Posted on 07.19.10 by Susan Hogeland, CAE

Paul Grundy Visit - Round Two!

As part of CAFP's continuing efforts to promote the Patient Centered Medical Home (PCMH) concept throughout the state, we were fortunate enough again to be joined by one of the major advocates for PCMH.  The force of nature that is Paul Grundy, MD, MPH, IBM Global Director for Health Care Transformation, visited California to collaborate with CAFP and others for the second time the week of July 12.  CAFP's own Kevin Grumbach, MD hosted a roundtable on PCMH on Monday, July 12 at the University of California, San Francisco to discuss health care workforce policy issues and to examine why California is behind the curve on PCMH adoption.  OUTCOME:  representatives of business, medical groups, health plans and others expressed an interest in developing an organization similar to the Patient Centered Primary Care Consortium, which Dr. Grundy chairs, in California as a means of promoting PCMH.  CAFP hopes to be front and center in founding such an organization.

On Tuesday, July 13, a host of other meetings were scheduled, including those with physician representatives of Sutter Health, Brown and Toland Medical Group and Blue Shield Medical Director Meredith Mathews, MD, along with Andy Halpert, MD.  On Wednesday, July 14, CAFP and Dr. Grundy headed to Fresno for a meeting with members of the community and the Fresno Unified School District Joint Health Management Board, which is interested in a PCMH model of care for its members.   CAFP Board member for District VI Adriana Padilla was present, along with member Kathy Flores and other physicians, to participate in the discussion. 

As a result of all of these meetings, CAFP learned there is a good deal of interest from family physicians in the PCMH model - in Sacramento, Fresno, San Francisco, San Diego and elsewhere.  Our challenge now is to bring folks together and help provide the tools needed to transform practices and provide the policy pressure to improve payment for PCMH services.

Board in Brief

The CAFP Board of Directors met on July 10 and took care of business at the first meeting chaired by new president Jack Chou.  Legislative Affairs Committee Chair Taejoon Ahn, MD and Legislative Advocate Tom Riley updated the Board on two key sponsored pieces of legislation, AB 1542, CAFP's Patient Centered Medical Home definition bill, and AB 2093, legislation to improve payment for purchase, storage and administration of vaccines.  Both bills were passed out of the Senate Health Committee on June 30, but still have obstacles to surmount before final passage.  The Board received a report on 25 other bills of concern and took positions on seven new bills ranging from mandatory CME for hepatitis (oppose) to a prohibition of sales of electronic cigarettes to individuals under the age of 18 (approve).  The legislature is in recess now, so Tom Riley is taking a much deserved vacation.

The Board also approved the Academy's audit report from Bregante and Company, which provided an unqualified opinion about CAFP's finances - a good thing - and noted CAFP's administrative expenses are a low 11 percent, meaning 89 percent of Academy spending is for programs.  The Board also appointed a new Health Care Workforce Task Force to address challenges in the family medicine pipeline and the CAFP delegation to the CMA, including Carla Kakutani, MD; Eric Ramos, MD; Steve Green, MD; Taejoon Ahn, MD; Patricia Samuelson, MD and Sam Applebaum, MD (a newbie!).  Thanks and congratulations to all.

A  47-page report on progress toward achieving the goals and objectives of the 2010-12 CAFP Strategic Plan was reviewed and approved, as was a reduction of 50 percent of dues for new physicians in their first year of practice, contingent upon the AAFP Board doing the same.  Callie Langton, Associate Director of Health Care Workforce Policy and New Physician Board Member Jay Lee, MD led a focused discussion on health care workforce opportunities in the new health care reform legislation.  A resolution opposing AAFP's contract with The Coca Cola Company to support its patient-facing website, www.familydoctor.org, was approved for submission to the 2010 AAFP Congress of Delegates and the Board okayed an affiliation with Atlantic Health Partners discount vaccine purchase organization to CAFP members in return for a minimal fee based on sales.  This is very timely as we face the back-to-school vaccination rush, the onset of flu season and the pertussis epidemic. 

CAFP's Cynthia Kear to Testify at the FDA this Week

Cynthia Kear, CAFP's Senior Vice President, will testify this week before the Food and Drug Administration panel meeting to further consider the Risk Evaluation and Management Strategy (REMS) for long-acting opioids.  CAFP has been actively involved in this discussion out of concern that patients continue to have access to whatever pain medications are efficacious for them and to ensure that REMS requirements are not burdensome for physicians.

Taking a Break!

I'll be on vacation the week of July 26, so there'll be no report from me the week of August 2 - I just don't know how you'll manage!  Happy summer!

Posted on 07.16.10 by Ronald Fong, MD

Sponsored by CAFP, Paul Grundy, MD, MPH, IBM's Global Director of Health Care Transformation, spoke at the UC Davis Department of Family and Community Medicine in early June.  He focused on the implementation of the Patient Centered Medical Home (PCMH).  To gain support and respect from other stakeholders in health care reform, Dr. Grundy urged primary care physicians to redefine "generalists and specialists" as "comprehensivalists and partialists," respectively.  Throughout his presentation, he identified the physician-leader in the PCMH model as a "comprehensivalist."

As Dr. Grundy continued to cite "comprehensivalist" consistently and seamlessly, I began to see the wisdom of defining family medicine's mission and merits on our terms instead allowing others to continue to marginalize our contributions.  The abortion debate provides a prime example of the importance of protecting identity ownership.  The opposing sides have declared themselves as either pro-life or pro-choice.  Neither would accept the labels of anti-choice or anti-life, respectively.  To do so would compromise each camp's convictions.

Have we tacitly complied with the popular view that a primary care physician (generalist) is a jack-of-all-trades and a master of none over the last two decades?  Is this view partially responsible for the declining interest in family medicine among medical school graduates during that time period?  The public is skeptical of anyone being able "to know too much about much."  The default assumption is that a family physician is one who lacked the intellectual fortitude to pursue specialty training.  Therefore, this practitioner of limited skill deserves a corresponding limited compensation.

By advocating "comprehensivalists" in professional settings, we establish a mind set and change the dynamics of the dialogue.  In this mind set, family physicians can clearly delineate that providing coordinated and comprehensive care to patients in the setting of a long-term relationship is a skill that needs to be valued by all in order for health care to improve for everyone.       

Posted on 07.12.10 by Executive Vice President Susan Hogeland, CAE 

What summer slow down?  We haven't seen any summer slowdown.

Meeting with New UC Riverside Dean

Last week President Jack Chou and I were joined by chair of CAFP's Committee on Continuing Professional Development Geoff Leung, MD and Executive Director of the Riverside County Medical Association, Dolores Green at a meeting with G. Richard Olds, MD, MACP, the new Vice Chancellor, Health Affairs and Dean, School of Medicine, University of California Riverside.  Dean Olds was being shadowed that day by two medical students who must have been learning a lot about policy and workforce issues!

We were meeting with the Dean not only to welcome him to his new position, but also to reinforce CAFP's initial support of the new medical school based on its stated mission of improving access to primary care in the Inland Empire.  Dean Olds is in the process of recruiting assistant deans and others and who share the school's vision, an especially important issue with regard to the admissions process and we are hopeful there will be excellent representation of family medicine among them. 

