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Winter •2014

The VAFP Wishes You and Your Family a Happy and Healthy New Year!

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VAFP Mission Statementthe mission of the VAFP is to empower its members to be personal physicians who ensure accessible health care, dedicate themselves to ensuring the dignity and wellbeing of the citizens of Virginia, and are guided by the principle that the family physician is the specialist of choice for lifelong care.

VAFP Vision Statementthe vision of the VAFP is for Virginia to be the best place for family physicians and their patients.

OFFICERSPRESIDENTRobert Elliott, M.D.•Hurt

PRESIDENT-ELECTCharles Frazier, M.D.•Williamsburg

FIRST VICE-PRESIDENTLindsey Vaughn, M.D.•Suffolk

PAST PRESIDENTSean Reed, M.D.•Charlottesville

TREASURERRoger Hofford, M.D.•Salem

SECRETARYKent Willyard, M.D.•NewportNews

EXECUTIVE VICE PRESIDENTTerrence Schulte•Richmond

DIRECTORSRupen Amin, M.D.•Harrisonburg

Timothy Beirne, M.D.•Vinton

Grace Chiu, M.D.•Chester

Dena Hall, M.D.•Suffolk

Susan Hundley, M.D.•Clarksville

Patricia Matto, D.O.•Danville

Hughes Melton, M. D.•Bristol

Kate Neuhausen, M.D.•Richmond

ADVISORSMSV DELEGATERobert Elliott, M.D.•Hurt

MSV ALTERNATE DELEGATECharles Frazier, M.D.•Williamsburg

AAFP DELEGATESSterling Ransone, Jr., M.D.•Deltaville

Kurtis Elward, MD, MPH•Charlottesville

AAFP ALTERNATE DELGATESJesus Lizarzaburu, M.D.•Grafton

Mark Watts, M.D.•Vinton

EX OFFICIO MEMBERSNorman Oliver, M.D.UniversityofVirginia

Tony Kuzel, M.D.VirginiaCommonwealthUniversity

Christine Matson, M.D.EasternVirginiaMedicalSchool

Michael Jeremiah, M.D.VirginiaTech/CarilionSchoolofMedicine

Brian Dickens, D.O.VirginiaCollegeofOsteopathicMedicine

Michael G. Hueber, DO, MSLibertyUniversityCollegeofOsteopathicMedicine

The Virginia Family Physician is published by the Virginia Academy of Family Physicians1503 Santa Rosa RoadSuite 207Richmond, VA 23229

family physicianVTheW i n t e r • 2 0 1 4

Mark your Calendars!2015 VAFP Winter Family

Medicine Weekend January 30 - February 1, 2015

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InnovatIon

innovation drives progress, it is all around us in this ever changing medical environment. to be innovative, to create items and processes that are new, is a foundation of our profession. Physicians have been creative in approaches to diseases, cures for cancer, treatment for heart disease.

We are now asked to manage populations, control cost, create new systems for managing care. the issue with innovation is the risk inherent in trying something new. But if innovation doesn’t occur then no progress is made in solving issues that face us as physicians and confront our patients. in Family Medicine where by nature we provide care for all types of patients, who present

with problems that can be categorized as urgent/acute problems, chronic disease management, and wellness what innovative ways can we develop to continue to provide comprehensive, compassionate care throughout the spectrum of life? How do we create systems of care that are integrated, cost controlling and valuable? Can our business model be adapted to manage these different types of patient problems? For individual practice groups, hospital based practices, larger health systems even those that have been approved for PCMH to create these solutions without being able to share them across different provider groups only perpetuates part of the problem of spiraling health cost. these innovations somehow need to be shared across the continuum of healthcare delivery; otherwise medicine will continue to be fragmented and it will not be able to implement best practices. the next phase of Meaningful Use should help define this issue, even now Population Health management systems that are cloud-base can create data bases that are decrypted so that the data can be managed but the system stays blinded to the actual source of the data. this would allow a system on one brand of eMr to potentially share its data with another health system on a different eMr platform. How creative can we be?

this fall, the VAFP Board met in my home town of Altavista, at the Avoca Museum and briefly solved the physician shortage in our area. (see VAFP Board group photo at Avoca Museum) in this historic setting, we discussed the development of language for legislation to be presented at the upcoming General Assembly session on the issue of Prior Authorization. Mr. Hunter Jamerson, our Legislative Consultant has been instrumental in producing this bill and finding sponsors and supporters for it.

the VAFP Advocacy Day will now coincide with MSV White Coat Day for our specialty and is scheduled for February 11, 2015. the work of Dr. Sean read, Dr. Jesus Lizarzaburu, Mr. Jamerson and VAFP staff, along with MSV President Dr. Sterling ransone and MSV staff are to be commended for their efforts for facilitating this process.

VAFP President’s Message

robert elliott, MD

There are WORKPLACES. And there are FAMILIES.

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To learn more about career opportunities at Patient First, contact Recruitment Coordinator Eleanor Dowdy at 804-822-4478 or eleanor.dowdy@patientfirst.com or visit prcareers.patientfirst.com/

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the resident and Student representatives to the fall VAFP Board meeting, Dr. rawlings and Ms. Cetrone, were instrumental in driving the discussion toward the creation of a “Marketplace” for jobs available in the Commonwealth and for residency slots available in the different programs as VAFP hopes to promote the practice of medicine in our state. this marketplace will be located on the VAFP homepage and is in the process of being developed. there was again discussion on the development of a mentoring program for students and residents in Family Medicine.

At the October meeting of the AAFP Congress of Delegates in Washington D.C. our delegation of Dr. Kurt elward, Dr. Sterling ransone, Dr. Jesus Lizarzaburu, and Dr. Mark Watts, successfully submitted and won approval for a resolution to seek standardization of the prior authorization process, and a resolution that directs the AAFP in its advocacy efforts to create model legislation that could be used by different state chapters.

At the MSV House of Delegates in Williamsburg, MSV and VAFP pledged support to work together in the upcoming

General Assembly on the issue of prior authorization.

the recent State Legislative Conference in new Orleans presented issues on the

national front that can be utilized on the state level. the Health is Primary campaign, launched at last month’s AAFP Scientific Assembly, was presented and discussed.

As we approach this holiday season i wish you all the best of times, and thank you for the continued diligent work you do for the patients of our Commonwealth. i look forward to seeing you at the Wintergreen Meeting January 30 – February 1, 2015. if any of these items have stoked your innovative insight please feel free to share with me at President@vafp.org.

