from the office after Wednesday this week - helping my mother celebrate her 90^th birthday, Midwestern weather permitting.  Please contact Shelly Rodrigues if there's anything with which you need assistance.

Posted on 02.16.10 by Michelle Look, MD 

More rain and snow today. All of the Alpine events have been postponed. It has been on the quiet side for medical, but the delay has been good for our skiers Stacey Cook to recover from her crash, and Lindsey Vonn's boot bruise to heal.

In the meantime I have been gaining important skills in multiscreen viewing. With 3-6 screens running at all times, the technology is impressive. We receive all of the live camera views from the Olympic broadcasting feed, it goes into something called a 'Slingbox" that holds up to 60 minutes of footage and this is sent remotely to our coaches on the hill. Using their iPod Touch they can view, replay, and analyze curve by curve each run instantly AND in high definition.  The entire coverage is also taped and sent by courier to them. Sometimes coaches are not happy with the camera views so our staff will climb up trees, hike up parallel hills too steep to snowshoe or even ski to try to capture another viewpoint. Women's luge is starting from the Junior start and they are unhappy with that, but at this point we are glad they are thinking of safety first.

We were happy with the results of Nordic Combined. Finishing second, fourth, and sixth is the result of many years of preparation. Their success is a representation of how our USOC development program in smaller sports can work. Cross-country athletes are scouted at the International level. They are tested in the lab to see whether they have the baseline VO2 max, lactate profiles, forceplate and vertical leap ability to be considered to add ski jumping. Their levels are then compared to previous US and truthfully Norwegian Olympians and if they meet the requirements, basic training begins, which includes, a mandatory move to higher altitude living. If you look at our top two Nordic combined athletes they were both born in Steamboat at 7,000-foot elevation and have lived and trained there as well.  Just prior to coming to the games, we flew over several tanks of oxygen from Colorado Springs for them to do high intensity training breathing 100 percent O2 in their backpacks with the nasal canula in their mouths. This allowed them to basically "train low" while living "high" at 7,000 feet. A formula that apparently worked.

Our wall is filling with the pictures of US medals won so far. The pressure our HPC staff feels for our team to win medals is fierce. I have not heard such shall I say "vigorous" cheering  for the US to beat Canada since my days at UCLA-USC games. We were able to make it into the village last pm for Bode Miller's bronze medal ceremony. The gold went to Switzerland and they went crazy. To win the gold medal in Downhill skiing is the ultimate in their country. They become superstars. They tell me Didier Defago will never have to work or pay for a meal again for life. Singing and dressed in flags they marched their medal winners from the stadium to the village ringing huge cowbells, These 60-80 year old men carried bells up to four feet large and required their whole body weight to ring.  You could feel their national pride.

Ahh the Olympics, nothing beats this.

Posted on 02.16.10 by Executive Vice President Susan Hogeland, CAE 

I'm happy to report the second Family Medicine Patient Centered Medical Home Summit was a smashing success with nearly 100 attendees and excellent reviews.  It's exciting to us when the excitement among residents - and even program directors - is palpable.  Rich Roberts, a former AAFP President, was keynote speaker for the event held at The California Endowment's wonderful headquarters in Los Angeles.  Rich is always inspirational.  Other leading lights of family medicine helping us with the two-day program included President Tom Bent, Board member Jimmy Hara, past president Joe Scherger, and Family Physician of the Year Alan Glaseroff, among others.  CAFP thanks all of those who presented and participated, as well as our co-sponsors and financial contributors Southern California Permanente Medical Group and Northern California Permanente Medical Group's Community Fund.  We also thank Pfizer, which gave an unrestricted grant in support.  Finally, a special shout out to staffers Sandy Newman, Shelly Rodrigues, Dasha Sakharova and Jane Cho who worked especially hard to make the program a big success.

CAFP has provided suggestions to AAFP on its extensive comments on proposed regulations for implementation of meaningful use regulations.  We were in general agreement with AAFP's analysis of the regulations, but suggested some altered language with regard to disparities issues on which we have considerable experience because of our work on The Medical Leadership Council.

