First Quarter 2013 The Scope of Family Medicine A Publication of the Alabama Academy of Family Physicians • www.alabamafamilyphysicians.org Medicaid Advisory Commission Submits Report to Gov. Bentley PG 10 2 The Scope of Family Medicine The Scope of Family Medicine Spring 2013 Officers Contents *Allen Perkins, MD, President *Tom Kincer, MD, President-Elect From the President ..............................................5 Drake Lavender, MD, VP Northwest (’14) Pamela Tuck, MD, VP Southeast (’15) Alabama’s Rural Health Plan ..............................6 Jarod Spear, MD, VP Northeast (’16) Boyd Bailey, MD, VP Southwest (’13) 2013 Alabama Legislative *Mike McBrearty, MD, Treasurer Jeffrey E. Arrington, Executive Vice President Regular Session Snapshot ....................................8 (*indicates member of the Executive Committee) Medicaid Advisory Commission Submits Board of Directors *Tonya Bradley, MD, Chair Report to Gov. Bentley ......................................10 Jerry Harrison, MD, At Large (’13) Julia Boothe, MD, At Large (’15) Provider Payment Accuracy Is Focus of State- Pamela Tuck, MD, At Large (’14) Nelson Cook, MD, Calhoun County Branch Based RAC Program ..........................................10 Michael McBrearty, MD, Gulf Coast Branch Lisa Columbia, MD, Jefferson County Branch Project Designed to Prevent Preterm Births Tracy Jacobs, MD, Resident Chapter President Fuller McCabe, Student Representative in at-Risk Recipients ..........................................11 Congressional District Reps Medicaid, ADPH Collaborate to Build Vacant – District 1 Beverly Jordan, MD – District 2 New Enrollment System ....................................11 Michael Goodlett, MD – District 3 Laura Lee Adams, MD – District 4 HHS Revises HIPAA Privacy Rule ....................12 Kristy Crandell, MD – District 5 Albert Smith, MD – District 6 Save the Date! ....................................................16 Bob Grubbs, MD – District 7 AAFP Delegates Advertisers Melissa Behringer, MD (’14) Alabama Department of Public Health, Epidemiology Division ............. 14 Steve Furr, MD, (’13) Alabama Department of Public Health, Immunization Division ...............4 AAFP Alternate Delegates Alabama Disability Determination Service ...............................................13 Tonya Bradley, MD (’14) Belk & Associates, Inc. .............................................................................. 14 Jerry Harrison, MD (’13) Children’s of Alabama ............................................................................... 16 Coastal Insurance Risk Retention Group, Inc. .........................................15 Scope Managing Editor Jeffrey E. 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The views and opinions expressed in Scope do not www.ipipub.com Published March 2013 • 2013/1 2013 Published March necessarily reflect the policy of the Alabama Acad- emyAlabama of Family Academy Physicians. of Family Physicians 3 The Stethoscope of 2020 FROM THE PRESIDENT The Stethoscope of 2020 by Allen Perkins, MD When Laennec invented the stethoscope entists were trained in laboratory investiga- patient safety and the quality of care pro- in 1816 and physicians no longer had to tion as a prelude and foundation for clinical vided, as well as participate in lifelong put their ear to the patient’s breast, health training and investigation in university hos- practice improvement. care delivery changed. Asepsis, effective pitals. All physicians had a responsibility to • Physicians are generally not prepared to be treatments for syphilis and other break- generate new information and create prog- advocates for patients on issues related to throughs soon followed. By 1910, everyone ress in medical science, with assignment of social justice (for example, elimination of was aware that medical training and prac- this task to both laboratory and clinical sci- health care disparities and access to care) tice needed updating. “Heroic” treatments entists.”1 This system was created and was and to be citizen-leaders inside and outside (such as blistering, bleeding and purging) dominant for almost 100 years. of the medical profession. were known to cause harm to patients and • Physicians often lose altruism and qualities were avoided. Patients had been exposed In 2007, the American Medical Asso- of caring as they proceed through training to newfangled technology such as antisep- ciation offered a critique of the care we and enter the practice environment. tic surgery, vaccinations and public sani- Flexnerian physicians deliver.2 The good • Because of their training, physicians find tation. Most of the public understood the news: Doctors who train and practice in it difficult to deal with the inevitable un- advantages of scientific medicine, though the Flexnerian model are knowledgeable certainty arising from incomplete or con- they didn’t know quite what it was. Almost and technically proficient in providing care flicting information. Additionally, they all physicians now wanted to say they were for acute disease; they wish to do what is are not typically prepared to convey their practicing in a scientific manner, though, best for their patients; and patients respect uncertainty when interacting with patients in truth, many were not. them as credible sources of information. and colleagues. • Many physicians are not prepared to utilize Abe Flexner was hired to assess the state of The bad news? To paraphrase from the re- information technology to assist in infor- medical education in 1910 and determine port, though many of us do try very hard, mation acquisition and management. if the schools were up to providing practi- all of us are deficient to some degree in the • Physicians are trained to be autonomous. tioners for the scientific age. As a result of following areas: This can be a barrier to providing patient- his report, the ideal of medical education • Physicians are not prepared to evaluate centered care, where patient values and and practice changed. The new leaders en- the care they provide in their own prac- desires are an integral part of shared deci- visioned a system “in which physician sci- tices and to use the results to improve sion-making. The expectation of autonomy diminishes the ability of physicians to act as team players with other physicians and other health professionals. • Physicians are not prepared to participate in ethical and political discussions about the allocation of health care resources, which are not limitless. • Graduates do not acquire skills in cul- tural competence/awareness and to recog- nize that some patients may have health literacy issues. In the future, we must perform consistently better. Partly as a response to the findings in this report, our Academy and others signed on to the joint principles that now form the basis for the patient-centered medical home (PCMH) model of primary care de- Continued on page 13 Alabama Academy of Family Physicians 5 Alabama’s Rural Health Plan An Analysis of Access to Primary Care in Rural Alabama Published by The Office for Family Health, Education and Research, UAB School of Medicine, Huntsville Regional Medical Campus Executive Summary Findings Conclusions A comparison of the health status of Ala- An extensive review of the health outcomes Community-oriented access to primary bama’s citizens to nationally recognized literature relative to primary care services, care through a relationship with a family health status indicators show that rural primary care access and primary care provid- physician is the most functional and practi- Alabamians do not compare well with ers finds that patients of primary care physi- cal way to improve the health status of Ala- the United States as a whole or even with cians had better health outcomes regardless of bama’s rural population. The communities Alabama’s urban population. Alabama’s the geographic area, year or outcome measured. in which Alabama’s rural hospitals are rural residents have significantly poorer Traditionally derived physician/population