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T H E Q U E S T I O N T O P H Y S I C I A N S . . . W H Y N O W ?

In the Fall 2013 issue of The Virginia Family Physician, in an article titled “Where We’re Headed,” I predicted that an ever-increasing number of medical practices would be purchased by hospital systems. In the Spring 2014 issue of the same journal, in an article titled “The Unintended Consequences of Physician-Hospital Integration,” I noted the potential (and likely) downside to this medical practice purchasing binge hospital systems continue to be on. This is the third in the “trilogy” of articles on this subject. This article offers my take on why the purchase of medical practices may be happening from a physician’s perspective. First, let’s debunk the myth that this hospital buying phenomenon will unwind just like it did in the mid-1990s. Unlikely. This practice consolidation has legs. It’s caused (partially, at least) by laws that seemingly aren’t going away. The 2014 Practice Profitability Index reported that, of the 5,064 physicians surveyed, 47% either already sold their practice, are looking to sell, or are considering selling. The reasons for this trend vary. Many middle-aged to older physicians simply are tired of running a small business. With hospital employment comes the ability to come to work at 9am, go home at 5pm, and have most weekends free. The hassle of filing insurance claims for lower and lower reimbursements takes its toll on other physicians.

And then there’s Obamacare. The fear of the unknown. New regulations adding to physicians’ administrative work and the consequence of having to put ever-increasing amounts of money into their medical practice. It’s also those Gen Xers. Those physicians who are, by and large, actually frightened by the prospect of running a private medical practice in today’s marketplace. It’s much easier to let a hospital do it. A salary. Less hassle. More time with family. That’s what they’re looking for. For folks like me who enjoy the challenge of running small businesses and gauging customer satisfaction, I suppose this trend ultimately had to come. My first experience with the effect of a hospital’s buying binge of medical practices after a visit to my physician, now a hospital system employee, was to receive a bill from the hospital for the visit that was incorrect by $900+. I guess I should have expected no less.

K. Marshall Cook, Esq. VAFP General Counsel p. (804) 784-1900 f. (804) 784-1903 e. marshall@kmarshallcook.com

is a summary of health care information that will appear regularly in the Virginia Family Physician. Although it is written by the Academy’s General Counsel, it is not legal advice. The Academy and I hope its contents will be informative and helpful in your medical practice.

K. Marshall Cook, Esq. VAFP General Counsel p. (804) 784-1900 f. (804) 784-1903 e. marshall@kmarshallcook.com

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ResolutionsVirginia’s Resolutions to the AAFP Congress of Delegates Met with Significant Success

in an effort to engage the AAFP on several key issues which the VAFP Officers, Board of Directors, AAFP Delegates and Alternates and many members felt needed to be addressed nationally, the VAFP submitted three resolutions to the AAFP COD. One focused on standardization of the prior authorization process, the second directed the AAFP to move forward on creating state model legislation and the third sought to ensure up-to-date medication formularies.

A report of the resolutions and the AAFP Congress of Delegates actions are below:

Resolution 305: RESOLVED, That

the American Academy of Family Physicians collaborate with the American Medical Association (AMA), America’s Health Insurance Plans (AHIP), and other appropriate stakeholders to develop and implement best practices for the standardization of the prior authorization process across managed care plans in order to improve patient care, reduce errors, reduce delays, and decrease administrative burdens and costs imposed on family physicians, office staff and carriers, and be it further

RESOLVED, That the American Academy of Family Physicians, in coordination with appropriate stakeholders, develop and support model legislation at the state level to implement best practices for the standardization of the prior authorization process across managed care plans in order to improve patient care, reduce errors, reduce delays, and decrease administrative burdens and costs imposed on family physicians, office staff, and carriers. (See page 9 for full verbiage)

resolution 305 seemed to strike a chord with a variety of state delegates and was adopted with no amendments. the resolution received national attention in AMA MOrninG rOUnDS 10/23/14: (see below)

Group adopts resolution seeking

standardization of prior authorization process. Medscape (10/23, Tucker) reports that the

American Academy of Family Physicians Congress of Delegates had adopted a resolution called

“Request the American Academy of Family Physicians to Work With Insurers to Reduce the Administrative Burden for Medication Prior Authorization.” In particular, the “resolution asks AAFP to collaborate with the American Medical Association, America’s health insurance plans, and other stakeholders to work toward standardization of the prior authorization process across managed care plans and to develop and support model state-level legislation to implement best practices for

such standardization.” Resolution 509: RESOLVED, That

the American Academy of Family Physicians include in its legislative advocacy efforts the development and dissemination of model state legislation on key issues posing shared challenges to chapters. (See page 10 for full verbiage)

Surprisingly, despite the size of the AAFP membership, there has previously been no mechanism to develop model legislation to help chapters in state advocacy efforts. AAFP staff was concerned about the cost of taking on this effort but after debate on the floor of the Congress of Delegates (led by AAFP Delegate and Past President Kurt elward, MPH, MPH) the resolution passed with the provision that the AAFP would indeed not only provide guidance but also work on development of model legislation where none exists. this is a major win for the VAFP’s legislative efforts with the Virginia General Assembly. the Congress amended the resolution to read:

RESOLVED, That the American

Academy of Family Physicians

include in its legislative advocacy efforts the development of a system for the AAFP to collect, maintain, develop, and disseminate models of legislation to the chapters for use in their home states.

Resolution 610: RESOLVED, That the American Academy of Family Physicians collaborate with appropriate stakeholders, such as the American Medical Association (AMA), other specialty societies, pharmacy benefit managers, and managed care plans to ensure provision of up-to-date medication formularies to physicians, pharmacists, electronic medical record vendors, and health systems, in an easy to use format, with improved standardization, and be it further

RESOLVED, That the American Academy of Family Physicians, in coordination with any other appropriate organizations and government agencies, identify legislative and regulatory solutions to standardize exchange of formulary information, and develop model legislation or regulation to ensure facilitation of timely patient access to medication, and be it further

RESOLVED, That the American Academy of Family Physicians request pharmacy benefit managers and managed care plans to provide the National Drug Code (NDC) numbers of medications covered so some electronic medical records users can update their software systems if possible and not depend upon the vendor, and be it further

RESOLVED, That the American

VAFP Delegate Kurt elward, MD chairs a reference committee at the 2014 AAFP Congress of Delegates.

