Posted on 11.22.10 by Executive Vice President Susan Hogeland, CAE

Last week was chock full of important events, so we're hoping things slow down a little as we approach Thanksgiving.  Let me begin this Update by wishing you and yours a very happy, safe and healthy holiday.  I hope we can all show a little restraint at the dinner table, remembering family physicians are on the frontline of the obesity battle!

We had some sad news last week from Jane Hogg, my predecessor as Executive Director here at CAFP - she's been in close contact with CAFP past president Hubert (Hugh) Upton, MD over the years - "Uppy" as she called him.  Hugh also was  a member of AAFP's board, and a stellar fellow all around.  He died last week. doing what he loved - restoring an old boxcar at a train museum in Grass Valley.  Our condolences go to Mrs. Upton and her family. 

SGR Cut Gets One-Month Reprieve

I'm going to cut and paste a recent message from AAFP President Roland Goertz, MD here on this very important issue: 

"The Senate has agreed to a one-month extension of the SGR at the current rate. The matter is pending in the House of Representatives. House leadership has commented that the issue will be taken up immediately upon their return to DC on November 29th, so that the President can sign an extension before November 30th, but that leaves another looming deadline at the end of December.

A Year-Long Fix

Because the ultimate goal of a permanent fix to the SGR payment issue is not considered possible at this time, the AAFP has been advocating for at least a one-year extension of the SGR -- preferably longer. However, the cost of a 12-month extension that will include some other necessary Medicare provisions is roughly $19 billion.

In the days ahead, legislators will have to decide if they have sufficient offsets to extend the SGR and for how long. There will be many political decisions involved, but considerable weight will be given to how important this is for local physicians. 

What You Can Do Now

This political gamesmanship will only end if legislators in Congress hear from their constituents -- you and your patients.

Please take a few moments today to contact your Senators and Representative - by phone, email or a personal visit to their local office. Remind your legislators that today you are compensating your nurses, physician assistants, and other staff with 2010 wages. You are paying for electricity, heating and water at 2010 rates. You are buying medical supplies and equipment at 2010 prices. Yet your payment for caring for Medicare and TRICARE patients is at the 2001 income level.

Next, arm your Medicare and TRICARE patients with information. The AAFP-developed toolkit (http://www.aafp.org/online/en/home/policy/federal/issues/cmsacttools.html), which is available for you to download and distribute, contains the following documents:

-a one-page fact sheet that briefly describes the current Medicare payment system and what steps Congress can take to make the system more equitable. The document also cites talking points for use with Congress, the media and patients, and it contains tips on how to make the voice of family physicians heard on Capitol Hill;

-a sample letter that physicians can send to their patients explaining problems with the current payment system and what patients can do to help fix the broken system; and

-a sample letter that patients can send to their respective representatives in Congress that describes the effect of the SGR on physician practices and patient care and what steps Congress can take to make the payment system work better for physicians and their patients.

Please consider educating and engaging your patients now. And keep the pressure on your Senators and Representative.

Congress can't continue to impose this financial uncertainty on physician practices and not expect that many will find it impossible to serve Medicare patients. The time has come to fix the payment system and provide family physicians with the operating stability necessary for their practices. 

Sincerely,

Roland Goertz, MD, MBA

President"

Enough said.  Please do as Dr. Goertz asks, and begin engaging your patients now about this important issue.

Medical Leadership Council Concludes a Nine-Year Run

Last Wednesday, November 17 marked the final meeting - for now - of The California Endowment's Medical Leadership Council on Cultural Proficiency (MLC).  After nine years of two meetings per year, The Endowment determined it would be unable to continue to support this effort to end disparities in health care caused by language access and cultural proficiency deficiencies.  CAFP has been the convener of the MLC since its inception, under the capable co-chairmanship of Len Fromer, MD, a CAFP past president.  The Council has had many accomplishments, including an excellent website to which physicians can go for county-by-county interpreter services information, materials on addressing language access in the medical office and many other tools to help address language access and cultural proficiency.  The latest products from MLC are two excellent videos for medical assistants; the first outlines why medical assistants want to help with addressing language access and the second is a practical, "how-to" to help them do so.  Both got excellent reviews from the county medical and specialty societies and other health care organizations in attendance.  CAFP hopes to continue to maintain the web site (www.medicalleadership.org) and is considering how we can help the MLC participants can stay up-to-date on language and cultural proficiency issues virtually.  Thanks to Dr. Fromer, past CAFP employees Laura Johnson-Morasch and Sandy Newman and current employees Shelly Rodrigues, Jane Cho and Leah Newkirk for all their hard work in support of MLC.  Thanks, too, to The California Endowment for its support and to our program officers Alice Chen, MD, Ignatius Bau, JD and Dianne Yamashiro-Omi for their guidance and to Catherine Direen, communications consultant, who helped us in so many, many ways.  

CA Family Physician Shortage Featured on PBS NewsHour

We were thrilled to learn that UC Davis Family Medicine residents and CAFP members Ashby Wolfe, MD, Brenden Tu, MD and Wai-Kui Lee, MD were highlighted in a report by PBS's NewsHour last week, along with Residency Program Director Tom Balsbaugh, MD, who explained the need for a robust primary care workforce if health care reform is to be successful in improving patient health and access to health care services. The report discusses the need to improve family physician payment and develop coordinated care within a physician's surrounding community. The video also features family physician David Katz, MD.  CAFP's media consultant, Catherine Direen, connected CAFP's Associate Director for Health Care Workforce, Callie Langton, with the PBS folks, and Callie helped them connect with the folks at UC Davis.  They all did us proud.  You can view the video here. 

CAFP Supports AAFP Comments on NCQA Accountable Care Organization Criteria

AAFP submitted comments on the National Commission on Quality Assurance's (NCQA) proposed criteria for recognition as an Accountable Care Organization (ACO).  CAFP also reviewed the criteria and notified NCQA that we support the AAFP comments in their entirety.

CAFP Signs on to PCPCC Letter to Senate Appropriations Committee

CAFP has signed on to a letter prepared by the Patient Centered Primary Care Consortium (PCPCC) to the Senate Appropriations Committee members requesting that the Senate include full funding for a range of programs and activities promoting primary care, particularly in the emphasis on developing and teaching the PCMH model, in any resolution or bill for the Fiscal Year (FY) 2011 Labor-HHS appropriations, specifically funding at the level recently authorized in the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act (P.L. 111-152).   

AAFP Staffer Visits CAFP

Elaine Conrad, CAE, AAFP Director of Membership, spent a day-and-a-half with CAFP staff members last Thursday and Friday, seeing how a large chapter operates.  It was an excellent give-and-take visit all around, and we thank her for coming.

Happy Thanksgiving, all!

Posted on 11.16.10 by Executive Vice President Susan Hogeland, CAE

AAFP State Legislative Conference Full of Good Ideas

Four CAFP staffers and two family physician leaders are freshly returned from AAFP's State Legislative Conference, which focused on health reform implementation efforts and efforts in many states to make the Patient Centered Medical Home (PCMH) a reality.  With speakers ranging from Mark McClellan, former director of the Centers for Medicare and Medicaid Services (CMS) and now Director, Engelberg Center for Health Care Reform at the Brookings Institute, to Rhode Island State Insurance Commissioner Chris Koller, and from AAFP President Roland Goertz to lobbyist Kevin Burke, the two-day conference covered the waterfront - the Mississippi waterfront, that is, since it was held in New Orleans.