The Dean spoke passionately about the service-based learning experience he wants for medical students and said he intends to graduate a ratio of 50:50 primary care to subspecialists from the school; CAFP noted that family medicine is the only pure primary care specialty and that large percentages of internists and pediatricians go on to subspecialize as "ologists." 

Paul Grundy, MD Show About to Start

Today kicks off the start of an intensive week of meetings featuring Paul Grundy, MD, MPH, IBM's Global Director of Health Care Transformation.  As I outlined last week, first there'll be a meeting at UC San Francisco hosted by Kevin Grumbach, MD, a roundtable on Patient Centered Medical Home (PCMH) to discuss related healthcare workforce policy issues.  Tuesday the 13^th at o'dark-thirty, Leah Newkirk, CAFP's Director of Health Policy, and I will drive Dr. Grundy to Sacramento for a meeting with representatives of Sutter Health facilitated by our own Carla Kakutani.  Then, it's back to San Francisco for a meeting with Brown and Toland Medical Group, then with Meredith Matthews, MD, Medical Director for Blue Shield of California.   All this will be even more fun for Dr. Grundy because it's his birthday!  On Wednesday, we drive down to Fresno for a 5 pm meeting entitled:  "Health Care Reform Impact to Value Based Plan Design and Primary Care:  The Potential for Improving Health and Reducing Costs in Fresno" and a discussion about the potential for a PCMH demonstration project in the city and county of Fresno.  That'll be it for us (well, there is the long drive home), but Dr. Grundy will go on to similar meetings in Southern California for the rest of the week.  I'm really not sure how he does it - he truly is the Energizer Bunny for PCMH advocacy.  Speaking of which, Adam Francis on our staff suggests this is one of the best presentations for patients about what a PCMH is; take a look:  http://www.pcpcc.net/content/emmi

Vaccines Media Attention Keeps Coming

Thanks to the hard work by our lobbying staff, a bill co-sponsored by CAFP, AB2093, to improve how physicians are paid for the cost of purchasing, storing and administering vaccines was passed out of the Senate Health Committee on June 30.  Part of the reason was the excellent press on the issue generated by CAFP, and even after the vote, the coverage continued.   For example, Dr. Patricia Samuelson was quoted here:  http://www.medpagetoday.com/Pediatrics/Vaccines/21072  and Dr. Marcia McKay was interviewed by National Public Radio reporter Kelly Weiss last week.

President Chou Visits CAFP

CAFP President Jack Chou spent three hours at Academy headquarters on July 6, meeting with the staff to review the Board agenda for July 10 and the 2010-12 Strategic Plan progress report.  Jack was well informed for the discussion on the plan at the Board meeting on Saturday in Los Angeles.

Board Meets in LA

The CAFP Board held its summer meeting at the Westin at Los Angeles International Airport on Saturday.  Leading off was a report from Taejoon Ahn, Chair of CAFP's Legislative Affairs Committee, and Tom Riley, CAFP Legislative Advocate.  There wasn't much good news about resolution of California's budget crisis, but the Board was pleased to hear about the progress of CAFP's Patient Centered Medical Home definition bill, AB1542, and the above-mentioned AB2093.  The Board also approved a recommendation from the Audit Committee to accept the 2009 audit and management letter from Bregante + Company after hearing an extensive report on the state of CAFP finances, which is good!  CAFP received an "unqualified" opinion from the auditors - another good thing.  The Board will review the IRS required Form 990 in time for submission to the IRS in August.

Posted on 07.06.10 by Executive Vice Presdient Susan Hogeland, CAE

Thanks to the tremendously hard work of our lobbying and policy staff, and the effort of past president Eric Ramos, who provided testimony, CAFP's PCMH definition legislation, AB1542, and our vaccine payment equity legislation, AB2093, both passed out of the Senate Health Committee on June 30.  Additionally, legislation by Senator Yee to remove naturopaths from the Osteopathic Medical Board was also passed.  There are still more hurdles for the PCMH legislation in the Senate Business and Professions Committee, but Tom Riley, CAFP's lobbyist, is confident we will prevail.  Congratulations and thanks to all involved in this effort.

President Jack Chou will be visiting CAFP today - we'll hold a brief staff meeting then break into small groups to review progress toward meeting the goals of the 2010-2012 CAFP Strategic Plan.  We'll also celebrate two birthdays:  Cynthia Kear's (July 5) and Leah Newkirk (July 7).  Happy birthday to both.

In another Herculean (see first paragraph), but slightly less successful effort, CAFP spearheaded submission of a letter to Toby Douglas, head of the Medi-Cal program, urging the State of California to submit a Letter of Intent to the Centers for Medicare and Medicaid for Medicare's Multi-Payer Advanced Primary Care Practice Demonstration Project.  The Academy rounded up a coalition of 20 individuals and organizations supportive of participating in the demonstration project, but the state declined to play.  We had proposed that the Fresno area, among others, be considered as the site of a demonstration.  CAFP is continuing discussions with the Fresno Unified School District's Joint Health Management Board about a patient centered medical home demonstration project and will accompany IBM Global Director for Health Care Transformation, Paul Grundy, MD, MPH at a meeting on July 14 in Fresno. 

Plans for Dr. Grundy's second visit to California have nearly been completed.  On tap is a  Roundtable on Primary Care and the Patient Centered Medical Home organized by Kevin Grumbach, MD, at UCSF.  The Roundtable is intended as an open conversation among leaders in the health policy community in California to candidly discuss the challenges facing primary care in the state and the nation and to explore potential strategies to advance primary care reforms in the unique context of the California health care landscape.  Additionally, there will be meetings with representatives of Sutter Health in Sacramento and Brown and Toland in San Francisco to discuss PCMH.  We're very much looking forward to the week.

On Thursday of this week President Jack Chou, Geoff Leung, MD and I will meet with the Dean of the new medical school at UC Riverside, Richard Olds, to discuss health care workforce and support of primary care issues.  CAFP endorsed establishing a medical school in Riverside under the proviso that it have a primary and community care emphasis.  CAFP thanks Dolores Green, Executive Director of the Riverside County Medical Association for facilitating the meeting with Dr. Olds.

CAFP Immediate Past President Tom Bent has kindly consented to represent CAFP and speak at a California MD-WIC Network meeting panel discussion on July 29, 2010 in Santa Ana, CA.  We are still  searching for an FP who'd be willing to represent CAFP at a similar panel discussion on August 3rd, 9:30 CA WIC Program in Sacramento.  Please contact me if you are experienced in the Women, Infants and Children program.

CAFP submitted comments on proposed changes in NCQA's PCMH recognition requirements, as did AAFP. 

AAFP nominated three individuals proposed by CAFP for service on a two national commissions established by the The Affordable Care Act (PL 111-148).  The new law called on the Government Accountability Office (GAO) to appoint 15 individuals to the newly-authorized National Health Care Workforce Commission by September 30 and 19 members to the Board of Governors of the Patient-Centered Outcomes Research (PCOR) Institute. 