VAFP Alternate Delegate Jesus Lizarzaburu, MD pictured with AAFP President robert Wergin, MD.

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introduced by the Virginia Academy of Family Physicians

WHEREAS, the various managed care plans have different formularies and change their medication formularies due to fluctuations in average wholesale price and rebates, and accordingly, plans frequently change which chronic medications are covered, and

WHEREAS, managed care plans require family physicians to request prior authorizations before allowing our patients to continue on their chronic medications even if they are stable and other medications were not effective, and

WHEREAS, these prior authorization requests are time consuming for both family physicians and office staff, increase administrative costs, delay medically necessary therapies for afflicted patients, at times require additional office visits, therefore reducing access for other patients, and

WHEREAS, there is no consistent standardization in the prior authorization forms or processes between managed care organizations, resulting in delays and denials in medication authorizations, resulting in decreased patient quality in care due to authorization delays, therefore, be it,

RESOLVED, that the American Academy of Family Physicians collaborate with the American Medical Association (AMA), America’s Health insurance Plans (AHiP), and other appropriate stakeholders to develop

and implement best practices for the standardization of the prior authorization process across managed care plans in order to improve patient care, reduce errors, reduce delays and decrease administrative burdens and costs imposed on family physicians, office staff and carriers, and be it furthur

RESOLVED, that the American Academy of Family Physicians, in coordination with appropriate stakeholders, develop and support model legislation to implement these best practices at the state level.

Academy of Family Physicians support and encourage developing mobile, hand-held, and electronic medical record file applications at low costs to allow easy access and easy to use programs such as Cloud technology to keep medication formularies up-to-date, and be it further

RESOLVED, That the American Academy of Family Physicians, in coordination with other interested

organizations, work with the media to make the public and legislative bodies aware of the significant burdens and roadblocks for patients to timely access to medications and or procedures. (This resolution was referred to the AAFP Board of Directors for further review)

(See page 10 for full verbiage)

the VAFP is proud of the Delegation’s efforts to support their colleagues in their important work here in the Commonwealth.

the VAFP’s Delegation consisted of:

robert elliott, MD, PresidentKurtis elward, MD, MPH, DelegateSterling ransone, MD, DelegateJesus Lizarzaburu, MD, Alternate Delegatee. Mark Watts, MD, Alternate Delegate

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RESOLUTION 305Request the AAFP to Work with Insurers to Reduce the Administrative Burden

for Medication Prior Authorization

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Resolutionsintroduced by the Virginia Academy of Family Physicians

WHereAS, the levels of expertise and resources related to legislative advocacy efforts vary and in many cases are significantly limited at the state chapter level, and

WHereAS, the AAFP legislative team has considerable knowledge, wisdom and experience in developing and implementing legislative initiatives, and

WHereAS, a centralized approach to the development of draft legislation to address shared challenges confronting Academy members helps reduce for state chapters the needless redundancy of effort, conserves limited advocacy resources and improves efficiency, and

WHereAS, the numerous similarities in legislative structure, governing processes and key stakeholders in states outweigh the challenges posed by some of the state by state variations and political considerations, and

WHereAS, other national medical associations have had considerable success in recent years promoting adoption of their legislative agenda utilizing this strategy now therefore be it

reSOLVeD, that the American Academy of Family Physicians include in its legislative advocacy efforts the development and dissemination of model state legislation on key issues posing shared challenges to state chapters.

introduced by the Virginia Academy of Family Physicians

Whereas, there is no standardization between managed care plans regarding how medication formulary and prescription drug benefit information is provided to physicians, other providers and patients, and

Whereas, patients’ delayed access to medication increases overall cost by increasing emergency room visits and hospital admissions, and

Whereas, the medication formularies disclosed online may be different than what is available to a local pharmacy at the point of sale thus resulting in delays in patient care, and

Whereas, managed care plans and pharmacy benefit managers use different abbreviations on their formularies, at times making it difficult to interpret what medication is covered or not, resulting in increased prescribing errors, and

Whereas, some managed care plans are no longer supporting point of care medical applications to post their formularies on physician mobile devices for easy, accurate access prior to prescribing medications for our patients, and

Whereas, many family physicians are now using electronic medical records (eMr) in their care of the patients and depend upon up-to-date formularies in their eMrs before prescribing new medications, and some managed care plans are no longer supporting electronic medical record vendors to update their eMr formularies therefore making it more difficult to care for our patients due to costs, therefore, be it,

Resolved, that the American Academy of Family Physicians collaborate with appropriate stakeholders, such as the American Medical Association (AMA), other specialty societies, pharmacy benefit managers, and managed care plans to ensure provision of up-to-date medication formularies to physicians, pharmacists, electronic medical record vendors and health systems, in an easy to use format, with improved standardization, and be it further

Resolved, that the American Academy of Family Physicians, in coordination with any other appropriate organizations and government agencies, identify legislative and regulatory solutions

to standardize exchange of formulary information, and develop model legislation or regulation to ensure facilitation of timely patient access to medication, and be it further

Resolved, that the American Academy of Family Physicians request pharmacy benefit managers and managed care plans to provide the national Drug Code (nDC) numbers of medications covered so some electronic medical records users can update their software systems if possible and not depend upon the vendor to do so, and be it further

Resolved, that the American Academy of Family Physicians support and encourage developing mobile, hand-held, and electronic medical record file applications at low costs to allow easy access and easy to use programs such as Cloud technology to keep medication formularies up-to-date, and be it further

Resolved, that the American Academy of Family Physicians, in coordination with other interested organizations, work with the media to make the public and legislative bodies aware of the significant burdens and roadblocks for patients to timely access to medications and or procedures.

RESOLUTION 509Directing the American Academy of Family Physicians (AAFP) to include in its

advocacy efforts the development and dissemination of model state legislation

RESOLUTION 610Improving Use and Access to Managed Care Medication Formularies

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Hunter Jamerson, JD, MBA, VAFP Legislative ConsultantLegislative UpdateLegisLative UPdateVAFP has launched a major legislative

push: prior authorization reform. One of the major frustrations VAFP members report encountering in daily practice is the complicated and tedious prescription drug prior authorization system maintained by health insurance carriers and pharmacy benefit managers. in response to those concerns, VAFP staffed a joint workgroup with the MSV and other medical specialty societies. that workgroup identified several key reform priorities that have formed the basis of pending legislation.