I tweeted some of the highlights as the conference went along.  I will venture to say that for the Californians, some of the most exciting information came from Mr. Koller, who described how Rhode Island went about changing insurance payment to provide a monthly per member per month fee for PCMH services.  Craig Jones, MD, Director, Blueprint for Health, for the state of Vermont (formerly at University of Southern California) had a similarly exciting tale:  not only are primary care physicians receiving per member, per month payments for PCMH services, additional funds were used to hire community health workers who can provide and coordinate some of the services that physicians in small or solo practices cannot.  CAFP would like to meet with insurance commissioner-elect Dave Jones to discuss how his office might be a bully pulpit for PCMH.

Another Successful Grundy Visit        

IBM's Paul Grundy, MD, MPH had another whirlwind visit to California last week and CAFP had the privilege of setting up meetings at which Dr. Grundy could promote PCMH.  Dr. Grundy met with several representatives of Brown and Toland Medical Group at lunch and then traveled to Santa Rosa for a session with more than 50 health care professionals and representatives of health plans and business to discuss the need for the PCMH model.  CAFP past president Bo Greaves, MD and Sonoma chapter president Walt Mills, MD organized this very successful event.  The next morning, Dr. Grundy flew to San Diego for a series of meetings, including one with CAFP Speaker Steve Green's medical group at Sharp and one with the IPA at Sharp.

In his comments at the AAFP State Legislative Conference, Rhode Island Insurance Commissioner Koller aptly described Dr. Grundy as a "force of nature."  He is.

Staffers Out and About

Director of Health Policy Leah Newkirk represented CAFP at the California e-Prescribing Consortium's (CaleRx) Annual Meeting on November 9. The annual meeting focused on best practices in e-prescribing, performance measurement, medication management and optimizing e-prescribing functionalities.  Last Thursday, Callie Langton represented the Academy at the Rural Workforce Summit of the California State Rural Health Association.  She learned that some rural hospitals are recruiting new physicians on craigslist! 

CAFPers Tom Riley, Adam Francis, Callie Langton and I will meet this week with Cathryn Nation, MD, University of California Associate Vice President, to discuss health care workforce issues, especially the need for more family and other primary care physicians in light of health care reform. 

Leah Newkirk, Jane Cho, Shelly Rodrigues and I will fly to Los Angeles Wednesday for the final meeting of The California Endowment's Medical Leadership Council on Cultural Proficiency (MLC).  CAFP has been convener of this body of primary care and county medical societies, hospital and health plan and other organizations for the past nine years.  We are sad that The Endowment has decided to discontinue support at this time, but proud of MLC's accomplishments, the latest of which is an excellent set of two DVDs for Medical Assistants on Addressing Language and Cultural in Health Care Practices.  An extensive set of resources is available on MLC's website, which can be found at www.medicalleadership.org 

Congratulations and thanks to all the 34 organizations that participated in the MLC over these many years.  Some great relationships and partnerships were built as a result.

AAFP Staff Will Visit CAFP This Week

We're delighted that AAFP staff members Nancy Fisher and Eileen Conrad will visit CAFP on Thursday and Friday of this week "to see how a chapter works."  We are happy to welcome them to California and CAFP.

Posted on 11.01.10 by Executive Vice President Susan Hogeland, CAE

Out and About for CAFP

Staff was scattered hither and yon last week attending meetings on CAFP's behalf.  Medical Practice Affairs Manager Jane Cho attended Medicare third party administrator (TPA) Palmetto GBA's Mactoberfest conference to stay apprised of that carrier's Medicare payment issues.  CAFP was very active last year in resolving problems that arose when Palmetto GBA took over as TPA after it was discovered the prior administrator hadn't completed some crucial work.  In one case, CAFP intervention resulted in a CAFP member being paid within 24 hours after CAFP contacted Palmetto!

Leah Newkirk, Director of Health Care Policy, attended a California Association of Physician Groups /Integrated Healthcare Association-sponsored conference on Accountable Care Organizations (ACOs), the latest buzzword in integrated services.  CAFP hopes to help members prepare for participation in ACOs, if appropriate for them, and to ensure that all issues related to restraint of trade are resolved before physicians enter into such agreements.  We'd also like to see primary care physicians take a leadership role in these organizations.

I attended a meeting in Washington, DC on implementation of health care reform.  Leah and I participated in an enlightening call a week or two ago on which representatives of the state - Department of Health Care Services, Managed Care, etc. - updated us on administrative actions taken by the state to implement reform, for example, establishment of the Health Insurance Exchange, a sort of matchmaking service for Californians without insurance coverage.  If Republicans take over the House of Representatives, and, potentially, even the Senate, as is possible, appropriations for the vast array of programs to support reform may be in jeopardy.  This will please some and upset others, of course.  

CAFP staff also attended a Medical Board of California (MBC) Advisory Committee on Physician Responsibility in the Supervision of Affiliated Health Care Professionals meeting last week.  According to our legislative staff, this meeting signaled the expectation that the upcoming legislative session may include major proposals to expand various non-physician providers' scope of practice to meet the primary care capacity demands of federal health care reform. The MBC's Advisory Committee, along with the Medical Board itself and the Department of Consumer Affairs (DCA), may play significant roles in shaping these debates.

Legislative staff notes that this renewed activity comes on the heels of a controversial October 5 Institute of Medicine Report recommending expansion of scope for nurses in states such as California that do not allow independent practice. CAFP will maintain close vigilance to ensure that patient safety remains the top concern in the debates over scope, and will continue to advocate that health care providers engage in a team approach to care crucial to the patient centered medical home.

Legislative Advocate Tom Riley will present information about the IOM report to the CAFP Board of Directors on Saturday, November 6 and will detail current regulation in California on advanced practice nursing scope of practice.  CAFP will formulate its policy direction on scope expansion at a future Board meeting, after discussion at the Legislative Affairs Committee.

CAFP Foundation Board of Trustees and Board of Directors Meet Next Weekend

CAFP Foundation Executive Director Shelly Rodrigues has a prepared a packed Board of Trustees meeting schedule for November 5.  Under the leadership of President Bob Bourne, the Trustees will engage in some in-depth strategic planning for the Foundation.  The CAFP Board also has a very full agenda that includes adoption of the 2011 Academy budget, a presentation from Health and Human Services District IX Director Herb Schultz, former health staff for Governor Schwarzenegger, staff presentations on Accountable Care Organizations and scope of practice for advanced practice nurses and recommended legislative strategies for the coming session of the State Legislature.   

State Budget Realities Bite

The full impact of the Governor's line item veto of programs in the 2010-2011 State Budget has now become apparent.  Governor Schwarzenegger made almost $1 billion dollars in additional cuts that could have a very serious impact on prevention efforts in our state.  Among those cuts:  $18 million in local assistance funding for the Infectious Disease Branch's Immunization Program;  cuts to the state's much-neglected Immunization Registry, which will now lose $1.1 million in federal matching funds, reducing project funding by 50 percent.  The upshot:   all community health center immunization activities, collaborative projects and registry activities will be halted or dramatically curtailed and uncertainty exists about how or whether the California Department of Public Health will provide adult flu vaccine next season (2011-12).

Next Week!

As I've mentioned previously, we'll have another intensive day with IBM's Paul Grundy, MD on November 10; on the 11^th for more meetings on establishing patient centered medical homes, including one with CAFP Congress of Delegates Speaker Steve Green.  The next day, four CAFP staff members,   Legislative Affairs Committee chair Taejoon Ahn and past president and member of AAFP's Governmental Affairs  Commission Carla Kakutani will head for AAFP's State Legislative Conference, which will feature a special, half-day program on health care reform implementation - getting the drift here?  All implementation, all the time.   