Carla Kakutani, CAFP past president and president of FP-PAC, the California chapter's PAC, has been appointed to the Board of Directors of FamMedPAC, the American Academy of Family Physicians' political action committee.   To assist Dr. Kakutani in her efforts to engage more members in political action, Jack Chou, MD, CAFP's President-elect, has been appointed to the California Chapter Champion position for FamMedPAC by Jim King, its chair.  Congratulations to both!  Last week Dr. Kakutani and CAFP staff met with Dr. Don Kurth, Republican candidate for Assembly District 63 (a race to replace Assemblyman Bill Emmerson who is running for state Senate). Dr. Kurth is the current Mayor of Rancho Cucamonga and president-elect of the American Society of Addiction Medicine.  

We're putting the finishing touches on what promises to be an excellent 2010 CAFP Congress of Delegates in Sacramento March 6-8.  With both Paul Grundy, MD of Director of Health Care Transformation for IBM and Lori Heim, MD, AAFP President on the schedule, we think it will be an enlightening weekend for attendees.  It is always unfortunate to me that we have a relatively low turnout for such good programming and training - only about half of county chapter slots are filled.  At the request of Delegates and Alternates, we've expanded the Town Hall portion of the Congress to nearly three hours, and consolidated the "official stuff" to do so.  We give a "Hero of Family Medicine" award to an FP who has gone above and beyond the call of duty in service to the specialty and we offer outstanding media and legislative training sessions on Sunday afternoon.  The event concludes Monday morning with a legislative briefing and visits to the Capitol to meet with legislators from delegates' and alternates' districts. 

Staffers Sophia Henry and Dasha Sakharova joined CAFP President Tom Bent and past president Joe Scherger at a very well-attended Sacramento/Yolo joint chapter meeting arranged by Warren Brandle and Carla Kakutani with help from Sophia and Jessica Cho.  Almost 70 members were in attendance.  Way to go, Drs. Brandle and Kakutani!

EDITOR'S NOTE: CAFP member Michelle Look, MD is in Vancouver as a member of the US Olympic International Medical Staff and is providing a first-person perspective of the Winter Olympics as well as her duties.

Posted on 02.16.10 by Michelle Look, MD

I am a Board certified Family Practice-Sports Medicine physician and part of the US Olympic International Medical Staff. This is a volunteer position that doctors with Sports Medicine training and experience can apply for. Like our athletes, becoming a physician for the Olympic Games is the culmination of years of training and experience. Olympic physicians start with volunteering for two weeks at an Olympic training facility taking care of resident athletes and team training camps. 

A limited number of these physicians are selected by feedback from the US Olympic Sports Performance staff, coaches, and the athletes themselves and can work their way up through National competitions, world championships, world games, Pan American games, Paralympics and then, finally, the Olympics. For myself, after initially serving as a physician at the Chula Vista Olympic Training Center, I served as the US Olympic team physician for several national games, then in Thailand in 2007 for the World Games with the Women's Softball team and in Beijing and Hong Kong in 2008 for the Paralympics with the ParaEquestrian, Wheelchair Fencing and Paracycling teams.

My role as a team physician for the 2010 Winter Games in Vancouver is to take care of the medical concerns of our US Olympic Team athletes and staff. We will be taking 215 athletes and 150 staff to the Vancouver Games. Besides medical illness and injuries, one of the essential roles we play is also to oversee any drug testing that is performed, should our athlete be selected for testing, to ensure the process is done in a fair and legitimate way.  At these games, I will be serving as the Lead Physician for the Whistler High Performance Center. This is a center located outside of the Olympic village in Whistler for our athletes in Alpine Ski, Boblsled, Luge, Skeleton, Cross country, Nordic Combine, Ski Jump and Biathlon. At the High Performance Center, we will have an exercise physiologist, sports psychologist, video technician, massage therapist, outside coaches, athletic trainer, chiropractors and physicians for consulting and caring for athletes during the games. The goal of the High Performance Center is to recreate our athlete's training atmosphere as closely as possible and give them every advantage to perform at their best. Winter sports are very technical and even a slight upper respiratory infection or jetlag can be the difference between one of our athletes winning a medal or not.  I am honored to represent our country and contribute to the success of our US athletes while at the same time reaching a pinnacle in the practice of sports medicine.

