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Physician Fiscal Cliff Predictions

 

Now that we have survived the Mayan Calendar "end of the world," physician organizations like the American Medical Association and the American Academy of Family Physicians are trying to raise awareness of the "Physician Fiscal Cliff" of 27% Medicare Payment Cuts to Physicians as of January 1, 2013.

Does this seem like deja vu? Well, it is. The threat of Medicare Cuts to Physicians occur once or twice a year. One year ago, I wrote a post on this blog called "I will stop taking Medicare patients as of January 1st" which generated decent discussion on the blog, on twitter, and on facebook. AAFP has already posted information if physicians are considering opting out of Medicare.

So, here we go again. The bad news is that this story is not getting any traction in the main stream press - other than from our friends at Forbes yesterday who posted the article "27% Medicare Pay Cut For Doctors Real Danger In Fiscal Cliff." (BTW, the photo in the article is surgeons. This reinforces the bias against primary care physicians - Sheesh)

What's going to happen in this deal? Even with last night's failure of the US House to pass their "Plan B" bill, I'm still going to make these predictions which are in line to what has happened in past "crises":

  • The "Doc Fix" legislation will be split out of the main "Fiscal Cliff" negotiations and passed on it's own
  • Instead of a 27% cut, lawmakers will approve a 2 percent increase in payments, like they have in the past (Lawmakers will call this a 29% increase in physician payment. It's lawmaker math...)
  • This legislation will be for one month which will mean we'll all go through this again next month, similar to what happened in 2010 (Congress will not even consider a permanent Medicare SGR Fix)
  • The votes will be done and the President will sign on Thursday, December 27th, 2012

In past years, I've kept track of legislative updates on the website "The Hill" with looking for the key phrase "doc fix." What do you think of my predictions? Tell me where I'm wrong and tell me what your predictions are for this "Physician Fiscal Cliff" drama....

Mental Illness + Guns + American Culture = Tragedy

I will say this up front: Newtown, Connecticut will not be the last time tragedy strikes. For good or bad, in this age of social media including twitter, it is easier to track the coverage of this story and people's opinions about it. I have been thinking about this constantly today, and talking with my friends & neighbors about what happened this morning. (Above Image Credit: CNN)

Outlining the problems setting up this tragedy are well known and well documented: 

  • Mental Illness: It is no secret that there is lack of adequate tracking and treatment of the mentally ill in the United States. I wrote a series of posts more than 5 years ago following the Virginia Tech shootings: "Mental Care Delivery In the US," "Depression = Murderer?" "Privacy Laws Need Scrutinized" Will mental illness finally have its due and be seriously addressed in this country? Nope.
  • Guns: Do guns kill people? Yes. Do people kill people? Yes. Do we need more gun laws? Probably. Are there too many gun laws? Probably. Twitter is fired up on this issue right now. Will anything really change? Nope. Republicans will not let that happen.
  • American Culture: Of course there is a desensitization of violence in American culture. This has been happening for a long time. The usual suspects will be blamed including music, the internet, movies, television and video games. Will anything about these change? Nope. Democrats will not let that happen.

Newtown will be added to the litany of names of other tragedies like Columbine, Virginia Tech, Tucson, Aurora, this week's Happy Valley Oregon. The question always turns to this: "How can we prevent the next tragedy?" More gun laws? Probably. Better mental illness care? Probably. Changing American culture? Probably.

But, let me tell you this. Change is not going to happen. There has to me massive steps on multiple fronts to even try to address this very complicated problem. That is what makes this a continual sad situation. This story will be in the news cycle for two weeks. And, then after Christmas and after New Years, the drive to make change will dissipate. I wrote the following passage back in 2007 in a post entitled, "Can The Cycle Be Broken", and, again in 2011 following the shootings in Tuscon, and unfortunately, it still rings true today:

Of course, people are outraged by this situation. I'm outraged by what happened. But, I've seen this too many times. We are shocked by what happened, we mourn the victims, we blame whomever we need to blame for what happened, then we go back to our apathy until the next tragedy happens. Well, I'm sick and tired of this useless cycle. Instead of outrage turning into apathy, let's turn outrage into action. And, I'm not talking about knee-jerk reactions...

