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 Tom Riley 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.

Posted on 12.24.09 by CAFP President Tom Bent, MD

Today's historic Senate vote keeps alive our hope that 31 million more Americans will have access to health care coverage, which can dramatically improve their access to care. Yes, we still need to fundamentally reform the health care system to focus more strongly on primary and preventive care and to squarely confront cost containment and improving the quality of care. We also need to solve the primary care physician shortage so that the 31 million newly insured can actually find doctors to treat them. It turns out, however, that there just isn't the political will to solve everything at once. Coming as close as we can to universal insurance is a very good - and humane - first step. Among 19 industrialized countries recently studied, the United States had the highest proportion of deaths that could have been prevented by access to appropriate medical care. Let's start here.

AAFP Board Chair Ted Epperly, MD wrote Senate Majority Leader Harry Reid this week outlining the Academy's support for, and concerns about, the current Senate Bill. AAFP supports extending health insurance to as many Americans as possible and is in favor of other insurance reforms. Family physicians also appreciate the bill's recognition of the value of primary care with the bonus payment for five years for physicians whose practices are 60 percent primary care. To better address the primary care physician shortage, however, AAFP is asking that the bonus be made permanent and the threshold lowered to 50 percent. AAFP also is requesting that Medicaid rates come in line with Medicare primary care service payments.

The House and Senate will face serious differences when they return in January to hammer out a compromise bill for President Obama's signature, but I have high hopes for family physicians and our patients that this will be the first step on a road heading in the right direction. Here's wishing CAFP members and our patients the very best (that's politically possible) in 2010!

CLICK HERE TO VIEW A VIDEO VERSION OF THIS BLOG

Posted on 12.21.09 by Susan Hogeland, CAE 

As we approach year's end, I want to thank CAFP members for their support - both dues and moral, CAFP's leadership for all their hard work on behalf of family medicine, and CAFP's staff for not just doing the work, but believing in the cause.  In the event you don't watch or read until the end of this blog, we here at CAFP wish you the happiest of holiday seasons, and a healthy New Year - especially for those who don't yet have health coverage.  Let's hope that situation changes as a result of family medicine's and others' efforts.

You probably know the U.S. Senate is locked in a battle over health care reform - opponents are using filibusters and other procedural delaying tactics to prevent a vote on the reform bill; supporters are still fighting among themselves over the details.  Majority Leader Harry Reid is threatening to hold a vote on Christmas Day if necessary, but at the moment, it looks as if it will be a Christmas Eve.  Senator Reid is claiming to have the 60 votes he needs. 

A stopgap measure to delay the planned 21% cut to Medicare payments on January 1 has been approved by both houses of Congress.  That's EXCELLENT news for family medicine.

I wanted to update you on the excellent meeting we had last week with Paul Grundy, MD, IBM Global Services Director of Healthcare Transformation, and three members of his team about jump starting the Patient Centered Medical Home in California.  Dr. Grundy was incredibly generous with his offers of support for CAFP efforts and we are excited about the several avenues we'll be pursuing to make PCMH a reality in our state.  Tom Riley and Adam Francis have been working diligently to represent family medicine's interests as the State investigates a Medi-Cal 1115 Waiver to require a medical home-like practice for chronically or severely mentally ill Medi-Cal patients, among the highest utilizers of Medi-Cal services.  CAFP wants to ensure solo and small group practices are given an equal shot at becoming PCMHs for these patients, and the resources required to do so. 

Meantime, we are girding ourselves for the Governor's announcement about anticipated budget cuts - in the neighborhood of $21 million, focusing on identifying key contacts for the newly-elected Speaker of the Assembly, John Perez, and making plans for beginning implementation of the Academy's 2010-12 Strategic Plan.  This will include an all-member survey in January about attitudes and readiness for the Patient Centered Medical Home.  We want to establish a baseline to guide our efforts in helping you adopt those features of the PCMH that will make your lives easier and your patients' care even better.  Dr. Grundy noted that even without payment reform recognizing PCMH services, some TransforMED-transformed practices have seen a 12% increase in their bottom lines.  Who wouldn't want that?