SEE ALSO:

Michelle Look: A Sad Day (02/12/10)

Michelle Look: Life as a Speedskater (02/13/10)

Posted on 02.08.10 by Executive Vice President Susan Hogeland, CAE

This is a very busy week for staff on many fronts.  For the next two days, I will be with President-elect Jack Chou at the American Society of Association Executives Chief Elected Officer/Chief Staff Officer Symposium, an exercise every president-elect of the Academy but one has undertaken with me over the past eighteen years.  The year we missed was due only to budgetary concerns when we were in a federal antitrust lawsuit!  Jack and I will have an opportunity to learn one another's leadership styles and how best to work together - and it's a great chance to get to know one another even better.  For the last several years, executive directors and presidents-elect from other Western States chapters have also attended this meeting, so it's also an opportunity to network.

What promised to be our second very successful medical home summit for residency program directors and chief residents kicked off today in Los Angeles.  Pre-registration was more than 100!  AAFP past president and PCMH advocate Rich Roberts is keynote again, as he was at the first summit in 2008, and CAFP President Tom Bent is emcee. Sandy Newman, Dasha Sakharova, Shelly Rodrigues and Jane Cho are staffing the summit, which is combined with our Residents in Action media and legislative training program.  We're grateful to Northern and Southern Permanente Medical Groups for co-sponsoring and funding, and to Pfizer for an unrestricted grant.

Wednesday, Shelly Rodrigues and Cynthia Kear head to a confab in Wisconsin of the nine CS2day partners to plot and plan the next iteration of that very successful continuing professional development collaboration.  Pfizer has funded a second generation of the program, and the group is seeking additional funding as well. 

Legislative Advocate Tom Riley and Legislative Assistant Adam Francis have their hands full as well with the on-going battle in Sacramento over planned tremendous cuts in health care funding, including, potentially, elimination of Healthy Families.  Governor Schwarzenegger had bad news from Washington last week when the President's budget was released - only $1.5 billion of the requested $6.9 billion will be available to California.  Tom and Adam were also busy last week helping prepare testimony for Sacramento Residency Program Director Marion Leff, MD and CAFP Foundation Trustee Kiki Nocella, PhD for the Health Care Workforce Access Select Committee hearing led by Assemblymember Ed Hernandez, OD (D - Baldwin Park).

We're very happy to announce that not only will we be hosting AAFP President Lori Heim at the upcoming March 6-8 CAFP Congress of Delegates in Sacramento, we will also have Paul Grundy, MD, IBM's Global Director of Healthcare Transformation and President of the Patient-Centered Primary Care Collaborative at the meeting to speak about the business perspective on the patient centered medical home.  Dr. Grundy also hopes to speak at a CAFP-hosted session with legislative staff about the patient centered medical home.  We're delighted both Dr. Heim and Dr. Grundy will be with us, and invite interested members - delegates and alternates or not - to attend.

As I mentioned last week, the CAFP Board of Directors met by conference call on February 3 and most of the agenda was consumed with a discussion of the report from the Single Payer Task Force that resulted from adoption of a resolution at last year's Congress asking for a complete analysis of SB810, Senator Mark Leno's (D-SF) single payer health care reform bill.  The Board approved some new additions to our principles for health care reform overall, and a lengthy set of recommended amendments to the legislation, and authorized representatives of the Academy to meet and discuss the amendments with Senator Leno.  The Board did not endorse single payer at this time, however.

Posted on 02.01.10 by Executive Vice President Susan Hogeland, CAE 

Following the President's State of the Union address to Congress last week, AAFP President Lori Heim, MD wrote all Academy members to urge them to help keep up the momentum for health care reform.  Dr. Heim, who will be our guest at the upcoming CAFP Congress of Delegates in Sacramento on March 6-8,  emphasized the need for universal access, lower cost and higher quality, and building up the primary care physician workforce to meet the needs of Americans.  Dr. Heim also emphasized the importance of the Patient Centered Medical Home (PCMH) in achieving these goals.  She asked members to contribute to the Academy's political action committee, FamMedPAC, and visit the AAFP's health reform Web site for more information.   I hope each of you will do so.

CAFP had a busy week promoting the PCMH as well.  On Monday and Tuesday, Sandra Newman, Director of Health Policy, and I attended the National Committee for Quality Assurance's workshop on How to Facilitate Patient Centered Medical Home Recognition; on Thursday, Ms. Newman accompanied legislative advocate Tom Riley, legislative assistant Adam Francis, and Adrienne White, Managing Consultant, Public Sector, IBM Global Business Services on a series of visits to legislators and legislative staff in Sacramento to discuss the value of the PCMH.  On Thursday, I participated in a conference call with representatives of the American College of Physicians, District IX and the American Academy of Pediatrics, District IX on ways we might collaborate on a PCMH demonstration project in California. 