Um, uh, wait a minute. As I think about things now, I'm thinking about what realistically can happen? Would it mean a radical change in American culture? A culture that celebrates violence? A culture that makes celebrities out of people like Eric Harris, Dylan Klebold, and Cho Seung-Hui. Unfortunately, this is a culture that shirks at the idea of accountability. A culture that believes that it's someone else's job to fix the problem. A country and culture that feels no personal investment to fix its own problems. Am I wrong here? Please tell me I'm wrong...

It breaks my heart that tragedies like this continue to happen. But, if this status quo continues, I will wait for the next city to be added to this list to write about this again...

FamMedRocks Ep286: Dr Davis Liu

Thanks again to my guest on Family Medicine Rocks Episode 286 who was Dr. Davis Liu author of the book "The Thrifty Patient: Vital Insider Tips for Saving Money And Staying Healthy." We had a great conversation about the book which I think is a great read. It's only about 100 pages in paperback and really directed toward the patient/health consumer.

The titles of the chapters include "What To Do To Stay Healthy," "Prescriptions: Not Just For Sick People," and "Using Dr. Google: When To Seek Care And How To Get The Best Care." And, at the end of each chapter, there is something called "Take Home Points" which are the essential things to remember from that chapter.

In addition to the book, we talked about why we think Family Medicine is important and why it's important that Primary Care and Family Medicine need to be empowered to show the nation our value as physicians. You'll see in the video above, Dr. Liu's closing thoughts talking about Leadership.

In addition to this book, he is the author of "Stay Healthy, Live Longer, Spend Wisely." You'll see from his website that he has also written op-ed pieces and done a lot of media work when it comes to television and radio. We need more Primary Care and Family Physicians like Dr. Davis Liu getting out there in media.

I encourage you to check out the entire audio podcast for Family Medicine Rocks Episode 286. I also encourage you to check out the podcast page for the show, and subscribe to the iTunes feed. In addition follow me on twitter, "Like" the facebook page for this show, check out my youtube page, and take a look at my linked-in page. Enjoy!

Listen to internet radio with DrMikeSevilla on Blog Talk Radio

Open Letter to AAFP Board of Directors

 

Dear AAFP Board of Directors,

Through my inside sources, I have learned that your first Board meeting of the year starts today. Actually, it wasn't through secret sources, it was through social media. First of all, I just wanted to thank all of you for taking the time out of your busy schedules to serve the Academy - what an exciting time for all of you!

A lot of people out here will give you policy recommendations on where the Academy should stand on certain issues. This letter is not that. This letter is to encourage the Board to continue its great use of Social Media to effectively communicate with membership and to communicate with the public.

As a Family Physician and Social Media Enthusiast, I have really enjoyed things like the Leader Voices blog, the increased activity of twitter/facebook, and the beginnings of the use of video announcements/commentary by Board members. There was probably an "orientation to media" session given at some point, and I hope that social media was a part of that.

I wish you all the best in your work this week at your first Board meeting. It's easy to get caught up in the work of the Board, but don't ever forget us our here in the grassroots. Even more important than what you're doing behind closed doors, what's more important, in my humble opinion, is communicating "what" and "why" you're doing something to the AAFP membership. Have a great Board meeting.

Mike Sevilla, MD

#CPI12: Attendee Interviews

This is the next post in a multipart essay on last week's 2012 Conference on Practice Improvement organized by the Society of Teachers in Family Medicine and American Academy of Family Physicians. This conference took place in Greenville, South Carolina and previous posts were ones on the pre-conference and a video interview with Dr. Bruce Bagley.

I also recorded a couple of video interviews with attendees from the meeting, and you'll see them below from Dr. Jay Lee and Dr. Bryan Hodge. It's always great getting the attendee perspective at the meeting. Enjoy!

#CPI12: Risk Stratified Care Management

This is a second in a multi-part series talking about last week's Conference on Practice Improvement organized by the Society of Teachers of Family Medicine and American Academy of Family Physicians. The previous post talked about the pre-conference sessions.

In the video above, I talked with Dr. Bruce Bagley from TransforMED.com and AAFP specifically talking about the idea of Risk Stratified Care Management and why that is important in a Patient Centered Medical Home system. In addition, the AAFP just released a new RSCM Assessment tool last week to help assist clinicians in this process, and you can access that at www.AAFP.org/rscm

Dr. Bagley is even on twitter, tweeted during the meeting, and even attended our social media session. How cool is that? In the next few days, I'll be writing more blog posts and sharing more videos that I recorded at last week's #CPI12 meeting. Enjoy!