Posted on 10.26.10 by Executive Vice President Susan Hogeland, CAE

PCPCC Stakeholders' Meeting Featured Illinois Academy Project

Last week I traveled to Washington, DC to attend my second Patient Centered Primary Care Collaborative Stakeholders' Meeting, chaired by our friend, Paul Grundy, MD of IBM.  Peter V. Lee, JD, formerly of the Pacific Business Group on Health here in San Francisco and now Director of Delivery System Reform for the U.S. Department of Health and Human Services spoke on Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO) regulatory implementation in health care.  The Illinois Academy of Family Physician (IAFP) was there because two speakers from Illinois presented on the incredibly successful PCMH initiative in the state Medicaid program, in which IAFP has been a major participant and advocate.  Savings of more than $500 million has been realized over the two-year life of the project.  Question:  why doesn't California jump at this kind of savings? 

ACOs Are the Next Big Thing

CAFP's Director of Health Policy, Leah Newkirk, is attending the California Association of Physician Groups' two-day program in Los Angeles on ACOs this week.  It's a hot, hot topic.  CAFP's Board will have its second presentation on ACOs at the upcoming November 6 meeting.  We're all anxious to learn the scoop from Leah.

Scope of Practice and MICRA New Challenges in the State Legislature?

Legislative Advocate Tom Riley will also present to the Board of Directors on the new Institute of Medicine report on advanced practice nursing (APN), which recommends elimination of restrictions on independent practice for APNs and equates their care with physicians'.  CAFP will be formulating legislative strategies to ensure that health care teams work together to provide patients with the Patient Centered Medical Home.  Rumblings about changes to the Medical Injury Compensation Reform Act (MICRA) are not that unusual at the start of every new legislative session, and the upcoming session is no exception.  Keeping a cap on non-economic damages (pain and suffering) has been one of CAFP's and others' top priorities, and, if changing the cap raises its ugly head, we'll be there to ensure Californians have access to affordable care, thanks at least in part to MICRA holding the line on professional liability premium expenses.

CAFP Editor Michelle Quiogue at a Town Hall

CAFP Editor Michelle Quiogue, MD of Bakersfield will represent CAFP at a KVPR Valley Public Radio-sponsored Town Hall at the COS College of the Sequoias (Ponderosa Room), Tuesday, November 9, from  6:30-8:30 pm as part of a panel taking on the big topic of health care - the cost of health insurance, impact of reform, state budget cuts, etc.  The program will be recorded for later airing on the station's Quality of Life Program.  Thank you, Dr. Quiogue!

Mactoberfest Is Here!

Medical Practice Affairs Manager Jane Cho will attend Palmetto GBA's Mactoberfest meeting later this week to hear all about the Medicare third party administrator's latest doings.  Ms. Cho and former CAFP President Norm Rosen attended the Palmetto Contract Advisory Committee meeting in Burlingame last week on CAFP's behalf. 

New Staffer Marian Yee Attends Marin AFP Meeting

New CAFP staffer Marian Yee attended our Marin Chapter's meeting last Thursday and participated in an AAFP conference call on non-dues revenue as well.

Health Care Reform Meeting

It's back to WDC for me on Wednesday to attend a meeting on health care reform implementation.  Those miles do pile up. 

VOTE!

Please, don't forget to vote on November 2, or by absentee ballot any time before that.  Mine's already been sent in; has yours?

CAFP Loses Outstanding Member

This just in today from San Luis Obispo chapter president Mario San Bartholome, MD, MBA:  "It is with a heavy heart that I inform you all of the recent loss of Dr. Graciela "Chela" Sarmiento.  A model family physician, Dr. Sarmiento lost her life while traveling to serve at a medical mission in Mexico through the Flying Samaritans.  The plane crash also claimed the life of Dr. James Thorton, Andrew Thiel (a medic and student) and Roger Lyon, the pilot and an attorney from Cayucos.  Our condolences are with the families of all of these wonderful volunteers who lost their lives while selflessly helping others.  Dr. Sarmiento was a caring and active family physician with the Community Health Centers of the Central Coast and member of AAFP/CAFP.  She will be greatly missed." 

CAFP also extends its deepest sympathies to Dr. Sarmiento's family and to the families of the other individuals who were lost.

At Last...a Budget

We were relieved last week when, at last, after a record delay in doing so, the State Legislature finally passed a budget that DID NOT include deep cuts to health programs.  CAFP worked throughout the 18-hour budget deliberation, along with many allies, to prevent such cuts to, for example, Healthy Families and In-Home Supportive Services.  Many programs were still at risk, however, because of the Governor's line item veto power; the Governor cut a total of $962 million in health and human service programs, including reductions in to HIV/AIDs programs, community clinics, mental health services to special education students, the Black Infant Health Program, mental health positions in state hospitals and, perhaps most concerning of all considering our recent experience with H1N1 and pertussis outbreaks, $18 million in cuts to the Infectious Disease Branch's Immunization Program. The Immunization Branch of the California Department of Public Health provides leadership and support to public and private sector efforts to protect the population against vaccine-preventable diseases.  The budget also includes changes to the Medi-Cal reimbursement rate for physician-administered drugs.

Legislative Affairs Committee to Meet 10.20.10

The CAFP Legislative Affairs Committee will meet by conference call this coming Wednesday to set the Academy's legislative agenda for the next legislative session and review the past session's actions (or inactions).  We are still smarting from the Governor's veto of AB2093, legislation to increase payment rates to physicians for vaccine purchases and from the failure of the Legislature to consider our legislation to define the Patient Centered Medical Home (PCMH) (AB1542) as an urgency measure in the closing hours of the extraordinary session.  But, to paraphrase a famous actor once said, "We'll be back!"  Recommendations of the Legislative Affairs Committee will be considered by the CAFP Board of Directors, which will meet in Oakland on November 6.  A BIG thank you to all the members of the Legislative Affairs Committee for their hard, thoughtful work throughout the year!  They are called on repeatedly for their opinions about various legislative proposals and strategies, and are crucial to CAFP's legislative efforts.

Student Conference

A very successful CAFP student conference was held last Saturday at the University of California, San Francisco.  Staffers Cody Mitcheltree, Callie Langton, Chris Navalta and Adam Francis supported the event, which was attended by more than 55 students, with total attendance hitting nearly 100.  Congratulations to all those who planned and executed this successful event.

More on This Week

Associate Director of Health Care Workforce Callie Langton will be visiting the Stanislaus residency program Tuesday and then attending the Stanislaus County Academy Chapter meeting that evening.

Wednesday, I'll be flying to Washington, D.C. to attend the Patient Centered Primary Care Collaborative Stakeholders' Meeting.  This meeting brings together health care providers and organization representatives, business, government and others to hear the latest on PCMH implementation. 

Also on Wednesday, Norman Rosen, MD and Jane Cho, CAFP's Medical Practice Affairs Manager, will represent the Academy at a Palmetto GBA Contract Advisory Committee in Burlingame.  Dr. Rosen has kindly been representing CAFP on clinical issues at these meetings for several years (Barbara Kostick, MD has also represented the Academy).

On Thursday, Ms. Cho heads to Southern California for the graduation of participants in CAFP's Capacity Building Collaborative (C-4).  Congratulations to all the practices who participated in the 18-month-long collaborative to improve capacity to incorporate quality improvement/practice improvement into their practices by getting their practices in financial and process order, and to Ms. Cho for her efforts on this program. 