CAFP has learned that the Pacific Business Group on Health is moving forward on a PCMH demonstration project that carves out high-utilizing patients.  CAFP has expressed its concerns about this approach:  the expense and effort of establishing a PCMH should be spread across all patients, not a subset.  CAFP would also prefer to see an all-payer demonstration project so practices would not be expected to treat a subset of patients differently from other patients in the practice and some administrative burden would be eliminated.

Tom Riley and Adam Francis also continue to carefully monitor the State's discussion on the 1115 Waiver for Medi-Cal patients, which will seek to establish a PCMH for the most chronically and mentally ill patients. 

CAFP's efforts in Continuing Professional Development were recognized last week at the Alliance for CME meeting in New Orleans.  Between them, staffers Shelly Rodrigues, CAE and Cynthia Kear presented a total of seven times, primarily around CAFP efforts on collaborative quality improvement programs.  Shelly and Cynthia, with the help of Sandy Newman and Jane Cho, project coordinator, have established quite a reputation for CAFP as a quality improvement organization.  We'll be bringing the same kinds of expertise to our work on adoption of the PCMH to help family physicians get more enjoyment from the way they practice.

I'll be spending today with the ACTION program Advisory Committee members.  ACTION operates in parallel with The Medical Leadership Council on Cultural Proficiency.  Its intent is to develop capacity among California health care organizations to improve equity in care.   On Wednesday evening, CAFP's Board will meet by conference call for a brief agenda, the majority of which will be taken up with the report of the Single Payer Task Force.  More on this next week ...

Finally, the finishing touches are being put in place for CAFP's upcoming Medical Home Summit for residency program directors and chief residents, being held at the headquarters of The California Endowment February 8-9 in Los Angeles. 

Posted on 01.25.10 by Executive Vice President Susan Hogeland, CAE

What a difference a day makes - last week's special election in Massachusetts threw a monkey wrench into health care reform - who knew it could happen so quickly?  While no one would say the House and Senate bills were perfect by any stretch of the imagination, both were highly favorable to family medicine and primary care - and that was a good start.  Now, it seems all bets are off and CAFP and AAFP are standing by waiting to see what the House and Senate leadership will try to salvage, if anything.  But, life goes on.  CAFP will monitor this situation very closely and will try to save what is most beneficial to family physicians and their patients.

The budget battle continues as well.  CAFP has asked other primary care and patient advocacy organizations to sign a letter we have written to the Governor and legislators asking for consideration of a number of revenue increasing measures that could lessen the impact of cuts to health care services.  Deadline for agreeing to sign onto the letter is the 27^th of January.  Among the measures are nickel-a-drink tax increases for alcoholic beverages and sugar-sweetened beverages and an increase in tobacco taxes.

We are knee-deep in Congress of Delegates activities and Annual Scientific Assembly activities, as we will be through the first weekend in March for the former, and through May 15 for the latter.  Please register for the ASA as soon as possible - it promises to be outstanding.  Our CME stars, Shelly Rodrigues and Cynthia Kear, are presenting at the CME Alliance in New Orleans on many of the excellent CME activities the Academy has undertaken this year.  Between the two of them, they are giving six presentations - way to go!  Much of CAFP's continuing medical education success is tied to these two powerhouses.

Carla Kakutani was interviewed by Associated Press about the new timely access regulations for HMO patients after AAFP contacted us for help.  AAFP President Lori Heim was also interviewed and their comments (Dr. Heim's and Dr. Kakutani's) comments were carried extensively:  the article has appeared in more than 100 different publications, including ABC News online: http://abcnews.go.com/Business/print?id=9620424

Here's a brief sample of media outlets that have published the article (so far):

• Forbes
• ABC News
• Business Week
• Los Angeles Times
• Philadelphia Inquirer
• San Jose Mercury News
• Washington Post
• Boston Globe
• Cleveland Plain Dealer
• Dallas Morning News

Thanks to Legislative Advocate Tom Riley and media consultant Catherine Direen for providing deep background on this issue and connecting the dots for all concerned. 