CAFP's offices will be closed at 1 pm on December 24, and all day the 25^th.  I'm taking a blog break next week.  Our offices will also be closed at 1 pm on December 31, and all day January 1, 2010.  Happy New Year!

Someone apparently forgot to mention to the powers-that-be that we are approaching the holidays and things are supposed to slow down a little - they haven't.  In fact, they seem to be warp speed!

Last Friday, the members of the Single Payer Task Force met for four hours here at CAFP headquarters in response to a resolution adopted at the 2009 Congress of Delegates requiring an analysis of SB810, legislation that would establish a single payer health plan in California.  The resolution also requires development of amendments to SB810 that would bring it into compliance with CAFP's principles for health care reform.  Ultimately, the Task Force will make a recommendation to the Board, which, after consideration February 3, will forward a recommendation to the Congress of Delegates.  Thanks to Task Force chair Carla Kakutani, staffers Tom Riley and Adam Francis, and the members for their hard work.

Director of Health Policy Sandy Newman and Student and Resident Coordinator Dasha Sakharova were in Los Angeles last Thursday and Friday conducting a "From Residency to Practice" workshop for 16 resident members.  Topics ranged from an overview of the practice environment, to developing a business plan and evaluating and hiring staff, to professional liability insurance.  CAFP received a grant from the AAFP Foundation in support of this program.

On Wednesday, I'll have a phone conference with Dr. Carol Warde, chair of the Patient Centered Medical Home Subcommittee of the American College of Physicians District IX.  Dr. Warde and I will be discussing how CAFP and ACP can collaborate to help our respective members adopt features of the Patient Centered Medical Home.

And, as I mentioned last week, we're very excited to be meeting early on Thursday with Paul Grundy, MD, MPH, Director of Healthcare Transformation for IBM (which is a pretty cool title) and President of the Patient Centered Primary Care Collaborative, and three members of his team to discuss the Patient Centered medical Home.  CAFP President Tom Bent will attend the meeting along with past president Carla Kakutani, and, by conference call, President-elect Jack Chou.  This discussion will help us formulate engagement strategies for the business community and health plans around our PCMH work.

Last Thursday was the deadline for resolutions and delegations to the 2010 CAFP Congress of Delegates - we have a total of five resolutions for discussion about topics ranging from support for a single payer health plan to access to vaccine supplies and from health care disparities for youth and adults with developmental disabilities to ensuring data accuracy and quality for physician reporting.  Membership Coordinator Jessica Kuo has worked successfully with many chapters to submit full delegations to the Congress.

Congratulations to CAFP President Tom Bent, who was named Family Physician of the Year by his Orange County chapter in recognition of his leadership and community service.  Dr. Bent is COO and Medical Director of the Laguna Beach Community Clinic.

Finally, CAFP's offices will be closed Friday afternoon, December 18, for our annual staff holiday party.  I hope your holiday season is merry and bright so far.

Posted on 12.10.09 by CAFP President Tom Bent, MD

Recent work by CAFP members and staff on health information technology (HIT) opportunities for family physicians shows once again the power of association. The Academy is an ‘association' of physicians, which at times means we gather together as members of a medical specialty, to learn, to teach, and simply to compare notes.  To work together ‘in association' also has an even stronger meaning: the power we have when working as a collective whole rather than simply as individuals.

It takes the power of association to navigate many of the opportunities as well as challenges facing our profession. One new opportunity is the chance for solo, small, and safety net primary care practices to receive up to $65,000 in federal incentives to implement electronic medical records (EMR). The money is expected to be available in California early next year. While these funds won't cover all costs, it's never been a better time to take a step back, analyze the systems and processes that are the backbone of our practices, and determine how technology can improve our practice lives and our patients' health.

As I know personally, instituting an EMR isn't required for a practice to provide excellent patient care and track individual and population health, nor is it required for a practice to qualify as a Level 1 patient centered medical home as defined in NCQA certifying guidelines.  For those primary care practices ready to undertake the transition, however, this is an unprecedented opportunity and CAFP leaders and staff are working to ensure that the entire process goes as well as possible.