Last Wednesday-Friday, Shelly Rodrigues, Deputy Executive Vice President, represented CAFP at the AMA's Industry Task Force meeting in Baltimore, MD.

Posted on 10.12.10 by Executive Vice President Susan Hogeland, CAE

CAFP Works with CMA on Medi-Cal Waiver Legislation

CAFP spent a good deal of time and energy the past two weeks working with the CMA and other organizations on legislation seeking a waiver from the Federal Government for California's Medi-Cal program.  Consensus is that while some language in the legislation has been improved, it is not as prescriptive as CAFP would like it to be with regard to the Patient Centered Medical Home.  CAFP would prefer a clearer delineation of health care professional roles, a more detailed quality and innovation section and greater emphasis on patient centeredness.

Budget Nail Biter - Will AB 1542 See the Light of Day?

We needed a little more tension on the issues this week, so in addition to concerns about how the new state budget (if passed) will address such issues as support for in-home health care services and Medi-Cal, a great deal of uncertainty exists over whether AB 1542, CAFP's legislation to define the Patient Centered Medical Home (PCMH), will see the light of day during the extraordinary budget session.  Legislative leaders are reluctant to address any issue except the budget.  The Academy and other supportive organizations are working hard behind the scenes to ensure this bill receives an up or down vote. It isn't over until the morbidly obese lady sings, of course, but the next 48 hours will be an uphill battle. 

Nominating Committee Chair Calls for Nominations

CAFP Immediate Past President and Nominating Committee Chair, Tom Bent, MD encourages chapters and individual members to consider nominating qualified candidates for CAFP office.  The Nominating Committee will meet in November to consider candidates for 2011-12 President-elect, Speaker, Vice Speaker, Secretary-Treasurer, Rural Board Member, AAFP Delegate and Alternate and positions on the Nominating Committee itself.  Please contact me if you have nominations:  cafp@familydocs.org or 415-345-8667.

Countdown to the Student Conference!

Thirty-five students have already registered for CAFP's annual event for medical students on October 16! It will be held October 16 at UCSF and focuses on the Patient Centered Medical Home and caring for the underserved. This terrific event will give attendees the opportunity to interact with California family medicine residency programs, gain valuable skills in hands-on procedures, learn how to become involved in their communities and get answers to questions concerning how to apply to and interview for residency programs.  For more information, click here. Register for the conference at CAFP's online store.

Staff Whereabouts - On Your Behalf

Callie Langton represented CAFP in Sacramento last Tuesday at a Healthcare Workforce Commission meeting; Leah Newkirk represented the Academy at a Health Information Technology meeting in Sacramento on Thursday; this week, Shelly Rodrigues will attend an AMA Industry Task Force in Baltimore on behalf of the Academy.  Coming up:  a stakeholder meeting of the Patient Centered Primary Care Collaborative in Washington, DC on October 21 and a meeting on health care reform, also in Washington, on October 28 and 29.  Our FP-PAC Board met on October 6 to recommend last-minute contributions to candidates before the November 2 election, and to review fundraising. The Board agreed to co-sponsor an event with California's other primary care physician organizations to benefit a pediatrician running for the State Assembly in the Sacramento area, Richard Pan, MD. Our Legislative Affairs Committee will be meeting on October 20 to review the legislative session and plan for next year's advocacy activities.   

Full-Steam Ahead on PCMH/HIT/Capacity Building

The Academy is  developing a Health Information Toolkit that will help family physicians choose the electronic health record system that is right for them, and put it into practice. The toolkit will help primary care physicians' practices to work with  Regional Extension Centers (RECs) and Local Extension Centers (LECs) to undertake HIT adoption.  Interviews with RECs, LECs and family physicians who have or are adopting EHRs will begin this week to inform our work.

It's graduation time for CAFP's participants in our 18-month-long Capacity Building Collaborative.  Medical Practice Affairs Manager Jane Cho will lead the final learning session at The California Endowment Los Angeles headquarters on October 21.  Jane has done a fantastic job with C-4 (Cs 1-3 were our New Directions in Diabetes Care collaborative) and we plan to share the many learnings on how to help family physician practices gain the capacity to take on transformation with the membership.  Congratulations, all, for a job well done.

CAFP Nominates Allan Abbott and Jimmy Hara

CAFP submitted the nominations of Allan Abbott to serve on an AAFP Commission and Jimmy Hara for the American Board of Family Medicine last week.  Commission nominations are due October 15, so if you pine to serve, you'll need to get your application and jpg photo in ASAP, and go online to AAFP to file a Conflict of Interest statement. 

Posted on 10.04.10 by Executive Vice President Susan Hogeland, CAE

Governor Vetoes AB 2093

We were hugely disappointed when Governor Schwarzenegger vetoed AB 2093, legislation CAFP co-sponsored with CAPG, AAP and CMA to restore fairness to how physicians are paid for vaccines.  Despite this setback, we'll continue to encourage family physicians to vaccinate their patients and themselves for pertussis to prevent outbreaks such as California has experienced this year, including the deaths of nine infants.  We'll be back ... Governor.

Oh, and we're waiting for AB 1542, our Patient Centered Medical Home legislation, to come up as an urgency measure during budget deliberations - according to press reports over the weekend, the vote on the budget will happen Thursday. 

CAFP Covered the Waterfront Last Week

We Survived the AAFP Congress of Delegates!

Your Delegation to the AAFP Congress of Delegates, Jack Chou, MD; Carla Kakutani, MD; Jeff Luther, MD and Eric Ramos, MD and I attended the AAFP Congress of Delegates in Denver last week prior to the start of AAFP's Annual Scientific Assembly.  The Western States did very well in the elections:  Glenn Stream, MD of Spokane, WA was chosen as President-elect in a run-off with David Ellington, MD of Lexington, VA; Ken Bertka, MD of Holland, OH was the third candidate.  New Board members include Barb Dody, MD of Wasilla, AK and Rick Madden, MD of Belen, NM, in addition to Robert Wergin, MD of Milford, NE.  Congratulations to all!

Our Delegation fought the good fight on a number of issues, including AAFP's Consumer Alliance program and whether to continue its relationship with The Coca Cola Company.  CAFP and four other states submitted resolutions suggesting the relationship be ended, but we were out voted 94-16 - ouch.  The students, residents, National Caucus of Special Constituencies and pretty much everyone else testified against the anti-Coke resolutions.  Both Drs. Kakutani and Chou were quoted in AAFP stories:

"This organization's reputation and integrity are its most valuable assets," delegate Carla Kakutani, MD, of Winters, CA, testified. "I don't want to sell that for anything."

"We heard in the Town Hall meeting and the reference committee that there is tremendous pressure for the Academy to find alternate (revenue) resources," said Jack Chou, MD, of Baldwin Park, CA, president of the California AFP, during the COD session. "But in California, our members didn't think (the agreement with TCCC) was the right thing to do. That said, we belong in the AAFP. The Congress of Delegates is a forum for national debate, and we just came up short. The Congress heard the minority voices. The democratic process worked."

To read more about the Congress, please go to: http://www.aafp.org/online/en/home/publications/news/news-now/2010cod-assembly/20100929codallianceprogram.html

CMA's House of Delegates Met over the Weekend

As if sitting on one's rear through the AAFP Congress wasn't enough, two of our Delegates and one of our Alternates flew home early from that meeting to attend CMA's House of Delegates in Sacramento over this past weekend.  Dr. Kakutani was a Delegate, Dr. Luther was an Alternate Delegate.  Dr. Chou was attending on behalf of the Los Angeles County Medical Association and will become a member of the CMA Board of Trustees from Los Angeles (congratulations again, Jack!).  Our other Delegates were Steve Green, MD and Patricia Samuelson, MD; our other Alternate Delegates were Taejoon Ahn, MD and Sam Applebaum, MD.