VAFP has drafted a reform bill for introduction in the 2015 General Assembly regular session. the draft legislation has several goals: transparency, uniformity, and efficiency. Among the key tenets proposed are: a common prior authorization form for use across all health plans, electronic prior authorization options, waivers for mental health and chronic disease management prescriptions when a patient has proven to

be medically stable on an existing regimen, a maximum 48 hour response window, and broader publication of formularies and prior authorization procedures.

While these tenets represent some of the most basic ideals of the prescriber community, there will still likely be significant changes as any legislation moves forward. negotiations with bill patrons, Commerce, Appropriations, and Finance committee legislators, not to mention with the health plans and prescription benefit managers, may require significant compromise or a piecemeal approach. Moreover, the legislative process can ultimately take years to produce legislation that is signed into law. But introduction of such reform legislation is a significant first step. the participation of VAFP members as Key Contacts to legislators and in Advocacy Day activities is more important than ever. Please be on the lookout for a call to action as we move through the legislative session.

We approach the 2015 General Assembly

regular session in a much different political posture than we saw in the run-up to the 2014 General Assembly regular session. Last year, power was split between the parties in the General Assembly. this year, the republican party maintains a supermajority in the House of Delegates while control of the Senate has flipped from operational control by the Democratic party to a narrow 21-19 republican majority. Lt. Governor northam, a Democrat, will continue to break any tied votes.

Perhaps the most significant challenge of this session, other than the prior authorization reform initiative, will be defending provider reimbursement, residency program funding, and health care safety net support in the budget. Virginia continues to struggle with a major deficit (in part due to the effects of federal sequestration), so more cost cutting looms. even as VAFP goes on the offensive on prior legislation, we will be working equally hard on budget defense.

At the recent AAFP State Legislative Conference (SLC), held november 14-15, 2014 in new Orleans, LA, several issues were presented but perhaps none more important than the Direct Primary Care (DPC) model that is getting a lot of traction.

For those of us who have been working diligently to become certified as a Patient Centered Medical Home (PCMH), we do not want to remember all the hard work that has gone into these efforts, only to find out that the electronic health record does not produce the reports that are required to get a particular core measure met.

imagine if you were able to provide your patients with the best care possible, with easy access and the ability to measure quality as it relates to your patients, and if you could do this without mandated paperwork, filing claims or having to see patients face to face for every little problem or issue. is it possible? the answer is yes!

Direct Primary Care is a form of primary care which embraces both PCMH principles and what some would describe as concierge practice all rolled into one. the premise is simple: a patient pays a physician a membership fee every month for a year and the physician provides that patient with access to care as the patient needs it. What

is the difference between that and PCMH or concierge practice you ask? Well for starters, there is no “certification process” needed. You provide the patient with care needed and they pay up front for it. And unlike concierge practices the monthly fees are extremely affordable, between $50-70 per month. the patient needs labs? You can provide them in your office based on what you negotiate with the local labs. Prices are transparent and therefore cheaper. DPC is not insurance.

if you compare these monthly fees with internet or cell phone service, to have a doctor in your corner is extremely affordable. this has become obvious to many businesses as they are now paying this monthly fee for their employees and providing a catastrophic policy for those employees (therefore saving lots of money).

At the AAFP Scientific Assembly in Washington, DC, i attended a series of lectures on this practice type. One of the speakers was challenged about the expense of this program. He pointed out that in his community one of his patients had the bronze ACA plan (in nC) with a deductible of $6,000. So for that patient, $600 per year was a lot more affordable than meeting his deductible.

At the State Legislative Conference (SLC) it was pointed out that there is language in the

Affordable Care Act to have Direct Primary Care practices tied to catastrophic health insurance plans, so this type of practice will be here to stay (at least for a while). it does provide employers with a reasonable option to continue to provide employees with some medical coverage. Other issues were also presented at the SLC which included scope of practice challenges, Medicaid expansion in several states, and a review of the political landscape as it relates to healthcare.

For me and for many others, DPC was the highlight of the conference as it gave me hope that there are ways to regain the focus on the doctor-patient relationship by removing interference from third parties in our ability to care for our patients. i do not need to be “certified” by someone who has never cared for patients, and my patients will be the judges of my care.

Stay tuned. Your VAFP will have a lecture and a workshop on this topic at the Wintergreen conference which you will not want to miss!

thank you for your support of the VAFP’s legislative efforts!

respectfully,

Jesus Lizarzaburu, MD, FAAFPVAFP Legislative Committee Chair

Report on AAFP State Legislative Conference

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Virginia Academy of Family Physicians 2015 Family Physician of the Day

Participation Form

Name

Address/City/State/Zip

Phone Fax Email

As the Family Physician of the Day, you will be responsible for staffing the courtesy medical station from 9 am to 3:30 pm Monday - Thursday and 9 am – noon on Friday. Directions and more specific information will be provided with confirmation of your assigned date.

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q I will participate in the 2015 General Assembly Family Physician of the Day Program sponsored by the Virginia Academy of Family Physicians. Please note that I have chosen the following 3 dates from the calendar that I will be able to participate. I have listed the dates in order of preference. (Note: every effort will be made to provide you with your first choice)

1._____________________________

2._____________________________

3._____________________________

Please return the completed

Participation Form to:

VAFP 1503 Santa Rosa Rd.

Suite 207 Richmond, VA 23229 Phone: 800/843-8237

Fax: 804/968-4418 Email: mschulte@vafp.org

Donate now to FamDocPAC, the Political Action Committee of Virginia’s Family Physicians!!

FamDocPACThe Political Action Committee of Virginia’s Family Physicians

“FamDocPAC puts family doctors at the table when health care decisions are made.”

FamDocPAC is the political action committee through which you can support the election or re-election of those candidates for state office who share your commitment to family medicine.

To donate please visit www.famdocpac.org. You will receive a commemorativelapel pin in recognition of your donation.

FamDocPAC1503 Santa Rosa Road, Suite 207, Richmond, Virginia 23229 Phone: 804-968-5200 Fax: 804-968-4418

Richmond Donor$250+

Yorktown Donor$175 to $249

Williamsburg Donor$100 to $174

Jamestown Donor $50 to $99

a specIal thank you to those vaFp members

that donated to Famdocpac In 2014

- your support Is greatly

apprecIated.