The role of the Workforce Commission is to review health care workforce and projected workforce needs and to provide comprehensive information to Congress and the Administration to align resources with national needs.  AAFP has recommended CAFP nominee:

• Kevin Grumbach, MD, FAAFP, chair of the Department of Family & Community Medicine at the University of California, San Francisco School of Medicine.

Dr. Grumbach is also being recommended to this Commission by the California Health and Human Services Agency and the Labor and Workforce Development Agency, to which CAFP also nominated him.

The purpose of the Board of Governors of the Patient-Centered Outcomes Research Institute is to help advance the quality and relevance of evidenced based research in helping to treat patients. The Institute will identify research priorities, establish a research project agenda, and assist in carrying out that agenda.  AAFP has recommended CAFP nominees:

• Diane Rittenhouse, MD, MPH, Associate Professor of Family and Community Medicine at the University of California, San Francisco (UCSF) and Associate Professor in Residence, Step 1, Philip R. Lee Institute for Health Policy Studies at UCSF

• Joseph E. Scherger, MD, MPH, Vice President for Primary Care at Eisenhower Medicine Center in Rancho Mirage, California and Clinical Professor of Family and Preventive Medicine at the University of California, San Diego School of Medicine

In addition, Theodore G. Ganiats, MD, Interim Chair of the Department of Family and Preventive Medicine at the University of San Diego (UCSD) and Executive Director of the UCSD Health Services Research Center was also nominated and recommended, through another source.

CAFP congratulates and thanks all for their willingness to serve and represent family medicine.

Posted on 06.28.10 by Susan Hogeland, CAE

Another Medicare Reprieve
As I hope you've seen on the flash update on our website, Congress finally got its act together long enough to retroactively repeal the 21 percent Medicare physician pay cut and retroactively provide a 2.2 percent increase through November 30 - not a perfect solution, but temporary relief from what could have been a financial disaster for family physicians trying to care for their Medicare patients.  AAFP tells us they will be developing the following:

1) Legal advice to members who may decide no longer to see their current Medicare patients about how to avoid any issues of patient abandonment;

2) Continued availability and updates of a handout for members to give to patients asking them to go to Speak Out and write letters to Congress about this mess;  

3) Information for members about their status with Medicare as "participating" or "non-participating" providers, and how they might consider totally opting out of Medicare; and

4) A draft letter for members to use if they wish no longer to accept new Medicare patients.

In the interest of patient care, CAFP is hopeful that few if any family physicians will choose to opt out of Medicare and, with more hard work between now and November 30, a permanent fix to the Sustained Growth Rate problem will be found.

CAFP Gets Great Press for Immunization Bill, AB 2093
Staff and media consultant Catherine Direen pulled the CAFP equivalent of a college "all nighter" last week to secure some great press for the bill CAFP is co-sponsoring with others, AB 2093 (M. Perez) to ensure physicians are paid fairly for providing vaccinations to their patients.  You can take a look at a couple of articles here:  http://news.google.com/news/search?pz=1&cf=all&ned=us&hl=en&q=shaya+mohajer; "CA doctors hit cost of whooping cough vaccine:" http://www.cnbc.com/id/37930431; and California Health Line:  http://www.californiahealthline.org/articles/2010/6/28/vaccines-for-whooping-cough-too-costly-to-provide-physicians-say.aspx

AB2093 and CAFP's legislation to define the patient centered medical home, AB1542 (D. Jones) will be heard on June 30 in the Senate Health Committee.  CAFP has asked all Academy members to contact members of the Senate Health Committee and encourage their "yes" votes for both bills.

CAFP Leads Charge to Get the State of California to Apply for Medicare Advanced Primary Care Practice Demonstration (MAPCP) Project
CAFP spearheaded an effort last week that resulted in 18 organizations or individuals signing onto a letter to Medi-Cal's Toby Douglas asking the State of California to submit a Letter of Intent for the newly-announced Medicare Multi-Payer Advanced Primary Care Practice Demonstration Project.  CAFP and the other signers offered assistance to the state in pulling together an application due August 17, saying the demonstration project was too important to let the opportunity pass.  CAFP is hopeful Fresno County might ripe for a patient centered medical home demonstration project and has been working with representatives of the Fresno Unified School District health plan toward that end.    

CAFP's 2009 Audit Gets Good Results
I'm always happy to tell you that your Academy passed its audit in good shape - the Board will consider recommendations by the Audit Committee to approve the 2009 Financial Statement and management letters.  CAFP is fiscally sound, but we're always trying to improve our processes.

Posted on 06.21.10 by Susan Hogeland, CAE

Can things come at us any faster or more furiously?  CAFP is faced with an abundance of riches - so many opportunities, so little time.  Your staff has operated at what seems like warp speed the last six weeks.

What's on our plates?  First and foremost:  Sacramento.  While trying to stay abreast and have input into the continuing budget negotiations, we've also been working on AB1542, legislation to establish a definition for Patient Centered Medical Home.  Legislative Advocate Tom Riley, Director of Health Policy Leah Newkirk and Legislative Assistant Adam Francis met with Assemblyman Dave Jones and others on June 17 to work out challenges to the bill, which will be heard in committee on June 30.

CAFP has also taken a lead role in seeking to convince the State of California to at least submit a Letter of Intent in response to Medicare's proposed Multipayer PCMH Demonstration project request for proposal.  We have been working to identify important stakeholders, including those who might be willing to devote resources to help the state prepare a proposal - CAFP among them.  The Letter of Intent must be submitted by 30 June, so this is a high priority.

Shelly Rodrigues will represent us at a summit among in Chicago on potential educational initiatives on alcohol abuse and obesity the first three days of this week.

CAFP issued a letter of support for Donald Berwick, MD to be Director of Medicare and Medicaid Services.  Dr. Berwick is head of the Institute for Healthcare Improvement and highly qualified.  He also has AAFP support.

We are finalizing our 2009 Audit and presenting it to the Board of Directors on July 10 - your Audit Committee, chaired by Secretary-Treasurer Del Morris, met Tuesday evening, June 15 to discuss the draft financial review and management letters with representatives of Bregante + Co.  The Audit Committee approved sending the documents on to the CAFP Board with an "adopt" recommendation. 

We continue to organize another visit to California by IBM's Paul Grundy, MD, MPH, including a roundtable on Patient Centered Medical Home and California's health care workforce challenges at UCSF, in collaboration with Kevin Grumbach, MD; meeting with representatives of the Sutter Health Plan and Brown and Toland Medical Group; and another meeting with the Fresno Unified School District to discuss the potential there for a PCMH demonstration project.

CAFP joined a coalition encouraging that a "Health and the Great Outdoors National Town Hall" sponsored by the White House be held to promote exercise and outdoors activity.  June has been officially proclaimed as Great Outdoors Month by the President and all 50 governors and First Lady Michelle Obama launched her promotion for getting kids active outdoors on June 1 - see her website: http://www.letsmove.gov/outside/index.html A coalition of physicians and leaders from non-profit public land organizations are behind this effort, with San Francisco member Daphne Miller asking that CAFP sign on.  The coalition's goal is two-fold:  1) to expand resources for mental and physical health by creating formal institutional links between health care and public lands; and  2) to create a new paradigm to fund the recreation infrastructure on public lands which supports healthy activities.