Thanks to all of you for your perseverance and endurance, and to Tom Riley, Legislative Advocate, and Adam Francis, Legislative Assistant, for staffing the Delegation.  There'll be more to come on the outcomes of the meeting.

CAFP's Own Congress of Delegates Will Be Held in Sacramento March 5-7, 2010

This is a reminder to all chapters to get resolutions and delegations in to CAFP by mid-December.  The meeting will be held at the stylish Citizen Hotel right in the heart of Sacramento.  The hotel has wonderful political sayings throughout.  And, speaking of politics, on the 7^th, we'll do our annual legislative visits after an excellent briefing by our legislative staff and leaders.  More information to come.

Workforce, Health Information Technology, Membership, Continuing Professional Development - We're Working on All of It

Callie Langton is heading to Sacramento this week for a meeting of the new Workforce Development Council; Leah Newkirk and Jane Cho are off and running on CAFP's Health Information Technology project, funded by The Physicians Foundation for Health Systems Excellence; Sophia Henry is going full-bore to develop a membership recruitment plan for the remainder of this year and 2011 in anticipation of a visit by two AAFP staffers in mid-November; Shelly Rodrigues, Cynthia Kear and Marian Yee are keeping the Continuing Professional Development department humming with meetings, proposals and more meetings.  Our Annual Student Conference will be held on the 16^th and Cody Mitcheltree is busy recruiting attendees. 

Posted on 09.27.10 by Executive Vice President Susan Hogeland, CAE

And, They're Off...

... to the AAFP Congress of Delegates and Scientific Assembly in Denver.  Your delegation - Jack Chou, MD; Carla Kakutani, MD; Jeff Luther, MD; and Eric Ramos, MD are well-prepared for the three-day meeting marathon, having reviewed all the resolutions, Board reports and commission reports with the CAFP Executive Committee members.  Positions were taken on nearly half of the 55 resolutions under consideration, ranging from ours and others' resolutions calling for AAFP to rescind its contract with The Coca Cola Company for support of its patient-facing website to transparency for guidelines expert panels (also ours) to support for the Independent Payment Advisory Board.  

Our delegation will meet with those of the other western states at the Western States Forum on Sunday evening to discuss issues of mutual concern and to hear from candidates from the western states.  Watch for updates on the CAFP website, Facebook and Twitter!

State Budget and CAFP's AB 1542

The media today reported the budget impasse may end as soon as today (fingers crossed); that means CAFP is on a tight timeline to get its urgency bill, AB 1542, a bill to define the Patient Centered Medical Home, through the State Assembly before adjournment.  Legislative Advocate Tom Riley and Legislative Assistant Adam Francis, with the help of the bill's author, Assemblymember Dave Jones, and his staff, as well as a "village" of other supporting organizations and their lobbyists have been working hard to do just that.  Stay tuned ... we hope the next step will be to encourage the Governor to sign the bill!

$145,000 Grant to CAFP to Help with Health Information Technology

You may have seen in the press that CAFP secured a $145,000 grant from the Physicians Foundation for Health Systems Excellence to help physicians begin adopting electronic health records (EHRs) and achieving Meaningful Use now that there are federal funds to cover some of the expense.  The California Medical Association Foundation received a similar grant, and we hope to collaborate with CMA/CMA-F to make sure our respective grants go as far as possible toward providing the help that small and solo primary care offices across the state need so much as they adopt EHRs.  CAFP's particular hope is EHR adoption will be a crucial step toward transformation into the Patient Centered Medical Home. 

CAFP Signs On to Letters from Patient Centered Primary Care Collaborative

CAFP signed on to two letters from the Patient Centered Primary Care Collaborative (PCPCC):  One to Secretary of the Department of Health and Human Services Kathleen Sibelius and Office of Management and Budget Director Jeffery Zients and another to Administrator of the Centers for Medicare and Medicaid Services, Don Berwick, MD. 

In the former, the PCPCC "ask" was that the Administration's proposed FY 2012 budget fully fund a number of programs promoting primary care  and emphasizing development and teaching of the Patient Centered Primary Care model at levels authorized in the Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) and the Health Care and Education Reconciliation Act (P.L. 111-152).   

The letter to Dr. Berwick related to the primary care incentive payment (PCIP) section of PPACA equal to 10 percent of a primary care practitioner's allowed charges for primary care services under Part B between January 1, 2011, and before January 1, 2016 on a quarterly basis, calling for an expanded list of services to qualify for the payment, among other requests.    

New Health Reform Website for CAFP

The Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) hit its six-month anniversary on September 23.  CAFP wants to help you understand what's in it for you and your patients, so we expanded our health care reform website.  An email to all members was sent on the 23^rd announcing the new site.  You can view it here: http://www.familydocs.org/advocacy/health-care-reform.php 

Discussions Continue on Hoped-For PCMH Pilot Project in Fresno

CAFP is still in discussions with representatives of the Fresno Unified School District health plan about the feasibility of a Patient Centered Medical Home (PCMH) pilot project there.  Unlike other states in which the state government has played a major role in establishing statewide PCMH pilot projects, pilots in California are being driven more by individual champions:  Bo Greaves, MD in Sonoma, where word is Sutter Health has allocated significant funds to support a project among its physician offices; San Francisco, where Larry Shore is transforming his office and working to convince Brown and Toland Medical Group to adopt the model; San Diego where physicians at Sharp Reese Steely have indicated interest, and elsewhere.  One way or another, we're going to do this thing!

Staff Hurrahs, Hellos and Good-byes

Congratulations to Shelly Rodrigues, who reached her 18^th anniversary with CAFP on September 1; to Karen Brent, who reached her 11^th anniversary on September 7.  Marian Yee joined us on September 1 to work in continuing professional development.  Mariah Brooks, Executive Assistant and Office Manager, has left the Academy - to work on becoming a teacher.  We wish her well and thank her for her service over the past four years.

Posted on 09.20.10 by Executive Vice President Susan Hogeland, CAE

AB 1542 Lives!

With your help - and only with your help - we'll yet get a definition of the Patient Centered Medical Home into statute in California before the end of November - Legislative Assistant Adam Francis sent out a Legislative Update last Thursday outlining what YOU can do to make it happen:

Your help is needed to ensure that all the Assemblymembers who previously supported the bill do so again when the bill is brought up for a vote. To find out who your Assemblymember is, please enter your work and home address here: http://192.234.213.69/amapsearch/framepage.asp and click "Find." If your Assemblymember matches any of the names below, please personalize this letter and mail it to him or her ASAP. Fill in the Assemblymember's last name and use the following address:

The Honorable Assemblymember _____________

State Capitol Building

Sacramento, CA 95814

Assemblymembers who voted in support of AB 1542:

If your Assemblymember is not listed above, please call his or her district office using the contact information given on the website and ask him or her to support the bill. 

Big Media Week For CAFP

CAFP member and immunization expert Patricia Samuelson of Sacramento was CAFP's representative at a press conference last Thursday in Sacramento held by the State Department of Public Health on the topic of pertussis.  District IX of the American Academy of Pediatrics also participated with state epidemiologist Dr. Gil Chavez, and Dr. Samuelson was quoted on the AP wire.   