One important component of the process is the technical assistance that many practices rely on to prepare for implementation. As part of this federal initiative, money has been set aside to provide a range of resources to practices. Such resources can be accessed through a series of regional extension centers (RECs) now in development throughout California and the nation. On behalf of my many CAFP colleagues, I recently outlined our priorities for technical assistance services in a letter to California Deputy Secretary for Health Information Technology Jonah Frohlich, MPH. My intent is for the letter to serve as a blueprint as the state moves to coordinate all activities related to technology adoption. One of CAFP's priorities is ensuring that medical practices are assisted in focusing on process redesign and readiness before they begin work on EMR implementation. Through CAFP members' successes in our New Directions in Diabetes Care initiative these past few years, we've learned how important this is. As you have likely heard from your colleagues, having an electronic mess instead of a paper mess doesn't help much. I'm hopeful that the thoughtful approach the State is taking will help practices avoid the electronic mess and instead, focus on improving the quality, efficiency, outcomes, and vitality of their practice.

CAFP also is advocating for the RECs to establish the goals of improving patient outcomes and patient experience through the use of technology. We know these important goals will not be reached if use of an EMR is seen as the ultimate goal in and of itself.

CAFP also is advocating for effective, efficient, and transparent coordination by the RECs, including EMR procurement for solo and small practices and close coordination with the State's Health Information Technology Exchange, Medi-Cal ‘meaningful use' incentives, and other programs. We also need to ensure that our silent safety net - that is, practices caring for under- and uninsured Californians outside the clinic system - have the resources and support they need. It's just not possible for most individual family physicians to monitor and influence the State of California's approach to these matters but together, ‘in association,' we can.

CLICK HERE TO VIEW A VIDEO VERSION OF THIS BLOG 

Posted on 12.07.09 by Executive Vice President Susan Hogeland, CAE 

The deadline for receipt of chapter delegation names to the 2010 CAFP Congress of Delegates as well as for resolutions is this Thursday, December 10.  Planning is well underway for the event which will take place in Sacramento March 6-8.  We've just been notified AAFP President Lori Heim will attend to speak to the Congress and induct our new officers.  Those interested in being delegates or alternates should contact their chapter presidents or district directors.  All members are invited to attend; all members may also participate in our legislative and media training sessions on Sunday afternoon, and the legislative visits on Monday morning, March 8.

The Academy is closely following action by the Food and Drug Administration calling for a Risk Evaluation and Mitigation Strategy (REMS) for long-acting opioids.  Family physicians are major prescribers of long-acting opioids because they see so many patients with chronic pain.  CAFP is concerned that significant bureaucratic hassles could result in unwillingness to prescribe and, therefore, loss of access to care by patients with chronic pain.  I attended an FDA hearing in College Park, Maryland last Friday to monitor the situation.  The Industry Work Group presented its initial findings calling for more patient education about risks, proper storage and disposal, and risks of accidental exposure for those for whom the drugs are not prescribed; voluntary education for providers about proper patient selection and prescribing, a common medical guide, communications plan and training and/or certification.   By the end of the evaluation period for the REMS (seven years), however, the upshot could be an effort to tie DEA licensure to fulfillment of mandatory educational requirements.  CAFP has written the FDA to state our concerns and to indicate we plan a survey of our membership early in the year to determine what impact potential FDA steps could have on their practices.

CAFP leaders and staff will have the privilege of meeting with Paul Grundy, MD, IBM Global Director of Healthcare Transformation, the business guru of the patient centered medical home (PCMH) movement and tremendous advocate for primary care at CAFP headquarters on December 17.  Dr. Grundy contacted CAFP after reading of our strategic plan goal to become a center of excellence for PCMH education over the next three years.  Again, CAFP plans to survey its members to obtain baseline data on their state of readiness to consider adoption of PCMH features as a means of improving provider and patient satisfaction with care as well as the bottom line.