We will be working on a resolution passed by our 2010 Congress of Delegates calling on AAFP to rescind its contract with The Coca Cola Company for support of the AAFP patient-facing website, www.familydoctor.org (NOT to be confused with CAFP's website, www.familydocs.org!).  Our Delegation to AAFP will meet Tuesday the 22^nd by conference call to discuss how other states are approaching the issue after our delegation to the National Congress of Special Constituencies was disappointed in its effort to pass the same resolution.

Our C-4 Capacity Building Collaborative will meet on Wednesday, July 23 for an informative session with member Michael Zimmerman about managing patient panels and risk stratification.  C-4 is CAFP's project to determine whether we can help family physicians improve their internal processes and financial viability to create capacity for quality improvement and practice re-design/transformation into the Patient Centered Medical Home.

Last week we submitted two grant applications to The Physicians' Foundation for Health Systems Excellence - one for a toolkit to assist physicians in analyzing whether to apply for Medicare or Medi-Cal funds to support health information technology efforts to achieve meaningful use, as well as to determine what, if any, services might be obtained from Regional Extension Centers, Local Extension Centers and Service Providers - and the other for leadership training for CME faculty.  We're keeping our fingers crossed. 

Posted on 06.14.10 by Executive Vice President

If CAFP's last week is any indication, the movement for adoption of the Patient Centered Medical Home (PCMH) may be reaching critical mass. 

Among the evidence:  1)  The entire May issue of Health Affairs was dedicated to the topic of PCMH and included articles by the leading lights of primary care.  I spotted a legislative staffer in the Capitol toting the two-pound issue with her to our PCMH briefing.  Authors in the issue included our own Kevin Grumbach, MD of UCSF as well as FOFMs (Friends of Family Medicine) Alice Hm Chen, MD, Tom Bodenheimer, MD and Paul Grundy, MD, MPH.  The renowned Barbara Starfield, MD also wrote an article in the issue.  I commend ALL the articles to you. 

2)  Medicare issued a request for letter of intent (LOI) for participation in a six-state demonstration project called the Multi-payer Advanced Primary Care Demonstration Project (naturally it has an acronym:  MAPCP).  CAFP engaged in multiple discussions last week to encourage the State of California (which must submit the LOI) to take the bit in its teeth and at least submit an LOI.  We even have a recommendation of an ideal location for such a demonstration.

3)  Our meetings featuring IBM's Global Director for Health Care Transformation, Paul Grundy, MD, MPH were resounding successes.  We led off with a meeting with Kevin Grumbach, MD, Chair, UCSF Department of Community and Family Medicine to plan a roundtable discussion to discuss the policy implications of PCMH in addressing the health care workforce shortage when Dr. Grundy returns to California on July 12.  The next morning, Director of Health Policy Leah Newkirk and I drove Dr. Grundy to Sacramento where Tom Riley, our legislative advocate, and Adam Francis, legislative assistant, had put together an afternoon briefing in the Capitol for 40-plus legislative staffers and lobbyists about PCMH.  This briefing was co-sponsored by the Senate and Assembly Health Committees and engendered a lively discussion.  That evening, we met with representatives for the Fresno Unified School District, which is interested in a PCMH demonstration for its 25,000 employees.  We discussed the viability of the Fresno area as a potential MAPCP site and planned a second meeting on July 14 for the District and other large employers in the Fresno area.  I have contacted CAFP Board member for the Fresno area district, Adriana Padilla, MD, to discuss with her how to engage local family physicians.  CAFP will undertake a brief survey of FP members in the community to assess their interest as well.  Finally, early Wednesday morning, we met with the chairs of the primary care residency programs at UC Davis.  The meeting was organized through Dr. Tom Balsbaugh, program director for the family medicine residency program, and his staff member, Jim Stutz.  The family medicine residency program in Davis has a number of politically engaged young residents, two of whom attended the meeting. 

4) TransforMED's final report on the national demonstration project was issued.  Was all the news good?  No.  The challenges of transforming physician practices are huge; barriers are significant; but who has a better idea?  Business as usual is not sustainable. 

Meantime, other bases were being covered as well.  Shelly Rodrigues, Deputy Executive Vice President and Callie Langton, Associate Director for Health Care Workforce traveled to Los Angeles to attend the "Building Quality and Equitable Health Care Systems," a conference sponsored by California Pan-Ethnic Health Network.  Shelly and Cynthia Kear, Senior Vice President for External Relations, flew to Chicago on Thursday for a special summit on the anticipated Risk Evaluation and Mitigation Strategies on long-acting opioids while Callie represented CAFP on Friday at the California Health Workforce Alliance meeting in Oakland. 

We're not convinced things are ever going to slow down, not even for the summer season.

We have a full plate again this week in Sacramento working on numerous pieces of legislation we're following closely as well as continuing discussions on the California budget crisis - or at least it used to be a crisis.  Now it just seems as if it's business as usual!

I am pleased to announce two things:  1) CAFP President Jack Chou, MD has ALSO been elected to the California Medical Association Board of Trustees representing the Los Angeles County Medical Association.  How does the guy do it?  2)  Marian Yee will be working with the Academy in the Continuing Professional Development Department for the month of June - if she likes us, she might return on September 1 to work full time. 

On Tuesday evening this week, our Audit Committee will meet to review the draft 2009 audit and management letters for the Academy.  The Audit Committee will make a recommendation to the Board, which meets on July 10.  On July 8, President Jack Chou, Geoff Leung, MD and I will travel to Riverside to meet with the dean of the new UC Riverside School of Medicine to discuss the need for primary care and family physicians in California. 

Posted on 06.07.10 by Executive Vice President Susan Hogeland, CAE

CAFP had a banner week last week and we're on track for the same this week. 

To briefly recap activities in the State Legislature last week, CAFP's co-sponsored bill (with CMA and AAP) AB 2093 (M. Perez) passing out of the Assembly on a tremendous 73-1 vote.  AB2093 would require health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring a vaccine plus the cost of administration. Thirteen other CAFP-supported bills also made it out of the Assembly last week - quite a coup for our Legislative Advocate Tom Riley and Legislative Assistant Adam Francis - thank you, guys, and all the family physicians who played a big role, too.

As mentioned in last week's update, we prepared information for family physicians on the California Physicians Practice Improvement Initiative relative to Blue Shield making public information on individual physician quality performance and alerted members to the need for being appropriately registered with Medicare to meet PECOS regulations.  Two documents now reside on the CAFP website to help with these issues.

We started work on a grant application to The Physicians' Foundation for Health Systems Excellence that would permit us to assist our members as they consider whether to apply for financial incentives under Medicare OR Medicaid for adoption of health information technology and achieving meaningful use.  If we receive the grant, we will develop information on how to determine which incentive to go for and how to evaluate what services provided by the Regional Extension Centers and Local Extension Centers would be helpful in achieving meaningful use and to evaluate the quality of those services.  Leah Newkirk, Director of Health Policy, is lead on that application.