#CPI12 Pre-Conference

 

This is my first Conference on Practice Improvement meeting and it was a great Pre-conference day. For those who are not familiar, this is organized by the Society of Teachers of Family Medicine and the American Academy of Family Physicians and the location of this year's meeting is in Greenville, South Carolina.

The highlight for me was a Pre-conference session talking about practice transformation and clinical innovation. Of course, there were concepts on the Patient Centered Medical Home talked about, but there was so much more. Being at the grassroots, it's difficult to see the big picture, because I'm just trying to keep up with day-to-day office duties, like keeping up with my electronic medical record.

But, it was great to see a presentation kind of put everything together from "Who is in your medical neighborhood" to "This is how you use data driven care to improve the quality of your patient care." I have never really had the time to dive into my own EMR and explore its full functionality and do things like find trends in clinical numbers or use the EMR as a patient registry to remind myself of preventative maintenance issues.

Dr. Bruce Bagley from TransforMED.com introduced an entirely new webpage on the AAFP website having to do with Risk Stratified Care Management. This asks you, "How can you formally figure out which patients are going to require more of your time & attention and your staff's time & attention?" We kind of do this already informally, but what is very exciting is this chart which puts this concept in an organized format.

Day Two of the conference is today and is highlighted by main stage speaker Christine Bechtel whose talk is entitled "Patient Centered Care: What is it and how do we get there?" You can follow along on twitter with the #CPI12 hashtag. I'm also going to try to record video interviews during the conference. Stay tuned for more updates!

Healthy Holiday Eating Tips

It's holiday time again and there's nothing better to do than gathering with friends and family for a meal. Are there ways to have healthy holiday eating? You bet there are. In the video above, I talk about some tips to still enjoy your meal, but still make some healthy choices.

The TV interview above is a short 2 minute chat set up by Salem Community Hospital and recorded at WKBN-TV in Youngstown, Ohio on Monday, November 19, 2012. If you found this interview helpful, I also encourage you to check out previous interviews at MikeSevilla.TV. Also check out my other social media areas like the facebook page for this website, audio podcast site, my twitter feed, and my linked-in page. Enjoy!

Here's To The Crazy Ones

"Here's To The Crazy Ones. The misfits. The rebels. The trouble-makers. The round pegs in the square holes..." The video above is from the Apple "Think Different" campaign. What's unique about the video above is the voice over is by Steve Jobs, and not by the orignial actor who did the spots...

I read a post today from my friend Dr. Bryan Vartabedian, otherwise known as @Doctor_V on twitter. He talked about a band of tweeting pediatricians called "Tweetiatricians" whose name was born at the American Academy of Pediatrics meeting last week. In the post, he says that some liked the moniker, and some didn't. Some said that the name diminished from what pediatricians should be doing on social media. He writes...

I may be the wrong person to be chiming in here.  I’m sometimes accused of taking all of this too seriously.  I do struggle with the balance of levity and leadership.  And I’ve noticed that the more people who watch me, the more challenging it is to be myself in the most transparent sense.

Of course, this made me reflect on our little Family Medicine social media group that was coined #FMRevolution on twitter by my good friend Dr. Jay Lee. If I have been accused of anything, I've been told that I'm not taking all of this serious enough. "Mike, you joke around too much on social media with all of your Doctor Anonymous shenagigans," I've been told in the past.

Maybe it's a generational thing, but doctors are not "joiners" these days. When it started, it was really fun to join a group of Family Docs who used twitter a lot. And, no one thought that #FMRevolution would go from a small little group to being mentioned at the podium by more than one AAFP Board member at our annual meeting.

So, what ever you call it #FMRevolution, #Tweetiatrician, or whatever - the easy part is catching their attention. The hard part is keeping their attention, and even more difficult that that is figuring out a way to turn that feeling, emotion, and camaraderie into action. Whether you're a Family Doc, or Pediatrician, or anyone else. The real power of social media is bringing about change: "...because the people who are crazy enough to think they can change the world, are the ones who do."