Last week, Director of Medical Policy Sandy Newman met with Assemblyman Jared Huffman, CMA,  representatives of Blue Shield of California, and the Pacific Business Group on Health (PBGH) to discuss release of data which CAFP and CMA believe to be flawed from the California Physician Performance  Initiative.  CAFP wrote to PBGH on November 4 to discuss in detail CAFP's concerns about the data's accuracy and to offer to work collaboratively to achieve a better outcome. 

In addition, we remain actively engaged in the Regional Extension Center (REC) issue; Ms. Newman will be attending another REC meeting next week.  On Wednesday of this week, she and I will be meeting with Dr. Betsy L. Thompson, Chief Medical Officer, Centers for Medicare and Medicaid Services for Regional IX to discuss Medicare issues in particular.  On Friday of this week, CAFP will host a meeting of our Single Payer Task Force, which was set up by action of the Congress of Delegates to examine under what conditions, if any, CAFP would support single payer health care reform legislation.

Posted on 11.30.09 by Executive Vice President Susan Hogeland, CAE 

RECs, REMS, HIT, EMR, PCMH - sometimes it seems as if our work at the Academy is a never-ending series of acronyms. 

We just sent a detailed letter to the State health information technology folks, those charged with helping Regional Extension Centers (RECs) get off the ground and working with physicians and others to achieve meaningful use.  In our letter we outlined what we view as necessary conditions for ensuring sustainable RECs. 

This includes such things as a common governance structure across all current and subsequent applicants designed in such a way that all relevant stakeholders have full representation, as well as a set of centralized core services, including EMR procurement for solo and small practices, clinics and hospitals.  We would also like to see "certification" of local service providers to ensure quality, close coordination with the State's HIT infrastructure and the Medi-Cal meaningful use incentives and other programs.  To see a copy of the letter, please click here.  CAFP is particularly concerned that physician offices are prepared appropriately before EMRs are introduced, since we have learned from our New Directions in Diabetes Care collaboratory that office processes often need work before EMR installation to avoid productivity losses.

Health Information Technology is a useful, but not mandatory, component for practices seeking designation under NCQA (another acronym) as a Patient Centered Medical Home.  There are three levels of PCMH, and Level 1 does not require an electronic health record (EHR!).  As I reported recently, CAFP hopes to establish itself as a Center of Excellence for Patient Centered Medical Home education.  CAFP is working to ensure that the RECs provide adequate resources and assistance to solo and small physician practices to ensure they can achieve meaningful use and qualify for HIT support under Medicare or Medi-Cal.  Sandy Newman, Director of Health Policy, developed preliminary information about what meaningful use means, although final requirements have not yet been issued.

Debate on the floor of the U.S. Senate begins this week on health reform legislation.  CAFP's Board took a position of support on the bill at its November 7 meeting.  The Board believes the House and Senate bills promote the interests of patients in a manner that is consistent with CAFP policy.  AAFP has also announced its support of the House and Senate bills. 

This week we're also following action by the Food and Drug Administration that may have a potential impact on family physicians' ability to prescribe long-acting opioids.  I will be attending a Risk Evaluation and Mitigation Strategy meeting held by the FDA on December 4 in College Park, Maryland.  FDA is concerned about misuse and abuse of long-acting opioids and CAFP wants to ensure that family physicians' ability to appropriately care for their patients is not inhibited. 

Finally, CAFP received word from the California Department of Public Health last Wednesday that our and other medical organizations' request for an extension to exemption of the H1N1 vaccine to the state's mercury law has been approved.

Posted on 11.23.09 by CAFP President Tom Bent, MD

Now that both the U.S. House and Senate have health care reform bills in play (HR 3962 and HR 3590, respectively), the gloves are coming off among advocates on all sides. As CAFP president, I urge you to make your voice known in any of the public forums; the stakes for family medicine are high. Please join other CAFP members and me as we work to inform the medical public's perspectives on health care reform. I've provided links to highly visible health policy blogs below so you can get started right away.