Today we will be submitting the names of the four individuals I mentioned last week for two national bodies established by health care reform legislation:  Health Care Work Force Commission (Kevin Grumbach, MD and Katherine Flores, MD) and Patient Centered Outcomes Institute (Diane Rittenhouse, MD and Joseph Scherger, MD).  Each of these nominees is outstanding and would do a wonderful job of representing family medicine.

Now, to this week:

First, Shelly Rodrigues and Callie Langton will head to Los Angeles Monday morning to participate in "Building Quality and Equitable Health Care Systems," a conference sponsored by California Pan-Ethnic Health Network in Los Angeles.  Callie will also represent CAFP on Friday at the California Health Care Workforce Commission meeting at The California Endowment in Oakland.

Leah Newkirk and I will meet with Paul Grundy, MD, MPH, Director of Health Care Transformation for IBM, Kevin Grumbach, MD and others at San Francisco General Hospital to begin planning for a meeting in mid-July on policy changes needed to implement the Patient Centered Medical Home(PCMH) in California.

On Tuesday morning, Leah and I will drive Dr. Grundy to Sacramento where Tom Riley and Adam Francis have arranged a legislative briefing in the Capitol for legislative staff and lobbyists on PCMH.  More than 30 have pre-registered for this meeting.  That evening, Dr. Grundy and CAFP will meet with representatives of the Fresno Unified School District to discuss a possible PCMH demonstration project in Fresno.  Finally, Wednesday morning, we'll be meeting with representatives of the primary care residency programs at UC Davis to discuss the PCMH training model for residency programs and introducing the concept to large institutions such as the University of California. 

Cynthia Kear, Senior Vice President for External Relations and Shelly Rodrigues, Deputy Executive Vice President will travel to Chicago on Thursday for an important two-day meeting on the Food and Drug Administration's plans to develop Risk Evaluation and Management Strategies for long-acting opioids. 

Meantime, we're hearing about some continuing issues with GBA Palmetto, the Medicare third-party administrator, and some other practice management issues, which Manager for Medical Practice Affairs Jane Cho is working to address. 

Kudos to Membership Coordinator Sophia Henry and all CAFP staff for their efforts in dramatically reducing the number of non-paying members over the past two months.  AAFP figures indicate that despite the significantly earlier deadline for dues payment, we are actually ahead of where we were last year.  Congratulations and thanks to all!

Posted on 05.31.10 by Executive Vice President Susan Hogeland, CAE

I am pleased to report that CAFP had good luck in the State Appropriations Committee last week, where five of our top priority bills were passed out, including AB 2093 (M. Perez), which requires health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring vaccines, PLUS the cost of administration.  Other CAFP-supported bills addressed expansion of mental health coverage, requirement that plans provide coverage for maternity services, protection of patients from unfair insurance company practices and prevention of a requirement that Medi-Cal beneficiaries undergo semi-annual or quarterly eligibility determination, a requirement that adversely affects access to care.

CAFP also met with success last week in its first efforts to resist the Governor's budget proposal to enact a 12 percent reimbursement reduction for physician-administered drugs.  Our battle will continue in conference committee, however. 

On the federal front, CAFP is working to keep up the pressure in the US Senate for a permanent fix to the Medicare Sustained Growth Rate.  Thanks to temporary fixes putting off a 21.3 percent cut in Medicare payment a month or so at a time, the cut has not taken place.  AAFP's executive committee last week, however, decided that if Congress cannot provide a permanent fix for the Medicare physician payment formula, AAFP will not support any legislation that provides a temporary payment patch unless the legislation meets the Academy's new criteria, which are that any temporary measure must include a primary care payment differential and must extend at least through Dec. 31, 2012.

Last week we prepared information for members about Blue Shield's release on June 1 of California Physician Performance Initiative (CPPI)'s Measurement and Reporting Program data to launch a Physician Quality Recognition (PQR) program.  Director of Health Policy Leah Newkirk authored a document physicians in the Blue Shield network may use to guide their discussions with patients who have questions about the physician quality designations for a set of eight CPPI criteria scored in 2009. Some physicians have been designated as higher quality performing physicians for selective preventive screening and chronic care measures as a result of these scorings.  The Academy's document will be sent out via Academy in Action e-newsletter, but may also be obtained here. 

Ms. Newkirk also prepared an update for CAFP members on the Center for Medicare and Medicaid Services' (CMS) interim final rule for Medicare that creates new enrollment, ordering and referring and documentation requirements effective July 6. The provisions of the rule require that physicians ordering and referring specified items and services be enrolled in the Provider Enrollment Chain and Ownership System (PECOS) by July 6, 2010, changing the previously reported January 3, 2011 date given by CMS. All providers who enrolled in Medicare within the past six years, as well as those who enrolled more than six years ago and who have updated their enrollment information within the past six years, have enrollment records in PECOS. Those who enrolled more than six years ago and have not updated their enrollment information will need to submit applications to establish enrollment records in PECOS.  There is an exception to the requirement in the case of a provider who has validly opted out of Medicare, fortunately.  To obtain the CAFP-prepared PECOS document, please go here.

Last week, Callie Langton, CAFP's Associate Director for Health Care Workforce Policy, represented us at the State's Health Care Workforce Workgroup, a subcommittee of the Health Care Reform Taskforce charged with implementation of health care reform in California.  The Workgroup will focus on training and workforce development programs in Title V of the Health Care Reform Act.  The meeting in Sacramento was held to provide an opportunity for "stakeholders" to discuss and provide feedback on how California's implementation of the reform legislation will affect our health workforce and to provide insight on the health care industry's workforce development practices.   

Cynthia Kear, Senior Vice President for External Relations, represented the Academy at an important meeting on the Risk Evaluation and Mitigation Strategies (REMS) on long-acting opioids in Washington, DC on May 25 and 26. CAFP is concerned that too stringent restrictions on prescribing long-acting opioids will have a damaging impact on patients' access to care and pain relief and will be burdensome to physicians to the point of deterring some from prescribing these drugs. 

CAFP will be submitting two names to AAFP for consideration as appointments to the National Health Care Workforce Commission, established by the Affordable Care Act, the health law signed in March of this year.  The purpose of the Workforce Commission is to serve as a resource for the US Congress, Department of Health and Human Services and other agencies on the supply and demand for the nation's health care workforce.  The Commission will issue two reports:  the first will be a review of and recommendations for current policies and programs and the second will be on high priority areas such as GME or geographic distribution, for example.  The commission will work with the National Center for Health Care Workforce Analysis, in the Health Resources and Services Administration (HRSA).  CAFP will nominate Kevin Grumbach, MD and Kathy Flores, MD.