CAFP will sponsor the second Medical Home Summit for residency program directors and chief residents on February 8 and 9 in Los Angeles with the support of Southern and Northern California Permanente Medical Groups and Pfizer.  This important event is tied to CAFP's "Residents in Action" legislative and media training program for residents and is handled by Sandy Newman, Dasha Sakharova and Shelly Rodrigues.

Sandy Newman and I are attending the National Committee on Quality Assurance's Patient Centered Medical Home (PCMH)training for physician offices this week in Washington, D.C. so we can better understand what physician practices must do for NCQA recognition as a PCMH.  We knew it wasn't easy, but now we're even more impressed with the 146 practices in California that have achieved PCMH recognition so far.

Posted on 01.18.10 by Executive Vice President Susan Hogeland, CAE

Bob Bourne, Barbara Kostick, Carla Kakutani, Ron Labuguen and I spent several days in cold Kansas City representing you on AAFP Commissions - Continuing Professional Development, Health of the Public and Science, Governmental Advocacy, Education and, in my case, Quality and Practice Enhancement.  Not only did we take on sizeable agendas on key issues for family medicine, we also heard reports on health care reform and the AAFP Consumer Alliance program from AAFP leaders Lori Heim and Ted Epperly.  They outlined, as I did in last week's blog, the many benefits to family medicine and primary care contained in the health reform legislation, to say nothing of the benefit to patients.

My commission took on issues ranging from e-visits to retail health clinics, CPT codes to various payment reform options, the SGR update to meaningful use of HIT, as well as the progress made by TransforMED in helping family physicians transform their practices to full patient centered care.  It was 2.5 days of non-stop meeting and discussion on your behalf by extremely dedicated volunteers. The amount of clinical and practice management knowledge in the room - between AAFP staff and physician volunteers - is amazing.  What's further amazing is the amount of dedicated time outside of the actual face-to-face meeting those volunteers spend - most offered to serve on "work groups" to further address issues or develop policies, and there are several electronic meetings during the course of the year, as well as an unending stream of emails and work that has to be done online.  Despite the hectic schedules of the Commission members, there was clear enthusiasm for positively affecting the practice lives of family physicians.

As a side note, it was concerning to me that no one in our state asked to be nominated for service on an AAFP commission in 2010 - the largest state in the Academy now has only FOUR physician representatives on commissions; last year we had a total of seven.  If you have interest in serving, it's helpful to have served on a CAFP committee first, but it's not mandatory.  Please contact CAFP and ask for an application.  You'd be joining a very special corps of committed family physicians if you are appointed.

CAFP was very occupied with budget matters last week - past president Carla Kakutani was interviewed on Healthline after CAFP issued a press release outlining the impact of the budget cuts on health and suggested ways to avoid those cuts.  You can hear her at:  http://www.californiahealthline.org/special-reports/2010/health-advocates-legislators-see-little-to-like-in-governors-proposed-health-program-cuts.aspx   Thanks to Dr. Kakutani and past president Jeff Luther as well, for their willingness to speak with the media.

CAFP also represented you at yet another meeting of the Regional Extension Centers in Sacramento last Monday and remains very engaged in the meaningful use challenge.  Hundreds of pages of draft regulations have now been issued outlining the meaningful use requirements, so we and others are pouring over them to determine how best to advise you to access the funds offered from Medicare or Medicaid in your office. 

Posted by Executive Vice President Susan Hogeland, CAE on 01.11.10

The State budget and health care reform:  you may tire of hearing me talk about these two issues over the course of 2010.  Sorry.

As predicted, Governor Schwarzenegger's State of the State Address last Wednesday and subsequent release of his proposed budget on Friday indicate health care services are in for another major hit, especially Medi-Cal and In Home Health Services (IHHS) as we confront a $18.9 billion shortfall (with a $1 billion reserve).  The Governor promised to protect education and promote jobs, but made no such promises about protecting the health of Californians or protecting health care jobs.  As Legislative Advocate Tom Riley put it, how can you have a job, job, job, if you are sick, sick, sick and can't find a doctor, doctor, doctor? The administration has proposed $2.9 billion in cuts from health and human services!

Today, CAFP will issue its response to the budget, and will vow to fight on behalf of patients and the physicians who care for them.  We will encourage the Governor to rescind the corporate welfare tax breaks enacted in the last budget cycle so essential health care services can be preserved and access to care for those who need it most is protected.  It is appalling to think that our state would prioritize specific tax cuts that have shown no evidence of generating employment over health care for impoverished children.