The CAFP Board of Directors has endorsed HR 3962, and we are following debates and prospective amendments to both bills closely. The bills aren't perfect, but we at CAFP see this proposed legislation as a starting point. Both bills would: insure millions more patients so they could afford the care they need; fund patient centered medical home efforts; invest in remedies to the primary care physician shortage; and increase opportunities for more family medicine residents to train in community settings. (See CAFP summaries here.)

There's a saying in politics: ‘Let's not let the perfect be the enemy of the good.' (It actually comes from Voltaire's writing; he said, "The perfect is the enemy of the good.") Let's not stand by and let fail this historic opportunity to begin reforming health care. Now is a great time to put your thoughts in writing and see the immediate results of posting on prominent health policy blogs where debates are raging. It's also the ideal time to send a letter to the editor of your local newspaper.

The popular KevinMD.com blog is a great place to reach fellow physicians. Others include The Health Care Blog, the Wall Street Journal Health blog, the New York Times Prescriptions blog, and the Washington Post Daily Dose blog.

Here are a few examples of recent posts by CAFP members on KevinMD.com:  I posted this guest editorial and CAFP members David Bazzo, MD, Carla Kakutani, MD, and Jay W. Lee, MD all posted comments here. As you can see, you can post brief or detailed comments - it's up to you. The important thing is to show family physicians' support for health care reform. Please be sure to mention in the post that you're a member of the California Academy of Family Physicians.

For details of CAFP positions and health care reform talking points, please visit our Web site. For a wealth of research summaries and data you can cite, see CAFP's comprehensive report, Fractured: Family Medicine's Fix to Ensure a Healthy California, developed by CAFP Director of Health Policy Sandra Newman, MPH.

If you'd like assistance - more examples, additional background information - please contact CAFP's media liaison, Catherine Direen, at http://us.mc620.mail.yahoo.com/mc/compose?to=cdireen@familydocs.org or 415/595-7050. She'd be happy to get you started. The time to advocate for health care reform is now. 

Please join us.

Posted on 11.23.09 by Executive Vice President Susan Hogeland, CAE

It was an exciting weekend - the U.S. Senate moved forward to allow the debate on health care reform to begin, voting 60-39 on an entirely partisan basis, unfortunately.  I was in Seattle at the AAFP's State Legislative Conference when the vote was announced and a roar went up from the attendees.  With me were Taejoon Ahn, MD, chair of CAFP's Legislative Affairs Committee, Carla Kakutani, MD, past president and a member of AAFP's Commission on Governmental Advocacy, Tom Riley, CAFP's Legislative Advocate, and Adam Francis, CAFP's Legislative Assistant.

AAFP's Director of Governmental Relations Kevin Burke reported on positive steps taken under the new Administration to date:

• Reauthorization of the Children's Health Insurance Plan
• Authorization of stimulus funds of up to $44,000 per physician for HIT
• A rule proposed by CMS July 1, the net effect of which would be to increase payment in 2010 for primary care physicians of 2-4 percent, growing to 8 percent over four years. The rule eliminates consultative codes and recalculates physician expense with data from a recent AMA survey, paid for by the primary care specialties, a good investment. Mr. Burke said the CMS change was specifically and expressly proposed to favor primary care.

Reform legislation in the House benefits primary care in a number of ways, with a five percent bonus for primary care services (which would be permanent and for all Medicare charges), two types of Patient Centered Medical Home demonstration projects, Title VII and Graduate Medical Education funding reforms, and payment reform, including two percent growth in primary care.  AAFP is aware that more is needed, and will seek more, but this is the first time Congress has specifically benefitted primary care physicians, a policy change recognizing that better compensation is needed. 

Under the Senate bill, there is a 10% primary care physician bonus (if 60% of Medicare billings are for primary care services), among other things. 