Richmond Donor

Jeremy H. Freeman, MDJesus Lizarzaburu, MDJanice Luth, MDHughes Melton, MDrani rangavajhula, MDJanice ragland, MDJennifer Sharp-Warthan, MDJ. Douglas Smith, MDKent Willyard, MD

Williamsburg Donor

Samuel Caughron, MDBarbara Prillaman, MDSterling ransone, MDSaria Saccocio, MDLindsey Vaughan, MD

Jamestown Donor

John M. Carpenter, MDGrace Chiu, MDrobert elliott, MDValerie Mutchler-Fornili, MDValerie renninger, MDJames Wesdock, MD

2015 Family Physician of Day

date Filled

date Filled date Filled

date Filled date Filled

date Filled

14 15

• Approved minutes from the July 11 and 13, 2014 VAFP Board of Directors meeting held in Hot Springs, VA.

• Heard report from VAFP Legislative Committee Chair Jesus Lizarzaburu, MD and VAFP Legislative Consultant Hunter Jamerson, JD, MBA.

• Approved a motion to send a letter to

the MSV supporting their efforts on the prior authorization issue.

• Discussed the option to partner with the Medical Society of Virginia for the 2015 Advocacy/White Coats Day at the General Assembly.

• Approved a motion to task the VAFP Legislative Committee, utilizing

the same funds as in prior years, to determine the best format for Advocacy Day potentially inviting the MSV to join the VAFP.

• Heard report on the Medicaid Managed Care Physician Liaison Sub-Committee Meeting Chaired by VAFP treasurer roger Hofford, MD.

• Approved a motion to endorse the proposed ADHD medication algorithm.

• Heard report from Mr. Jamerson on the Governor’s Healthy Virginia initiative.

• Heard report on plans and programming for the 2015 Winter Family Medicine Weekend scheduled January 30 - February 1, 2015 at Wintergreen resort and the finalization of the contract to hold the 2015 VAFP Annual Meeting & exposition at the Williamsburg Lodge July 30 – August 2, 2015.

• Heard report from Kurt elward, MD on the 2014 Group SAMs and the proposed 2015 Group SAM schedule.

• Heard report from VAFP Practice redesign & Quality Committee Chair tony Kuzel, MD on the grant to establish a consultancy for small to medium practices through AHrQ on cardiovascular risk factors and he noted that the CMe topic at Wintergreen will be on Direct Primary Care.

• Heard report from resident & Student issues Committee Co-Chair Patti Matto, DO on the resident and student conference call held September 23, 2014.

• Heard discussion on next steps for the “Choose Virginia” program.

• Heard comments from VAFP resident and student representatives.

• Heard report from Communications Committee Chair Kent Willyard, MD on their willingness to help with the job placement website development and that the committee will continue to look at developing videos to promote family medicine.

• Heard report on VAFP resolutions that have been submitted to the AAFP Congress of Delegates.

• Heard report from Mr. Jamerson on the Department of Health Professions mid-level licensing issue.

Virginia Academy of Family PhysiciansBoard of Directors Meeting

October 4, 2014, Avoca Museum, Altavista, VA VAFP Foundation

14 15

VAFP FoundationVirginia Academy of Family Physicians Foundation

With the holiday season here, many of us are looking at ways to share our good fortune to support worthy causes. in addition, we are looking for opportunities to reduce our 2014 taxes.

the VAFP Foundation Board of Directors asks you to consider supporting the non-profit VAFP Foundation this holiday season in our efforts to support students, residents and our fellow family physicians in caring for our patients and fellow Virginians.

For more information on the VAFP Foundation, please visit www.vafpf.org or call 1-800-tHe-VAFP. Secure donations can be made online at www.vafpf.org or checks can be mailed to the VAFP office.

the VAFP Foundation thanks the following individuals and organizations for their support this year.

Grace Chiu, M.D.

Gene Clapsaddle, M.D.

Kurt Elward, M.D.

Edward Friedler, M.D.

Mark Greenawald, M.D.

Dena Hall, M.D.

Hampton Roads Academy of Family Physicians

Roger Hofford, M.D.

Jesus Lizarzaburu, M.D.

Hughes Melton, MD

Valerie Mutchler-Fornali, M.D.

J. Michael Ponder, M.D.

Barbara Prillaman, M.D.

Professionals Advocate Insurance

Sterling Ransone, M.D.

Sean Reed, M.D.

Lindsay Vaughn, M.D.

E. Mark Watts, M.D.

OUTPATIENT FAMILY MEDICINEPhysician Opportunities

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VIRGINIA ACADEMY OFFAMILY PHYSICIANSF O U N D A T I O N

16 17

the Virginia Academy of Family Physicians is offering group learning sessions to assist VAFP members with the completion of the Self Assessment Modules (SAM) that are required by the American Board of Family Medicine (ABFM) for completion of the Maintenance of Certification process. Physicians who are an American Board of Family Medicine (ABFM) Board Certified physician are required to complete Self Assessment Modules (SAM). For more information on specific recertification requirements from the ABFM, please call 888-995-5700.

it is the Academy’s experience through previous SAM workshops that for many physicians, this group learning approach is a much more effective (and efficient!) way for them to both satisfy the ABFM SAM requirement for Maintenance of Certification and to learn practical applications of the material. the SAM is a 60 question internet based exam and on-line patient management module. the faculty team will present each of the 60 questions on the test and discuss the important teaching points for each, which will facilitate the participant’s completion of each item. they will also guide the participants through the patient management simulation module. internet access will be provided to allow completion of the entire SAM such that when the participants leave this session, they will have completed their yearly ABFM requirement and will have received a total of 12 CMe credits!

VAFP Member fee - $200.00 and non-Member fee - $300.00To sign up for a SAM session, please visit www.vafp.org or call 1-800-THE-VAFP.

CalendarSaturday, March 28 (AM): richmond – Health BehaviorsSaturday, March 28 (PM): richmond – Pain Management

Saturday, April 25: roanoke – Health BehaviorsSaturday, May 16: norfolk - Hypertension

Saturday, June 6: northern Virginia – HypertensionSaturday, September 12: Harrisonburg – Preventive CareSaturday, October 17: Charlottesville – Preventive Care

Saturday, november 7: richmond – Hypertension*

(*tentative date pending release of the University of Richmond 2015 Football schedule)

Please note that an additional three SAMs will be offered in 2015 in conjunction with the VAFP CME Meetings. Health Behaviors at Wintergreen Resort on Friday, January 30th, Health Behaviors at The Williamsburg Lodge on Friday, July 30th and Coronary Artery Disease at The Williamsburg Lodge on Saturday, July 31st. For information on registering for these SAMs, please see the meeting registration materials.