Five cameras were present and 35 reporters participated by the conference call.   A big thank-you to Dr. Samuelson for representing CAFP on this important topic - nine infants have died so far this year from pertussis, underscoring the importance of immunizations for entire families, as well as ALL HEALTH CARE PROFESSIONALS.  Is it time for your booster?

Out and About

CAFPers were all over the state last week, protecting the interests of family physicians and meeting with members.  Director of Health Policy Leah Newkirk flew to Los Angeles on the 15^th to participate in the State eHealth Committee; Cody Mitcheltree, Student-Resident Coordinator, visited five Southern California medical schools to meet with Family Medicine Interest Groups; Cody, Sophia Henry, Membership Manager and Tom Riley, Legislative Advocate, attended the Los Angeles AFP chapter's meeting on the 16^th.  This week, Callie Langton will represent CAFP at the California Health Workforce Alliance on Wednesday.  Your Delegation to the American Academy of Family Physicians Congress of Delegates met last Wednesday evening to review the 55 resolutions coming before the Congress and take positions on many.  The Congress will be held September 26-29 in Denver, followed by the AAFP's Annual Scientific Assembly - there's still time to register!

Posted on 09.13.10 by Executive Vice President Susan Hogeland, CAE

Office Closed Friday, September 17

The CAFP office will be closed on Friday, September 17 for painting.  It's been 10 years since we moved into our "new" headquarters on Pacific Avenue, and it needs sprucing up.  The tires on the Chevy can't be changed while the Chevy is going 60 mph, however, so ... if you have an urgent matter on Friday, you may reach me on my cell on Friday at 415-819-3856.

Urge the Governor to Sign AB 2093

We need your help - the Academy's co-sponsored bill, AB 2093 (M. Pérez), was approved by the Legislature and is on the Governor's desk awaiting his signature. Please write to him TODAY and let him know the importance of adequate vaccine payment.  A letter you can personalize is available here.  Please fax/mail in your support for AB 2093. The Governor needs to hear from EVERY FAMILY PHYSICIAN IN THE STATE about the importance of maintaining access to vaccines.

Letters may be faxed to 916-558-3177 or mailed to: The Honorable Governor Arnold Schwarzenegger, State Capitol Building, Sacramento, CA  95814.

This bill (co-sponsored by the California Chapter of the American Academy of Pediatrics, the California Medical Association and the California Association of Physician Groups) would require a health care service plan or health insurer providing coverage for childhood immunizations to adequately pay a physician or physician group for the cost of administering a vaccine.

Other Bills of Concern

Ten other bills of concern to CAFP are on the Governor's desk as well - some we support, some we oppose.   For more information about these bills, please go here.

CAFP Media Efforts Continue Unabated

Our efforts to keep family medicine in the news in positive ways continue unabated.  On the 16^th, Patricia Samuelson, MD will represent CAFP at a press conference with the California Department of Public Health about pertussis immunization.  Past President Tom Bent will be interviewed by American Medical News about the importance of eligible kids being covered under State programs such as Healthy Families/Medi-Cal following publication of an Urban Institute study in Health Affairs.

Over the past two months, CAFP members have been interviewed on whooping cough, the budget, the shortage of family physicians and other primary care physicians, AB 2093 (see above) and AB 1542, our Patient Centered Medical Home definition legislation still pending in the Legislature.

Medical Student Outreach

Student-Resident Coordinator Cody Mitcheltree heads to Southern California on Monday for a series of meetings with Family Medicine Interest Group coordinators on five campuses - Loma Linda, Western, UCI, UCLA and USC.  He'll also be touching base with pre-doctoral coordinators to see how CAFP can further encourage medical students to enter family medicine training. 

Los Angeles Chapter Meeting

Legislative Advocate Tom Riley, Membership Coordinator Sophia Henry and Student and Resident Affairs Coordinator Cody Mitcheltree will attend the Los Angeles AFP chapter meeting on Thursday, September 16.  If your chapter is interested in having a CAFP leader or staff member attend and/or speak at your chapter meeting, please contact Sophia at the Academy.

Posted on 09.07.10 by Executive Vice President Susan Hogeland, CAE

So much for summer - San Francisco's was so bad, I had to leave the country for three weeks.  And, while I was away, we finally got our summer - three days of 90 degree weather.  Now it actually feels as if fall is in the air.  If your summer was like CAFP's, there really wasn't any let-up in the work, but traffic was better.

Now, it's full steam ahead with so many projects.  Most pressing, of course, is keeping momentum for AB 1542, CAFP's sponsored legislation, to define the Patient Centered Medical Home (PCMH).  It seems the rules of the legislation take into account the craziness that can prevail there in the closing minutes of sessions, and give additional chances to try again.  Thus it is with AB 1542, which, in a "Hail Mary pass" in the Senate, secured enough votes to pass, but then didn't get concurrence in the Assembly before it adjourned.  But wait, there's more.  We get another chance during the extraordinary session to consider the budget because AB 1542 is an urgency measure. 

For now, we are thanking our key contacts who pulled out all the stops, the legislators who voted with us, and thanking the many other organizations that helped us in our advocacy effort.  It's likely we'll be asking YOU for help before it's all over.  More than 40 other states have passed legislation having to do with PCMH; we think it's time California did, too.

CAFP Secures Two New Grants To Help FPs

The Physicians' Foundation for Health Systems Excellence, primary grantor for CAFP's New Directions in Diabetes Care project of a few years ago, has come through for us again.  CAFP will receive one grant to develop a Health Information Technology (HIT) Toolkit to help physicians achieve meaningful use with their electronic health records and another to help develop new continuing professional development faculty.  The Toolkit will be located on our PCMH Resource Center on www.familydocs.org when it has been developed, and will be available to any physician.

Welcome To New Staff Member Marian Yee

Last week, CAFP welcomed Marian Yee as Director of Continuing Professional Development.  Marian comes to us from San Francisco State University where she was engaged in both continuing professional development and student health.  Prior to that, she worked for the San Francisco Medical Society.

CAFP To Attend CMA Specialty Society Meeting

Your President, Jack Chou, MD, Legislative Advocate Tom Riley and I will attend a CMA Specialty Society meeting in Sacramento on Wednesday from 10 am - 3 pm.  CMA hasn't convened the specialty societies in more than four years. 

AAFP Activities This Week

CAFP staff will participate in a webinar today with Quality Improvement guru Bruce Bagley of AAFP on physician payment reform; I'll participate in Wednesday evening's meeting by conference call of the AAFP's Commission on Quality and Practice Enhancement.  Next Wednesday evening, the CAFP Executive Committee and Delegation to the AAFP will participate in a call to discuss and take positions on the 55 resolutions that will be considered by the AAFP Congress of Delegates when it meets in Denver September 27-29.  Too much fun!

Posted on 08.30.10 by Executive Vice President Susan Hogeland, CAE

AB 1542's Fate Hangs in the Balance - Your Help Needed

CAFP's bill to define the Patient Centered Medical Home is practically on life support, with very few hours left to live - unless we have your help in resuscitating it.  The Legislature has until tomorrow, Tuesday, August 31 to vote on bills and send them to the Governor and it's likely our AB 1542 will be heard TODAY on the Senate Floor.  The bill requires a 2/3 majority vote, so it is critical that you contact your Senator today, if you haven't done so over this past weekend, particularly if your Senator is a member of the Republican Party (prior analysis of the bill by the Republican Caucus was not supportive.) Please call and email your State Senator BEFORE August 31. Tell your Senator:

1)      "I am a family physician who cares for thousands of patients in your district."