Additionally, this week, we will continue to follow closely the efforts in Washington, D.C. to enact health care reform and to provide assistance to AAFP in advocating for patients and family physicians.  I was briefed last week by AAFP staff on how primary care is currently being supported by the Stimulus Act and would be supported by reform in many ways, especially financially.  From bonus payments to primary care physicians, to as much as a 5-8% increase in payment to primary care physicians, from efforts by the Centers for Medicare and Medicaid to reduce the gap between primary care and subspecialists to whopping increases in allocations for Title VII and VIII programs, it is clear that primary care is in ascendancy.  And, it's about darned time.

I learned last week, too, that family physicians and the Patient Centered Medical Home are being positioned by AAFP to play a key role when reform is enacted in controlling overall health care costs.  Family and other primary care physicians can keep bad stuff from happening to patients, and when and if it does happen, can prevent hospitalizations or work with other specialists to coordinate the provision and efficiency of care.  What a perfect role for FPs! Figures are just in noting that the ten year cumulative increase in family health care premiums amount to a 100% increase - $13,375 per year for the average family plan, $4,824 of which is paid by the employee!

I and several Academy members will be traveling to the frigid Midwest this week to attend AAFP's commission cluster meetings.  My 400+ page agenda for the Commission on Quality and Practice Enhancement kept me busy over the weekend, as I am sure similar agendas did our doctors. 

Some of you may know that Jessica Kuo, our Membership Manager, plans to leave CAFP this Friday to seek her MBA at Stanford.  Happily, Jessica will be staying on part-time to continue to implement our strategic plan efforts to recruit and retain members and develop chapters.  She has done an outstanding job over the past three years.   We have hired Sophia Henry, a UCLA graduate, to serve as Membership Coordinator, giving us a great membership department team that also includes Cody Mitcheltree, Membership Assistant.  Join me, please, in welcoming Sophia and wishing Jessica the very best.

Posted on 01.04.10 by Executive Vice President Susan Hogeland, CAE 

Happy New Year!  Mercifully, it was a quiet time between Christmas and the New Year - no health care legislation emergencies or practice disasters requiring Academy assistance.  So, we've all returned refreshed and ready to face what promises to be both a challenging and exciting year.

The issues are many - the ultimate outcome of health care reform efforts in Washington, D.C., the anticipated $20 billion budget shortfall here in California and the impact that may have on health care services, efforts to achieve meaningful use of health information technology and the associated rewards and penalties, the discussions around patient centered medical home with regard to chronically and/or mentally ill Medi-Cal patients, and the usual onslaught of legislation affecting health care.

Additionally, we're preparing for the March 6-8 CAFP Congress of Delegates and the 62^nd Annual Scientific Assembly, which will be held May 15-16 in San Francisco at the Grand Hyatt, Union Square.

We continue to hear from members about their opposition to AAFP's decision to maintain its contract with The Coca Cola Company in support of the AAFP patient-facing Web site, familydoctor.org.  Some members are not aware that membership with AAFP is unified with membership with CAFP.  By resigning membership in AAFP or deciding not to pay 2010 dues, you also end your membership with CAFP and your local chapter.  I encourage all California family physicians to remain members of AAFP and help CAFP fight for a policy change on the Coke issue, as well as help CAFP continue to fight overweight and obesity in our state through our legislative and public health efforts. 

AAFP has done and continues to do many good things in the public health arena.  I always encourage members not to let a single issue be the determining factor in whether they join or remain members of either organization.  I ask them to look at the big picture and to weigh, on balance, the many good things your organizations do on your behalf, and that of your patients.  It is easy to respect and admire the large majority of the work AAFP does; when we disagree, we need to work to change the policy, but taking our marbles and going home shouldn't be an option. 

In the coming year, it's likely we'll be calling on you more than ever to contact your state and federal legislators, consider testifying in Sacramento, share your experiences with Patient Centered Medical Home, respond to surveys that will help us direct Academy policy, serve on committees or task forces, and talk to your patients about key issues affecting family medicine and their good health.  Thank you in advance for responding to these requests.  It may be a bumpy ride - it may require a seat belt AND a helmet - but it's always a pleasure to advocate for family physicians.