2015 VAFP Self Assessment Module (SAM) Group Learning Sessions

Virginia Academy of

Family Physicians

2015 Annual Meeting & Exposition

July 30 - August 2, 2015

The Williamsburg LodgeWilliamsburg, Virginia

2015 Williamsburg Promo for Magazine_Layout 1 12/9/2014 2:33 PM Page 1

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18 19

Requiem for the Family Doctor1900

Dust curled and rose from the road as the doctor appeared riding a dark bay gelding, salt-tracks on his flanks. the horse went steadily, head down on loose rein, while the middle-aged man sat round-shouldered and rocked gently to the rhythm of the gait. His coat bore tracks of the road; the bag hooked to the pommel was scarred by miles and time. the pair followed the narrow, rutted path to the house, where an old lady lay ill. He brought few medicines and himself.

1946Young Doctor Wolfe’s office was over

the grocery store. Caged chickens were in the elevator, potatoes stacked in a corner as the folding lattice door opened. Sam and trudy rode to the second floor and entered the office.

Dora’s starched white uniform rustled as she moved, cap in place. He had been above Ferrum on a labor case and was late. they found a chair with an old Life Magazine, waited. the office offered no appointments.

He lumbered through the door in a rush, his dark rumpled suit hung loosely on his frame, ashes on the lapels. He carried an overfilled, black leather bag with tubes, and instruments; a stethoscope hung from his pocket and mud clung to his shoes.

Dora called patients. A mercury column

measured blood pressure, weight by upright scale and results were announced to the waiting room, to the chagrinand discomfort of many. they arrived and endured.

1955Doctor Wolfe’s practice changed with

a new hospital, with rooms full of patients. Mr. rand, dementia, room 3, Gertrude’s gown gapped to show a bare buttocks crease; ella Sue echoed as she grunted and pushed in labor.

Kate emma breathed rapidly over dry, toothless gums and fissured lips. He took her wrist, shook his head as his eyes narrowed and mouth tightened. He removed his coat, sat, held her hand and watched her breathe.

He was tired and she was dying. With head down, perhaps to pray, he offered her and the family what he had: himself, to share the burden and wait.

it was late. He sipped coffee and watched for the end.

1972Sock, his nighttime driver, stopped at

the Shively’s, just short of endicott a bit after midnight. Miss Florida had called, elkanah was sick, vomicking and running off. Doc carried his bag. And moved through the door into the back room. He took the Last Supper from the wall and

hung fluids onto the nail, drew up a shot, gave instructions to call if needed. He hugged her for a quart of beans.

1995“Could i please see your insurance

cards?” “ What is your date of birth?” “Fill out these forms.” “Do you have a Living Will?” “Should you get sicker go to the

emergency room. they will take care of you.”

2000“tom, the lady in 10 she has fever and

belly pain and my shift ends in less than an hour. So, would you take over?”

“She has a family doctor in Salem.” “Will do, but you owe me. You got some

tests?”“Yep. i took a glance at her and wrote a

couple of orders.”

2005I’m sorry, our family doctors don’t make

house calls, and they are unable to practice in the hospital.

But Mom, my mom, Grace Smith, she’s a patient of your clinic Dr. Hart is familiar with her and her problems.

-- Al Hagy

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Attend a three-and-a-half day live course with your colleagues to review the evidence-based principles of family medicine and learn effective test-taking strategies. register today at www.aafp.org/dcbre.

As an AAFP Member, you can save big on Board review resources from the AAFP.

How to Pass Your Boards

18 19

EOE/AA

Mountain States Medical Group and Russell County Medical Center, located in Lebanon, Virginia, are currently seeking a Full Time, Board Certi�ed, Family Medicine or Internal Medicine Physician. The quali�ed candidate will join a Brand New, Out-Patient Clinic in Lebanon, Virginia to provide services to their Community and Russell County Medical Center. This will be a Hospital Employed position with the following incentives:• Competitive Salary and Bonus • Full Benefits • Paid Malpractice • Generous Sign On Bonus • Relocation Assistance • Educational Loan Assistance • CME Reimbursement • PTO

Please Contact:Tina McLaughlin, CMSR, RCMC Senior Physician Recruiter276-258-4580 • mclaughlint@msha.com

An independent, primary care, multi-specialty practice located in Chilhowie, Virginia is currently seeking a BE/BC, MD/DO, Virginia Licensed, Family Medicine Physician to join their group Full Time. The group has 2 Physicians and 1 Nurse Practitioner. One Physician is retiring and group is recruiting to replace this physician. The clinic is certi�ed as a rural health clinic and provides a complete range of primary care services. The candidate will step into a thriving, completely independent, 60 year old practice that has many loyal patients, a hardworking loyal sta� with low turnover and excellent standing in the community. Johnston Memorial Hospital located in Abingdon, Virginia and Smyth County Community Hospital located in Marion, Virginia will be assisting the group with the following for the quali�ed candidate:• Income Subsidy for first 1-2 years • Sign On Bonus • Relocation Assistance • Educational Loan Assistance • Call: Phone Call Only, Every 3rd WeekGroup will provide:• Competitive Salary • Opportunity to Earn Above Average Income • Comprehensive Benefits Package • Medical/Dental/Vision Benefits • 401K Retirement Package with Match Program • Malpractice Insurance Provision • Allowance for Dues/Continuing Education

Please Contact:Tina McLaughlin, CMSR, JMH Senior Physician Recruiter276-258-4580 • mclaughlint@msha.com

Virgnia: Scenic Virginia – Great place to live and work. Smyth County Community Hospital and a private, long-standing, out-patient practice located in Marion, Virginia are currently seeking a Full Time, BE/BC Family Medicine Trained Physician to join their group. This is a well-established, financially sound, private group. The incoming candidate will have the opportunity to work with quality colleagues with outstanding training. Smyth County Community Hospital opened a brand new facility Spring of 2012 and has a well-established Hospitalist program to manage admissions, etc. The Hospital will also be o�ering a Competitive Income Subsidy, Sign On Bonus, Educational Loan Assistance, Relocation Assistance and possible in-training stipend. The group will provide a strong bene�ts package. Please Contact:Tina McLaughlin, CMSR, SCCH Senior Physician Recruiter276-258-4580 • mclaughlint@msha.com