CAFP will propose Joe Scherger, MD and Diane Rittenhouse, MD to AAFP for nomination to the new Board of Governors of the Patient-Centered Research Institute to improve health care quality and enhance evidence-based research.  The purpose of the Institute is to establish a research agenda; develop methodological standards; contract with eligible entities; request public input; and disseminate results to patients and providers.  The Board of Governors will include the Director of AHRQ, the Director of NIH and 17 appointed members.

We're putting the finishing touches on a hectic schedule for next week's visit by Paul Grundy, MD, IBM's Global Director of Health Care Transformation.  The first stop Monday afternoon will be at a San Francisco General Hospital meeting with Kevin Grumbach, MD and others about policy changes to facilitate adoption of the Patient Centered Medical Home  (PCMH) in California.  Tuesday afternoon, we head to Sacramento for an informational briefing and discussion in the Capitol on how PCMH can transform public and private health care.  That evening, we'll meet with representatives of the Fresno Unified School District and other Fresno-based employers interested in the PCMH model, and on Wednesday morning from 7-9 am (!) we'll meet with Thomas Balsbaugh, MD, program director for the UC Davis family medicine residency program and others.  Dr. Grundy will make a return trip to California for more discussion the week of July 12.

CAFP extends its deepest sympathies to Deputy Executive Vice President Shelly Rodrigues and her family over the death of her mother, Nancy Beachly, on May 6, 2010.  In true Shelly fashion, her mother's memorial service was held off so Shelly could staff the CAFP's Annual Scientific Assembly, with the assistance of Cynthia Kear and Karen Brent.

Posted on 05.24.10 by Executive Vice President Susan Hogeland, CAE 

The past week was a whirlwind of follow-up activities to the Board of Directors meeting and Annual Scientific Assembly, as we began the work of implementing Board actions and beginning the evaluation/debrief process on the 2010 meeting. Planning starts almost immediately on next year's conference as we determine through knowledge gap analysis what areas of curricula we should begin to develop.  We're always on the look-out for top speakers on key clinical topics, so if you have recommendations, please contact us at cafp@familydocs.org.  

All of the above was being done in the context of our deep concerns about the devastating budget revise issued by Governor Schwarzenegger on May 14. The budget revise confirmed the bad news about the failure to materialize of anticipated increases in state personal income tax receipts.  The Administration had already failed to secure hoped-for federal funds to offset budget shortfalls.   As a result, CAFP testified last Thursday against proposed cuts to health programs, including a whopping $750 million for In Home Health Services, as well as changes to the Medi-Cal program that will have a negative impact on access to care.  Some of these include reducing payment rates for physicians who administer drugs to their Medi-Cal patients by at least 12 percent, imposing co-pays, limiting the annual number of visits to physicians and clinics, and more.  If you have compelling stories aboutwhy such changes should not be permitted, please contact us at cafp@familydocs.org.

Inline with CAFP's efforts in Sacramento to enact legislation imposing a tax on sugar-sweetened beverages (SB1210-Florez), the CAFP delegation to the AAFP will work with several other chapters to strengthen a resolution passed by our own Congress of Delegates calling on AAFP to rescind its Consumer Alliance contractwith The Coca Cola Company and to refrain from future relationships with organizations whose products do not support the good health of patients. A similar resolution submitted to the National Congress of Special Constituencies was defeated, indicating the need for some resolution content "tweaking."  CAFP will continue its efforts to reverse the Coke arrangement, and appreciates the testimony of Jeremy Fish, MD (Contra Costa)and Adam Francis, CAFP Legislative Assistant in support of the sugar tax bill last week.  AAFP announced its second Corporate Alliance relationship with Nature Made health supplements (Pharmavite) on May 14. 

In other follow-up to Board actions, Director of Health Policy Leah Newkirk is working with the chair and a member of CAFP's Medical Practice Affairs Committee to develop recommendations to member physicians in the Blue Shield network on responding to patient inquiries about the Physician Quality Recognition (PQR) program listings.  Blue Shield announced that it will launch PQR on June 1, 2010 so patients covered under its plans may view network physician listings on a set of eight California Physician Performance Initiative (CPPI) criteria.  CAFP and other physician organizations raised serious concerns about the accuracy of the data collected under CPPI, and we continue to work to improve those data.  Stay tuned for these recommendations, which should come out later this week in Academy inAction.

CAFP and the CAFP Foundation convened the 19th meeting of The California Endowment's Medical Leadership Council on Cultural Proficiency last year, again bringing together 37 medical organizations to learn about issues related to resolving disparities in health care.  Deputy Executive Vice President Shelly Rodrigues presented a retrospective on the accomplishments of the MLC, which was very gratifying and indicated how the MLC has helped move the needle on cultural, racial andethnic disparity awareness among physicians, health plans and facilities, andother providers.  MLC is now examining how it can assist The California Endowment with its community health improvement efforts as well as implementation of health care reform in California.

Senior Vice President for External Relations Cynthia Kear attends an important meeting concerning the Food and Drug Administration's Risk Evaluation and Mitigation program on long-acting opioids this week.  CAFP has been a leader in working to determine the impact of a long-acting opioids REMS on family physicians and their patients, undertaking a nine-state survey in collaboration with otherstate Academy chapters to evaluate attitudes and continuing professionaldevelopment needs. 

Finally, on Saturday, May 22, CAFP launched its first regional legislative and media training program in Los Angeles to supplement the trainings it does at the annual Congress of Delegates in Sacramento. Sixteen CAFP members attended the event, including six residents and CAFP media star and President Jack Chou, MD.  The program featured a professional media trainer and CAFP's own legislative advocate Tom Riley and legislative assistant Adam Francis, and focused on providing members with the fundamentals of identifying audiences, framing and messaging.  Depending on response to the event, CAFP may hold two additional regional trainings this year. Stay tuned. 

Posted on 05.17.10 by Susan Hogeland, CAE 

CAFP concluded its 62^nd Annual Scientific Assembly on Sunday at the Grand Hyatt Union Square in San Francisco, the same hotel at which the 63^rd will take place on May 14 and 15 in 2011.  The 250 family physicians who attended seemed pretty happy about what they experienced; of course, the evaluations of the programs will tell the tale.  Those who spoke to me personally indicated they had their batteries recharged just by being among their fellow family physicians, hearing their questions, chatting with them during meals and breaks. 

Highlights of the meeting included the truly inspiring story of AAFP Board member Jeff Cain, MD who spoke Sunday afternoon about being on the other side of a stethoscope after a private plane he was piloting crashed.  Learning to re-calibrate life after the loss of both legs was a challenge he has met, finding new ways to pursue his love of snow and water skiing, among other sports.  He spoke movingly about how he relates to his patients now, especially those with physical challenges.

Terry McGeeney, MD, President of TransforMED and CAFP's own Len Fromer, MD provided hope of another type - hope about the future practice of family medicine as it fully transforms to patient centered care in the Patient Centered Medical Home.  Addressing the "tyranny of the urgent" through the smart application of technology and restoring the passion that family physicians bring to their practices are high on the agenda.  We heard from past president Carla Kakutani, MD and lobbyist Tom Riley about the hope the new health care reform legislation brings to family medicine and primary care - higher payments through Medicare, support of technology transformation and support of the Patient Centered Medical Home are just a few of the provisions that lent optimism to their discussion.