2)      "I urge you to vote in favor of AB 1542 when it is heard on the floor."

You may use the talking points below to make your case:

• AB 1542 (Jones) would define "Patient Centered Medical Home (PCMH)" to promote uniform standards of quality and access. By defining the PCMH, patients will benefit from a more continuous, comprehensive and seamless set of services - services for which public and private incentives are likely to increase in the coming months and years.
• The PCMH is a new but proven concept that stresses a team approach to care with an engaged patient at the center. It is a way to provide higher quality, more personal care using a team of health professionals who know the patient and work together to provide the right care at the right time.
• The PCMH improves the quality of care, particularly in the areas of preventive care and chronic disease management.
• In a PCMH, patients have enhanced access to their health care team through such means as open scheduling, expanded hours and new options for communication such as secured email.
• The bill has been amended to ensure that:

                  The bill will not cost the state money

                  The bill will not apply to the Section 1115 Medicaid Waiver

                  The bill will not create a demonstration project

                  The bill will not conflict with any aspect of Federal HC Reform

Please call NOW!  Thank you for your support of this important measure.  

To find out who your representative is, please visit the link provided below and enter your home zip code (or where you vote).  Find your Legislator.

Regulations, Regulations, Regulations

New CAFP staffer Leah Newkirk has been kept busy developing comments on the latest proposed regulations out of Washington, D.C.  On August 24, CAFP submitted a letter to Administrator of the Center for Medicare and Medicaid Services Donald Berwick, MD on the proposed rule regarding payment policies under the Medicare physician fee schedule and other revisions to Medicare Part B for calendar year 2011. The rule affects incentive payments under the Patient Protection and Affordable Care Act (PPACA) equal to 10 percent of a primary care practitioner's allowed charges for primary care services under Part B between January 1, 2011 and January 1, 2016 which are to be made on a quarterly basis.  PPACA defines primary care services as those services identified by Medicare payment codes and CMS's proposed rule includes a provisional list of codes. 

CAFP believes the list of services proposed is inadequate for capturing essential primary care services and that CMS has discretionary authority to broaden the list to reflect actual primary care services. PPACA includes discretionary authority when it defines primary care services as "services identified as of January 1, 2009, by the following HCPCS codes (and as subsequently modified by the Secretary)..." and urged CMS to use this discretionary authority to expand the list of codes included as primary care services to avoid the potential unintended negative consequence of excluding rural primary care practitioners and those working in Health Professionals Shortage Areas, who by virtue of the fact that there are not other practitioners in their areas, offer a broader range of services to their patients.  

AAFP also commented on the proposed rule.

Experiencing an Illness in a Foreign Country

I've been working from Mexico for the last two weeks - it's amazing what the Internet allows one to do.  One week into my trip, I developed an inner-ear infection that gave me newfound appreciation for what many kids experience growing up - I'd never had one before and this one was a doozie.  Inside of two days, my ear was swollen shut, the tissue surrounding it in my face and neck was sponge-like and it was, to say the least, incredibly painful.  After a sleepless night of realizing it wasn't going away on its own, no matter how much ibuprophen I took, my friends bundled me in the car and took me to the pueblo across the highway to the local physician.  His waiting room was his office was his exam room.  We had no appointment, but we were the only folks in the room, thank goodness, because it was about 12 x 14.  I think he was about 15 years old (I'm sure he was playing a game on the Internet when we arrived!).  I popped up on the exam table at his invitation, and with my friends looking on, he examined first my healthy ear and then my infected one.   HIPAA didn't seem to be a concern.  He agreed I had a bad infection and invited me to walk to the pharmacy with him.  It was just at the end of the hall.  He walked into the pharmacy as if he owned the place - apparently he did.

He went to a shelf, removed three items, wrote up a receipt and some instructions for taking the drugs (Bactrim, an anti-inflammatory/lidocaine ear drop, pain medication and nasal spray), wrote a receipt and took my payment ($65 for the visit; $70 for the drugs - Visa accepted).  So far as I know, no record of my visit beyond the receipt was made.  He did ask if I had any allergies to drugs.

So, was that health care concierge-style or advanced micro-practice-style?  Or urgent visit-style?  Or cash on the barrelhead style (what many physicians say they long for)?   I'm happy to report antibiotics, as of August 25, may no longer be sold without a doctor's prescription in Mexico.  And, thank you, Dr. Diaz, my infection has cleared up. 

Getting Ready

What's CAFP getting ready for?  A few things:  first, the upcoming AAFP Congress of Delegates - your delegation and executive committee will meet by conference call to review and take positions on the resolutions to be considered; CAFP has submitted two resolutions, one on AAFP's contract with The Coca Cola Company (asking AAFP to rescind), and another on transparency in guidelines committees.

Second, the Academy's 2011 budget - our noses will be to the grindstone for the next month and a half as we prognosticate and calculate.  The Board will consider the budget at its November 6 meeting in Los Angeles. 

Third, the AAFP Congress of Delegates marathon will continue for our delegation to AAFP because most of them also serve as delegates or alternates to the California Medical Association's House of Delegates meeting that immediately follows the AAFP meeting.  These folks are gluttons for punishment. 

Finally, the annual student conference will be held on October 16 at UCSF. 

Meantime, we're busy developing an HIT toolkit, completing work on our new Patient Centered Medical Home Resource Center, distributing the New Directions in Diabetes Care Best Practices compendium (available in both electronic and print formats), working with two residency program task forces, attending state workforce and HIT meetings, and more. 

Until next week ... hasta la vista.

Posted on 08.23.10 by Executive Vice President Susan Hogeland, CAE

Last Hurrah for AB 1542?

In the absence of a hail Mary-type pass, CAFP faces the very real possibility that AB1542, legislation to define the Patient Centered Medical Home (PCMH), will not pass.  CAFP legislative advocate Tom Riley and his staff have spent hundreds of hours on this legislation, with the assistance of physicians such as past presidents Carla Kakutani and Eric Ramos, both of whom have testified on behalf of the bill. 

Why has CAFP put so much effort into a definition bill?  It's a starting point - California is light years behind many other states in its progress on PCMH implementation.  A bill to define PCMH is a good starting point for our efforts to transform practices in our state.  Whatever the outcome of AB 1542, it won't be CAFP's last effort on PCMH.

CAFP-Supported Osteopathic Physician Bill Signed

Late Tuesday night, and with less than two hours remaining before his midnight deadline to take action, Governor Schwarzenegger signed into law CAFP-supported (sponsored by the Osteopathic Physicians and Surgeons of California) SB 1050 (Yee - D-San Francisco).  This important legislation will "re-separate" the functions of two very different oversight boards within the Department of Consumer Affairs; the Naturopathic Medicine Committee (NMC) and the Osteopathic Medical Board of California (OMBC). The bill will also remove the two naturopathic doctor positions from the Osteopathic OMBC. Naturopathic doctors, whose own board was slated for sunset, were added to the OMBC in the final minutes of last year's budget compromise, to the surprise of many. For more information, see AB X4 20 (2009-10 Budget trailer language) and SB 1050 (Yee).