Russell County Medical Center, located in Lebanon, Virginia, is currently assisting a Private, Out-Patient Clinic, C-Health in locating Full-Time, BE/BC, Family Medicine Residency trained Physicians to join C-Health. C-Health provides care to the community in three locations: Lebanon, VA, Honaker, VA and St. Paul, VA. They also assist Russell County Medical Center with In-Patients. C-Health is a stable and established group of 4 Physicians and 11 NPs. Russell County Medical Center will be providing the following incentives:Competitive Income Guarantee • Generous Sign On Bonus • Stipend Agreement • Relocation Assistance • Educational Loan AssistanceC- Health will provide:Medical Benefits • Malpractice • CME • PTO • CME

Please Contact:Tina McLaughlin, CMSR, RCMC Senior Physician Recruiter276.258.4580 mclaughlint@msha.com

20 21

New Me

mbersACTIVE

Arifur rahman Akhand, MD-WinchesterDeborah A Armstrong, MD-Lynchburg

Pamela Jean Bartell, DO-richmondDarya Kamy Beheshtin, MD-McleanKristin Orr Bresowar, MD-Abingdon

Jane K B Brummer, MD-SalemAurora Juliana Canlas, MD-Virginia Beach

Danielle M Carter, MD-FranklinJeanne t Chiang, MD-Mc Lean

Sarah elizabeth De Boer, MD-richmondShital Sureshchandra Desai, MD-Alexandria

James roane Dudley, MD-GloucesterMina Michele Garrett-Scott, MD-HerndonMaritza Adinee Garza, MD-Virginia Beach

Melissa Gibson, MD-ArlingtonPunit Goel-Glen Allen

Jimena Maria Gomez del Carpio, MD-Ashburnroberto Adrian Gonzalez, MD-norfolk

Mitsi Liset Gutierrez ramal, MD-HenricoDonald James Halke iii, DO-Portsmouth

nir Horev, MD-norfolkChristopher D imber, MD-South Hill

Akila V iyer, MD-Chantillyrasmiyah Jastan, MD-Abingdon

Shonna Jene Johnson, MD-Chesapeaketamice Jones, MD-norfolk

Venkata G Kada, MD-Virginia BeachKelvin Dimitri Kemp, MD, MPH, MBA-Stafford

Yusuf Hameed Khan, MD-AshburnUmakant Kori, MD-Fairfax

Mariatu Koroma-nelson-FairfaxAbdulkareem ibrahim Kraidy, MD-Lorton

Keefe Hugo Lobb-PowhatanMichael D Lockwood, DO-Lynchburg

Vladimir Markovic, MD-norfolkLaura evelyn Mcaleer-Leavey, MD-Yorktown

Michael Weston McDowell, DO-HalifaxKaren M McGeehan, MD-Virginia Beach

nguyen ngtam, MD-MidlothianMatthew Stephen Paine, MD-ChesterfieldSandra M Peery norman, DO-tazewell

Zinia rahman, MD-SpringfieldAntonio ramada, MD-Annandale

Meghana rutulkumar Shah, MD-Suffolk

Hon Michelle nicole Shippert, DO-PortsmouthDavid Wayne Stewart, MD-round Hill

Priscilla tu, DO-roanokeBetyshia Je’Anita Watson, MD-Virginia Beach

John James Wierzbicki, DO-Woodbridge

RESIDENTJames David Barlow, DO-Christiansburg

Alicia S Barnes, DO-newport newsJi Feng, MD-Charlottesville

Abel Moreno Flores, MD-newport newsClare Hector, MD-Fairfax

Cecilia Balocco House, DO-SuffolkSteven Lam, MD-north ChesterfieldJeanne Lumpkin, MD-Charlottesville

Vincent John nardone, MD-richmondJodi Anne newcombe, MD-norfolk

Curtis John read, DO-newport newsHelen Young rho, MD-richmond

Brian ignoring Wariboko, MD-newport news

STuDENTMs. ranya Abi-Falah-Henrico

Mr. Benjamin robert Adams-Doolittle-Blacksburg

Ms. emily Alberto-norfolkMr. Mohammad Ali-norfolk

Mr. Mohammed Fahad Ali-norfolkMs. Lindsey Alkema Marie Alkema-norfolk

Ms. racquel Allen-Virginia BeachMr. Justin Anderson-Henrico

Ms. elyse Anderson-MidlothianMs. Cshantara Audap-ArlingtonMr. Matthew Badgett-norfolk

Mr. Charles Benfield-richmondMs. Laura Binari -norfolkMs. Carlie Blake-roanoke

Mr. Christopher Boyd-CharlottesvilleMr. Michael David Brooks-richmond

Ms. Kim H Bui-norfolkMs. Jennifer Cavin-norfolk

Ms. rinita Chakrapani-CharlottesvilleMr. Vyshak Chandra-richmond

Ms. Carol rung-rung Chen-norfolkMs. Laura Coonfield, BA-norfolk

Mr. Matelin Crosen-WinchesterMs. Angela D’Amico-richmondMs. Alexandra raquel De Leon,

BA-CharlottesvilleAdrian Diaz, BS-richmond

Mr. Lane Donaldson-CharlottesvilleMr. thomas Jonathan Jackson Duncan-Yorktown

Ms. nelya ebadirad-FairfaxMr. Luke William edelmayer-richmondMs. Victoria Johanna eisenberg-norfolk

Mr. eric engstrom-HenricoMs. Lauren evers-Charlottesville

Mr. Jason L Fluegel-Virginia BeachMr. Kevin Foss-norfolkMr. John Gayk-norfolk

Mr. Lewis r Gergoudis-HenricoMr. Zane Giffen-roanoke

Ms. Sushmita Bharat Gordhandas-richmondMs. Ashly Gottschalk-Blacksburg

Ms. Anne Maria Grzegorczyk, BA-CharlottesvilleMs. Shilpa Guntaka-norfolk

Ms. Mariko Hanson-richmondMr. ryan Haran-richmond

Mr. Firezer Haregu-HarrisonburgMs. Kassimier Haynes-norfolk

Ms. Lauren Fulcher Hearn-richmondMs. Ashley Hilzendager-BristolMs. Callie Hlavin-richmond