But perhaps the most inspiring part of the weekend was Friday evening's Celebration Dinner at which some of family medicine's outstanding members were honored for their service to the specialty.  Cecilia Gutierrez, MD, of the UC San Diego Department of Family and Preventive Medicine, received the 2010 Award for Educational Excellence.  Dr. Guttierez said "As we teach, we need to always remember what it means to be a student, and the best way to do that is to remain humble students ourselves." 

Past President Eric Ramos brought many of us to tears when he was honored as Family Physician of the Year and shared the honor with his entire practice team - Jesusita Diaz, Ulicess Gonzalez and Nora Lohman - and his wife, Judy, whom he described as his best friend, partner and love of his life. 

But just when we thought it couldn't get any more touching or impressive, two more awards were given:  2010 Family Medicine Researcher of the Year went to Derjung Mimi Tarn, an assistant clinical professor of family medicine at the David Geffen School of Medicine at UCLA, who does research on physician-patient communication, focusing on patients' understanding of how to take medications.   In a video clip from "House," Dr. Tarn drove home her point when a patient was shown using an asthma inhaler like a perfume spray - it brought down our "house." 

The second award was given to Veronica Jordan, MD, a third year resident at Santa Rosa Family Medicine Residency Program.  Dr. Jordan was honored as Resident Family Physician of the Year, and what a wonderful story this young woman has.  Talk about giving us hope for the future of family medicine:  she was chief resident during her second year of residency and is described as a natural born leader.  She holds masters degrees in health and medical sciences from UC Berkeley, spent two years teaching and organizing small, rural communities in Ecuador and led demonstrations in her own community to advocate for health care reform.  

The entire CAFP staff was in attendance and heard the back stories for these presentations - as I told those assembled, what a fabulous introduction to family medicine and the Academy for our new staff members.  It's a wonderful reminder, too, for those of us who've been with the Academy a while, about why we do what we do, for the wonderful people and patients for whom we do it. 

Thanks for the honor.

Posted on 5.12.10 by Ronald Fong, MD 

Recently, I received two mailings regarding treatment of obesity.  One was an invitation to a pharmaceutical company-sponsored program discussing the role of the primary care physician in treating obesity.  The speaker is a physician who "consult[s] in the art, science and business of bariatric medicine" as per his website.  The other was an application to be a referral physician for a bariatric surgery clinic and increase practice income "by more than $20,000 per month without waiting for third party reimbursement." 

Has the role of family physicians in the treatment of obesity been reduced to the "business of bariatric medicine" and to a bounty of increasing "practice income by more than $20,000 per month?"  Are we resigned to contribute and benefit financially from the increasing number of bariatric surgeries performed with each passing year?  If so, we are committing a grave disservice to our patients by discarding the mantle of advocacy? 

The current legislative climate is beckoning for innovations to improve health care delivery at more efficient costs.  Scavenging profit from failed policies or vacated leadership is not consistent with the core values of family medicine. Our discipline resides in departments of family and community medicine.  We need to prioritize the "comity" in "community" to address the obesity epidemic.  This is an opportunity for family physicians to demonstrate our virtues.  We believe in treating the entire family, not isolating ourselves to an individual or to an organ system.  We believe that strong social interactions are a powerful determinant in improving our patients' health.  We believe that any viable health care system must have an active public health component.  We believe that the treatment of obesity involves seeking and maintaining partnerships with parents, spouses, and communities.

The obesity epidemic serves as a calling for family physicians to assume leadership and navigation.  We have an opportunity to reverse the current payment structure which values procedures over prevention, invasiveness over interaction, and production over productivity.  We need to segue from the examination room and surgical suites into city planning commissions, school boards, and public hearings.  While others extract dollars, family physicians are obligated to do no harm and to pursue the common good.  Our panels are not based on ability to pay.  Rather, our neighbors are our patients we have yet to meet and we can serve them without a consent form or a bill.   

Posted on 05.03.10 by Executive Vice President Susan Hogeland, CAE

Last week was a busy week on many fronts.  In Sacramento, last Friday was the deadline for all bills with any fiscal consequences to pass out of policy committees.  Three bills were of particular interest to CAFP - AB 1904 (Villines), which we opposed unless amended, would have allowed an out-of-state health insurer to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a California license; it would have exempted the carrier's plan or policy from California's minimum coverage requirements. CAFP wanted the bill amended to ensure all coverage mandates that currently exist in the state would apply to out of state carriers selling here. The bill was not amended, and failed passage in committee.

CAFP-supported SB 1050 (Yee), legislation that seeks to restore the Osteopathic Medical Board of California (OMBC) to osteopathic oversight only, was passed out of the Senate Appropriations Committee.  During the budget mess last year, OMBC was combined with the Bureau of Naturopathic Medicine (BNM).  Senator Yee's bill would remove the two newly-appointed naturopaths and replace them with public members; it would also ensure the BNM is solely responsible for the oversight of Naturopaths.  The full Senate will vote on the bill this week.

Unfortunately, we were less successful on AB2477 (Jones), legislation that would have prevented a requirement that Medi-Cal beneficiaries undergo semi-annual or quarterly eligibility determination.  CAFP's position is that requiring frequent renewals hinders access to care and ultimately is not a cost-saving measure.  The bill was put on the Suspense file in the Assembly Appropriations committee, however, despite our testimony.

CAFP also testified in the same committee in support of protecting family planning services and provider payment rates, and in opposition to cutting Prop 99 funding from the Early Access to Primary Care program.  We anticipate this week in Sacramento to be equally hectic.

CAFP Legislative Advocate Tom Riley and his assistant, Adam Francis, are putting the finishing touches on scheduled visits for our delegation to the AAFP's Congressional visit to Washington, DC next week.  The Sustainable Growth Rate fix will be at the top of the items to discuss with California's Congressional Delegation.

CAFP was well-represented at the AAFP's Annual Leadership Forum and National Conference of Special Constituencies in Kansas City, MO Thursday - Saturday.  President Jack Chou and President-elect Carol Havens (both as of May 14) attended ALF and we had two representatives in each of the five NCSC caucuses.  We heard extensive reports on how AAFP expects health care reform legislation to be implemented and how it is gearing up to help state chapters with implementation at the state level, as well as about the planned fix to the SGR.  I personally attended the Patient Centered Medical Home track during ALF and brought back some very valuable information to add to that gained at our PCMH planning weekend over the 24^th and 25^th of April.  Now it's time for the rubber to meet the road on PCMH, starting at our upcoming Annual Scientific Assembly in San Francisco the 15^th and 16^th of May at the Grand Hyatt Union Square.