 CAFP Immunization Bill Still Awaits Floor Hearing

The end of the two-year legislative session is Friday, August 27 and while CAFP's co-sponsored AB 2093 (M. Perez, D - Cathedral City is scheduled for a vote by the full State Senate, it's in a long queue of bills waiting to be heard. Our legislative staff needs your help - if you haven't yet contacted your senator to ask for support of the bill, please do so as soon as possible.   To identify your state senator, please go here:  http://www.leginfo.ca.gov/yourleg.html

CAFP Comments on 1099 Requirement

In an understandable effort to crack down on individuals and companies that fail to pay federal income taxes on some or all of their revenues and to help offset the expense of expanded health care coverage, provisions were contained in the Patient Protection and Affordable Care Act (PPACA)(HR 3590/PL 111-148) that amended current tax laws by expanding the reporting requirement to include the purchase of goods, as well as services, and to include purchases from corporations as well as from individuals.  The threshold for the requirement remained at $600; the effective date is January 1, 2012.  According to AAFP, the Congressional Budget Office has estimated that this provision of the Affordable Care Act will produce between $16 billion and $19 billion in additional revenue for the federal government over ten years.

The unforeseen consequence of the provision, however, is the additional burden it will create for small organizations and businesses - including medical practices - that must now file 1099 forms for all vendors with whom they do more than $600 worth of business.  At CAFP, that additional work is estimated to cost about $2,000 in accounting fees. 

There are competing bills in the U.S. Senate to amend PPACA - one that would repeal the provision and lower the threshold for the cost of insurance premiums to five percent from eight, creating an estimated two million more uninsured (Johanns R-NE), and another that would exempt businesses with 25 or fewer employees from the reporting requirement and raise the reporting threshold from $600 to $5,000 for businesses with more than 25 employees (Nelson D-FL).  The IRS also would be given authority to exempt payment for items with minimal compliance risk (e.g., office supplies, airline tickets and restaurant meals).

Senator Nelson's amendment would pay for the difference by repealing tax cuts for the five largest oil companies with more than $1 billion of before-tax income that currently allow them to deduct six percent of their income from oil and gas production from their tax liability.   

CAFP has provided input to AAFP on the amendments that urges no weakening of the provisions of PPACA, but seeks relief from the burden of the 1099 reporting requirement for members.

PCMH Discussions for Fresno Continue

CAFP remains closely engaged with representatives of the Joint Health Management Board for the Fresno Unified School District on the possibility of a PCMH pilot project in Fresno.  We are in weekly conference calls and recently communicated with the twenty-five family physicians who responded positively to a CAFP survey on interest in participating in a PCMH pilot project there.  Stay tuned!

Physicians' Foundation for Health Systems Excellence Awards Two Grants to CAFP

CAFP received word that The Physicians' Foundation for Health Systems Excellence has awarded two new grants to us:  one to help with a health information technology toolkit on meaningful use requirements for electronic health records and another to do leadership training for continuing professional development faculty.  Congratulations to CAFP staffers Leah Newkirk and Shelly Rodrigues for their hard work on these successful grants!  (Oh, right, NOW the real hard work begins.)

Congratulations to New Employees       

Three new CAFP employees completed their introductory periods recently:  receptionist Cecile Awayan, Director of Health Policy Leah Newkirk and Associate Director of Health Care Workforce Policy Callie Langton.  Marian Yee will begin working with the Academy on September 1 as the Director of Continuing Professional Development.

Posted on 08.09.10 by Executive Vice President Susan Hogeland, CAE

Legislative Activity Still Front and Center

The closing weeks of the legislative session have been incredibly hectic for CAFP's lobbying staff - with at least one new brush fire cropping up related to legislation that could be cumbersome for physicians who wish to provide patients with drug samples.  We're on it. ...

On the better news front, AB 2093 (M. Pérez), sponsored by CAFP, the California Medical Association, California Association of Physician Groups and the American Academy of Pediatrics), passed out of the Senate Appropriations Committee on a 7-1 vote last Monday.  The bill would require a health care service plan or health insurer providing coverage for childhood and adolescent immunizations to adequately pay a physician or physician group for the cost of administering a vaccine.  In addition, health plan contracts and insurance policies would be prohibited from imposing a deductible, co-payment, co-insurance or other cost-sharing mechanism for administering a childhood immunization.

The bill addresses a problem brought to CAFP's attention by members:  the payment physicians receive from health plans often fails to cover the cost to acquire vaccines for their patients.  The dilemma faced by many - subsidize each immunization given or turn away patients for this critical preventive care - is especially critical now, as California endures a pertussis epidemic.  The bill will now be voted on by the State Senate.

CAFP's legislation to define the Patient Centered Medical Home (PCMH), AB 1542 (Jones) faces additional hurdles in the Senate as well, but we are hopeful it will achieve passage.

Residency Program Directors Dine and Learn

CAFP hosted a dinner for nearly 30 family medicine residency program directors or their representatives on Tuesday, August 4 in Sacramento on the eve of the annual Song-Brown funding meeting (at which funds are distributed to programs based on service to the underserved).  Walt Mills, MD and Hector Flores, MD were instrumental in planning the meeting, along with Callie Langton, MPA, CAFP Associate Director of Health Care Workforce Policy.  Featured speakers included Lucien Wulsin, Peter Harbage and CAFP's own Tom Riley - all addressed health care reform's impact on the workforce.

CAFP Preparing for Long-Acting Opioids REMS

CAFP is spending a good deal of time trying to anticipate what the Food and Drug Administration will require with regard to its Risk Evaluation and Mitigation Strategy findings on long-acting opioids.  CAFP took the lead in putting a survey in the field in eight state academies, including California, to get a handle on family physician needs.  The results of the survey have been extremely helpful in providing guidance to the Academy and other organizations with which it has been collaborating on this issue.  CAFP Senior Vice President Cynthia Kear testified at an FDA hearing in Washington, DC two weeks ago and emphasized the importance of access to care and minimizing hassle for physicians who care for patients with chronic pain.

Dr. Grundy to Return to California

At CAFP's request, Paul Grundy, MD, IBM Global Director for Health Care Transformation and President of the Patient Centered Primary Care Collaborative, will return to California November 10-12 for select meetings with family physicians and others interested in becoming Patient Centered Medical Homes (PCMHs).  CAFP is working to set up meetings on the 10^th, but on the 11^th, Dr. Grundy will travel to San Diego for a meeting with the Sharp Rees Steely Medical Group, at CAFP board member Steve Green, MD's request.  A meeting with TRICARE and the Veterans Administration is also in the works. 

CAFP continues its work to encourage a PCMH pilot project in Fresno through the Fresno Unified School District's Joint Health Management Board. 

It was announced on Friday that IBM and ActiveHealth Management have teamed up to devise a new software system to help doctors manage patient care on a number of fronts:  Collaborative Care Solution is the name of the new management solution, which purports to help doctors track patient care, evaluate performance against quality standards and even indicate whether a patient has filled a prescription.  (http://www.businessweek.com/ap/financialnews/D9HDHT1G0.htm) It was further announced that Sharp Community Medical Group in San Diego is the system's first customer.

One of the most gratifying things about CAFP's work with Dr. Grundy has been learning just how many family physicians are in the midst of transforming their practices to PCMHs.  If YOU are doing such work, would you kindly let me know by email?  Simply say:  "Susan, I'm transforming my practice to PCMH."  It's likely I'll get in touch with you to learn more!

Swimming to Catalina

CAFP has some remarkable members - remarkable not only for their skills as family physicians (well, ALL our members are remarkable for that) - but also for the other activities they undertake. For example, on August 5, Vice Speaker Steve Green, MD swam the Catalina Channel in 11 hours and 31 minutes - a remarkable achievement!  Congratulations, Steve.  Are there any other crazy people out there who'd like to tell us about their exploits??

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!