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.