Neither bill has an SGR fix at this time, but AAFP is pulling out all the stops to avert the 21.2 percent cut in Medicare payments scheduled for January 1.  AAFP is asking all members to contact their representatives and ask them to support the Medicare Physician Payment Reform Act of 2009, HR 3961, which would replace the SGR formula with physician updates tied to inflation rather than specified targets.  A vote is anticipated sometime this week.  Go here to "speak out" on HR 3961 (http://capitol.aafp.org/aafp/issues/alert/?alertid=14329816 ).

While health reform and the SGR fix definitely will benefit family physicians, it is their patients who will benefit the most.  Speakers at the State Legislative Conference repeatedly drove home the message that health care reform is about families.  Legislators from Maine and Massachusetts discussed their reform efforts, including how they funded services and what they could have done better. 

It was disturbing to learn at the meeting that CAFP, the largest state chapter, ranks sixth in giving to the national political action committee, FamilyMedPAC.   With only $11,000 in contributions, California totaled less than half the amount that members of the Texas Academy of Family Physicians gave.  State legislative speakers repeatedly emphasized the importance of family physician involvement as key contacts, contributors, witnesses at hearings, etc.  I think we can do better - both with FamilyMedPAC and our own PAC, FP-PAC, and I challenge our members to do so in 2010.

This week at CAFP, we kick off with a meeting and luncheon for Alfred Gilchrist, the California Medical Association's new Executive Vice President.  We're delighted to welcome Alfred, who previously was Executive Vice President of the Colorado Medical Society, and Lance Lewis, CMA's Chief Operating Officer.

We here at CAFP hope you and your families and friends have a wonderful Thanksgiving holiday together.

Posted on 11.16.09 by Executive Vice President Susan Hogeland, CAE

We have our work cut out for us now that the CAFP Board of Directors has approved the implementation plan for our 2010-2012 Strategic Plan.

In addition to all the basics of running the organization - attending AAFP and CMA meetings, holding our own Congress of Delegates and Annual Scientific Assembly, combating legislation detrimental to family physicians and their patients in the state legislature, keeping our Web site up to date with fresh new material on issues ranging from health care reform to H1N1, CAFP has a new job:  making CAFP a center of excellent for educating our members on the Patient Centered Medical Home.

As I've commented previously, this is a big job, but it is closely aligned with the work the AAFP is undertaking both through its advocacy work in Washington, D.C. and through its subsidiary, TransforMED. 

Recognizing the magnitude of the job before us, CAFP plans to take a stepwise approach to PCMH.  First, where are our members on this issue?  How do they see themselves on the scale of readiness to adopt the features of PCMH?  If we don't know where we started, we won't know how to measure success, so our first step will be a survey of the membership.  In many ways, we see the PCMH work as a continuation of our efforts to help family physicians with practice redesign, as embodied in our now-completed New Directions in Diabetes Care project.   

Another "step" is currently underway because the state is moving quickly on it - the 1115 Waiver for Medi-Cal's PCMH-type plan.  The state will be seeking this Waiver from the Federal Government as it experiments with ways to contain costs and provide better care for Medi-Cal's sickest patients, including those with severe mental illness.  CAFP is engaging in this issue to ensure the cart isn't placed before the horse:  Will payment be adequate to support the enhanced care system?  Will physician practices be given adequate time and incentives to meet the standards being set for the new care systems? 

Meantime, Academy work continues on a number of fronts.  On Wednesday, several of us will travel to Los Angeles for the year's final meeting of The California Endowment's Medical Leadership Council on Cultural Proficiency.  CAFP convenes this group of 35 medical professional, health, and advocacy organizations, which has met twice a year for the past eight years to advance language access, cultural proficiency and healthcare workforce diversity.

On Friday, legislative advocate Tom Riley, legislative assistant Adam Francis and I will join AAFP Commission on Governmental Advocacy member Carla Kakutani, MD at AAFP's State Legislative Conference in Seattle for a weekend of in-depth discussion about legislative activities among state chapters.

Finally, we'll be notifying those nominated for higher CAFP office by the 2009 Nominating Committee, which met Tuesday the 10^th.  Elections will be held at the upcoming Congress of Delegates March 6-8 in Sacramento.  The deadline for resolutions and delegations is December 10.