Speaking of our ASA, there has been a full court press by the union representing hotel workers at the Grand Hyatt to get CAFP to honor the boycott that has been called against the hotel.  Please understand we signed our contract with the Grand Hyatt last June with the expectation the labor negotiations would be concluded by November of that year.  CAFP certainly supports workers' continued access to good health care benefits; to cancel our contract with the Grand Hyatt at this time, however, would cost CAFP $150,000 or more in penalties, funds our Board does not think can be sacrificed by CAFP.  We are offering full refunds to any registered attendee who asks, and have sent information about the situation to all those registered to make them aware of this offer.  We also investigated the feasibility of relocating our meeting to another hotel in San Francisco and none was available.  Please understand this is a boycott, not a strike. 

This week we welcome two new staff members:  Leah Newkirk, Director of Health Policy and Callie Langton, MA, Associate Director of Health Care Workforce Policy.  Cecilia Awayan also joined us as part-time receptionist/membership assistant last week.  We are happy to have all three with us and know you will welcome them at the first opportunity.

Posted on 04.26.10 by Executive Vice President Susan Hogeland, CAE

Over the weekend, nine family physicians and six staffers met for a facilitated discussion about the most effective place for CAFP to begin educating its members about, and helping them to become, more patient-centered in their care.  I'd like to extend our deep thanks to the following physicians for spending those two days sharing their expertise with us:  Larry Dardick, Anna Marie Gonzalez, Bo Greaves, Nancy Grossman, Carla Kakutani, Linda Lundeen, Alex Mari, Richard Payne and Rusty Renner.

Staff included Shelly Rodrigues, Cynthia Kear, Adam Francis and me, along with our staff-to-be, Leah Newkirk and Callie Langton.  Results of our discussion will be shared with the CAFP Board of Directors at its upcoming May 14 meeting, and incorporated into our strategic plan implementation work.

Congress of Delegates Correction

My apologies for incorrectly listing the dates of the 2011 Congress of Delegates meeting in last week's Academy in Action e-newsletter:  the correct dates are March 5, 6 and 7 at the Citizen Hotel in Sacramento.

Chapter Activities

Legislative Advocate Tom Riley spoke at last week's Los Angeles AFP chapter meeting, providing attendees with a legislative update on both Sacramento and health reform legislation.  Thanks to Tom for taking time away from his family to travel to Los Angeles.

Legislative Activities This Week

This week in Sacramento CAFP legislative staff will join Drs. Carla Kakutani and Irina deFischer, both CAFP Board members, to participate in CMA's Lobby Day in Sacramento.  CAFP provided financial sponsorship of the event as well.  CAFP FP-PAC representatives will also be busy this week interviewing candidates for the State Legislature so contribution recommendations can be made to the PAC Board.  If you haven't yet contributed to FP-PAC, please do so today at http://www.familydocs.org/fppac.   I am happy to report that $7,114 in PAC contributions was raised at the 2010 Congress of Delegates, compared to $1,221 in 2009 and $4,292 in 2008.  We're definitely on the right trajectory.

Final planning is underway for CAFP's participation in AAFP's Congressional visit in Washington, DC on May 11-12, just before our own Annual Scientific Assembly in San Francisco.  Six physicians and one staff will attend.  Dr. Randi Sokol, a resident from UC Davis, is the recipient of an attendance scholarship from AAFP, for which we thank AAFP.

On the Home Front

We welcomed a new part-time receptionist/membership assistant here at CAFP today - Cecilia Awayan - who will be working 8 am-noon until her teaching obligations conclude for the summer.

Drs. Jack Chou and Carol Havens and I will travel to Kansas City this week for AAFP's Annual Leadership Forum.  CAFP's representatives to the National Caucus of Special Constituencies will also travel to Kansas City for that annual meeting; former Membership Manager Jessica Kuo will be providing support to the group. 

There is still time to register for our upcoming Annual Scientific Assembly here in San Francisco at the Grand Hyatt Hotel on Union Square.  Call CAFP at 415-345-8667 to register by phone or go to http://www.familydocs.org/professional-development/ASA.php to do so today.

Medicare Update Extended to May 31

After returning from its break on April 15, the Senate passed and President Obama signed into law an extension of the current physician payment rate until May 31 preventing, once again, implementation of a 29.2 percent cut in Medicare payments.  AAFP and CAFP will keep up the pressure to enact a permanent extension.  Also on the Medicare front, CAFP is working with AAFP to identify additional codes that should be included among those used frequently by primary care physicians to care for Medicare patients to help FPs qualify for the 10 percent bonus payment enacted in health care reform legislation.  Members of CAFP's Medical Practice Affairs Committee are weighing in on this issue. 

Promotions at CAFP

Jane Cho, who's been with CAFP for the past four years as Senior Project Coordinator, has been promoted to Manager, Medical Practice Affairs.  Jane will have continuing responsibility for our Capacity Building Collaborative (C-4), which concludes in November, and will take on new duties in the coding and billing, privileging, practice management and scope of practice.  Congratulations, Jane!

Cody Mitcheltree, who's been with CAFP for the past two years as Membership Assistant, will serve as Medical Student and Resident Coordinator, taking over the position formerly held by Dasha Sakharova, who has left the Academy.  Cody will work with the student and resident organizations on the Fall Conference and National Conference, student and resident activities at the CAFP Annual Scientific Assembly, the CAFP Foundation Preceptorship Program, and the Family Medicine Interest Groups, among other duties.  Congratulations, Cody!

New Hires at CAFP

CAFP has hired to new staff members:  Leah Newkirk, JD, will assume the position vacated by Sandy Newman, MPH - Director of Health Policy - on May 4.  Her responsibilities will include health information technology issues, including meaningful use, implementation of the patient centered medical home, the impact of healthcare reform on family medicine, policy issues related to payment for primary care and more, much more.  We have also hired Callie Langton, MPA to take on the new position of Manager, Healthcare Workforce Policy.  Callie also begins work on May 4.  Callie will be handling all things education - graduate medical education funding, workforce diversity, residency training programs, new workforce provisions in healthcare reform legislation, and more, much, much more....  Please welcome our new staff members when they arrive and wish them luck!

Trouble on the CPPI Front

The California Physician Performance Initiative (CPPI), on which we've reported previously, experienced a dust-up this week when the California Medical Association announced its intention to withdraw from the CPPI advisory body upon learning Blue Shield of California would publish on June 1 information on physicians which CMA believes is based on faulty data.  CAFP, too, weighed in with its concerns about the data used to create physician profiles in this project, sending an extensive list of areas with which we took issue last November.  The CAFP Board of Directors will be considering our further participation in CPPI when it meets on May 14.

PCMH Weekend Approaching

April 24-25 will be "all PCMH all the time" as CAFP staff meets with eleven family physicians from around the state to nail down where we should begin on PCMH implementation for California family physicians.  Consultant Nileen Verbeten will serve as facilitator for this meeting. Stay tuned.

Annual Scientific Assembly

We're hoping family physicians are "last minute" types because registration for our upcoming Annual Scientific Assembly could use some help.  This extremely reasonably-priced meeting is not only packed with excellent, high quality continuing medical education on key topics for family medicine, it's also a great opportunity to share ideas and problem solve with your peers in a wonderful setting - the Grand Hyatt San Francisco.  Complete a couple of SAMS, go out to a great dinner, share your successes, or commiserate with fellow family physicians at this annual event.