Ms. Kristen Hojnowski-CharlottesvilleBenjamin Honig, BA-norfolk

Mr. Justin Hoskin-Virginia BeachMs. tiffany Hsiao-richmondMr. ryan Hunley-Blacksburg

Mr. Mat Jameson-Lee-richmondMr. Max Jameson-Lee-richmond

Ms. Lachrisa Jennings, DO-richmondMr. Christopher Josef-richmond

Mr. Jeremy James Kalma-richmondMr. Yusufu Bampia Kamara-Woodbridge

Ms. Sheila Kapyur-richmondMs. Sylvia V Kauffman-CharlottesvilleMs. Ashleigh Marie Keator-StauntonMr. Jonathan Scot Kirshner-norfolk

Lauren Klein-CharlottesvilleMs. Paulina Krause, BS-Chesapeake

THE VAFP WELCOMES NEW MEMBERS

20 21

New Me

mbers Mr. Alex Kremers-richmond

Ms. nikki Kumar Kumar, MS-roanokeMr. Amauri Latham-richmond

Mr. Alexander Scott Lawson-CharlottesvilleMr. Andy Chao Hsuan Lee-Charlottesville

Ms. Allison Levitt-richmondMr. Peter Lo-richmond

Santhi Logel, MA-norfolkMr. erik Loken-richmond

Ms. Sahar Lotfi-emran, PhD-richmondMs. Sashka Luque-Charlottesville

Mr. Andrew Christian Luxhoj-newport newsMr. Andrew D Lyell-richmond

Mr. Sohaib Malik-norfolkMr. Mohammed Mamdani-richmond

Mr. McHuy McCoy-norfolkMs. nicole neveln-norfolk

Ms. Samantha Min Min ngaw-norfolkAnh tuan Huu ngo-richmond

Ms. Sabrina V ngo-ChantillyMr. Steven Van nguyen-richmond

Mr. Khoa A nguyen-richmondMs. Miki nishitani-richmond

Mr. Jigar Patel-norfolkMs. Sarah Patton-norfolk

Mr. Joseph Pechacek-roanokeMs. Katherine Peng-richmond

Mr. Michael Poppe, USn-richmondMs. Yassaman Pourkazemi-Charlottesville

Mr. David Bruce Powell-norfolkMr. rollin r reeder-norfolk

Ms. Sherin rouhani-CharlottesvilleMs. Macy rupprecht-BlacksburgMs. Arhanti Sadanand-richmond

Ms. Mana Sassanpour-ChristiansburgMr. Parth Shah-norfolk

Ms. Sanam Shahid-South ridingMr. eric Shapiro-norfolk

Ms. Avni raheja Sharma, BS-richmondMs. Ayesha Mariam Shaukat-norfolk

Mr. nicholas Simon-Falls ChurchMs. Jigna Solanki-Charlottesville

Mr. Matthew Gray Spivey-roanokeMs. Mary Caitlin St. Clair-Virginia Beach

Ms. Sarah Stokes-Blacksburg

Ms. Chantel reeves Styles-Virginia BeachMr. ronald Sutton Jr.-richmond

Ms. Christa tabacaru-CharlottesvilleMr. Derek thackston-richmond

Mr. Joseph McCullen truett-ChristiansburgMr. Brian turchioe-norfolkMs. Jennifer Vaz-Centreville

Mr. navin Vigneshwar-richmondMs. Ashley Keller Volaric-Charlottesville

Ms. Michelle Wagner-richmondMr. nick Walter-richmondMs. evelyn Wang-norfolk

Mr. thomas Ward-CharlottesvilleMr. Chris Winstead-Derlega-Charlottesville

Mr. richard Youn-richmondMr. Christopher Young-richmond

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22 23

nominate your peers for a 2015 VAFP Award! Annually, the VAFP presents the Virginia Family Physician of the Year Award, the F. elliott Oglesby, M.D., Volunteer of the Year Award and the James P. Charlton, M.D., teacher of the Year Award in Family Medicine. Submitting a nomination is easy. Visit www.vafp.org/awards and click on the Award nomination Link on the home page. if you have questions, please e-mail mschulte@vafp.org or call 1-800-tHe-VAFP. nominating material must be received no later than May 30, 2015.

2015 VAFP Awards – Submit Your Nomination

On-Line Now!

2015

January 30-February 1, 2015VAFP 2015 Winter Family Medicine WeekendWintergreen resort – Wintergreen

July 30 – August 2, 2015 VAFP 2015 Annual Meeting & exposition the Lodge at Colonial Williamsburg, Williamsburg, VA

2016

January 29-31, 2016VAFP 2016 Winter Family Medicine WeekendWintergreen resort – Wintergreen

CMECME Calendar

VAFP is on Social Media!vIrgInIa academy oF FamIly physIcIans (vaFp) Facebook page http://www.facebook.com/pages/Virginia-Academy-of-Family-Phy-sicians-VAFP/240401672645405

vaFp twItter account@VAFP_FamilyDocs (www.twitter.com/VAFP_Family-Docs)

Inspiring Better Health Join a team that puts the patient first

If caring for patients is the reason you became a doctor, join the nearly 600 physicians of Carilion Clinic who share your philosophy. A nationally recognized innovator in healthcare, Carilion is changing the way medicine is practiced. Our medical-home approach to primary care lets you focus your energy on the highest risk patients, while the electronic medical record enables seamless coordination with Carilion specialists in nearly 60 fields. And with online access to their medical records, patients can become more involved in their care, too. With tools that make you more efficient and an environment that values better care, Carilion gives you the freedom to focus on your patients’ well-being — without overlooking your own.

Virginia’s southwest region is one of the best kept secrets. Quality of life in the Blue Ridge Mountains is high and the cost of living is low. The area offers a four-season playground for mountain and lake recreation, as well as a rich array of arts, humanities and cultural experiences.

Family Medicine outpatient opportunities are available in the following southwest and central Virginia communities: Galax (FM)* Martinsville (FM or IM)* Rocky Mount (FM)* Tazewell (FM)*

* For information on additional incentives available for designated locations, contact Amy Silcox, physician recruiter, Carilion Clinic, 800-856-5206 or amsilcox@carilionclinic.org.

AA/EOE

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CarilionClinic.org

22 23

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