Grant Hoekzema

Health is primary: Family medicine for America's health.

PURPOSE More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to “renew the specialty to meet the needs of people and society,” some of which bore important fruit. Family Medicine for America’s Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). METHODS Family Medicine for America’s Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. RESULTS The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support effective care; improving research underpinning primary care; and actively engaging patients, policy makers, and payers to develop an understanding of the value of primary care. The communications plan, called Health is Primary, will complement these strategies. Eight family medicine organizations have pledged nearly

Accountable care organizations: an opportunity for synergy.

20 million and committed representatives to a multiyear implementation team that will coordinate these plans in a much more systematic way than occurred with FFM. CONCLUSIONS Family Medicine for America’s Health is a new commitment by 8 family medicine organizations to strategically align work to improve practice models, payment, technology, workforce and education, and research to support the Triple Aim. It is also a humble invitation to patients and to clinical and policy partners to collaborate in making family medicine even more effective.

Hitting the ground running: medical student preparedness for residency training.

With the reelection of President Obama, full enactment of the Patient Protection and Affordable Care Act is all but certain. Part of that legislation is the establishment of Accountable Care Organizations (ACOs). These large networks require a minimum of 5,000 Medicare patients, and will assume the total costs for their care in many cases. Over 140 ACOs are already established with over 130,000 physicians and 2.2 million beneficiaries.1 Much of the broad legislation governing ACOs has yet to be converted to specific regulations, which will vary between states. Because so much of this change has yet to be decided, and large systems will have to rapidly adapt, ACOs may become a sudden order of business for family medicine program directors. ACOs are a model of shared risk for costs and savings of a defined population. The more patients a network has, the more easily they can spread the costs of expensive care of the relatively few. In the ACO model, hospitals will shift from revenue centers to cost centers. ACOs have the potential to shift systems to embrace wellness rather than reactive illness care. In the future, we may get reports on how much our patients cost the system, rather than how much revenue we generated with our level-4 visits, inpatient billing, and procedures. Many systems will need to increase their primary care workforce as more patients have health coverage, and systems shift their emphasis to outpatient and preventive care. Insurance and payment reforms are the first 2 steps in health care reform. The third phase is delivery system reform.1 A need to educate those making ACO formation decisions will exist, regarding the value of family medicine residency programs to ACO networks. One of the fundamental objectives of the National Institute of Program Director Development (NIPDD) training is to understand the worth of your program; in the world of ACOs, our 2 principal strengths to promote will be cost-effective care and workforce generation. To truly provide population health care (rather than just those who come to see us) will require a fundamental shift in perspective for our systems, and most of us as well. Many of us will need to learn new skills; we will need to strongly advocate for resources such as case managers, chronic disease registries, and searchable electronic health records to provide high quality, cost-effective health care to a population. We also need to advocate for payment reforms that truly reflect our value to our systems. If we are not involved in the early formation and leadership of ACOs, we risk maintaining the status quo of huge payment disparities between procedure-based specialists and diverse primary care practices. These disparities discourage future medical students from entering primary care, which eventually will hurt all of our patients. Residency education about cost-effective care is optimized if the system can provide each resident with clinical quality and cost data on their own panel of patients, rather than having them subsumed under the faculty patient panel. We need to advocate for not just teaching about quality improvement, but doing it in our residency practices. Family medicine has a long and celebrated history of advocating for our patients. With the formation of ACOs, there is a moral imperative that we advocate for systems that reflect our values as a specialty. In the next few months, many decisions will be made that will affect both process values (the rules that govern decision-making processes such as transparency, accountability, and participation) and content values (clinical effectiveness, cost-effectiveness, justice/equality, and autonomy).2 We all need to ensure that family medicine has a voice at the table, and that we are proud of the end result. After all, the ACOs created in the next few months will be the ones our graduates will be practicing in for the foreseeable future.

Residency “Dashboard”: Family Medicine GME’s Step Towards Transparency and Accountability?

The fundamental task of all program directors is to graduate residents who are prepared and competent to practice the scope of family medicine “without direct supervision.” There is a sense that this is becoming increasingly difficult. Even before July’s anticipated duty hour changes, there is

Sharpen the Saw

As we drive to work each day, we each see things unique to our locales, but one thing in common is that we all look at our vehicle’s dashboard. We do this because it is one place that shows us information that affects each trip we make, unlike the weather outside, which may or may not have an

A FAMILY MEDICINE RESIDENCY PROGRAM CURRICULUM RESOURCE

The longevity of program directors is often inversely proportional to the level of stress and burnout experienced. The average “lifespan” of a program director is currently 7.5 years.[1][1] An effective method to prevent burnout is participating in ongoing professional development. Just as

EDUCATION GAPS BETWEEN FAMILY PHYSICIANS AND LICENSED NURSE PRACTITIONERS

Family medicine has been thrust into the national spotlight by the Affordable Care Act of 2010 bringing the concept of the medical home to the forefront and placing family physicians at the hub of the medical care delivery model of the future. These events also task training programs across this

IMPLICATIONS OF THE 2011 ACGME DUTY HOUR RULES

As millions of Americans gain coverage for medical care in the coming years and as the need for primary care in patient-centered medical home (PCMH) models increases, our medical homes will need to provide more access to care. One such method is through advanced physician extenders which include

THE DELTA-EXCHANGE

In May 2010, Dr Thomas Nasca, Accreditation Council for Graduate Medical Education (ACGME) CEO, outlined the process of revising the 2003 duty hour requirements. He stated the overriding principles of patient safety and excellent patient care in teaching settings, delivering outstanding education

The family medicine match: bull market or dead cat bounce?

Imagine, if you will, a large boardroom with a mahogany table. Around this table sit the 500 smartest people in the world. In the front of the room is a fully connected white board that collects the myriad of ideas that this group generates. This miracle of science categorizes all the great ideas