The Difficult Conversations Show

On this episode of Texas Family Doc Talk, we’re joined by Dr. Jed Constantz, a strategic consultant in the field of primary care finance and delivery reform. He’s been in the health care industry for more than 30 years, working with payers, employers, and physicians to implement solutions to improve the quality and efficiency of care while reducing costs. He is now the principal strategist at Advanced Primary Care Strategies. We discuss the increasing prevalence of employers purchasing primary care directly from physician groups and practices, a strategy many refer to as direct-to-employer primary care. Show notes Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model, JAMA Network Open, April 30, 2020National Alliance of Healthcare Purchaser Coalitions Primary Care Project -- Overview and StrategyContact Dr. Jed Constantz at https://www.linkedin.com/in/jed-constantz/

On the sixth episode of TAFP’s podcast, Texas Family Doc Talk, we’re joined by Erica Swegler, MD, to discuss changing the fee-for-service payment model for primary care to prospective payment and what that would mean for family physicians and their patients. Dr. Swegler serves on the AAFP Board of Directors, she’s a past president of TAFP, and she owns a solo family medicine practice in Austin.

Tim Martindale, MD, of the Martindale Family Medicine Clinic in Waco, Texas, became ill with COVID-19 on April 5, 2020, and when the symptoms started, they hit fast. "It was not a light thing. It was a powerful anvil knocking me down," he says. Dr. Martindale describes his battle with the disease, several techniques and activities that probably kept him out of the hospital, and what his return to practice has been like.  Show notesRead Dr. Martindale's posts on the KWTX Channel 10 website.Read more in this story from the American Heart Association News.

TAFP's Jonathan Nelson talks with Paul Tatum, MD, director of the Hospice and Palliative Medicine Fellowship at the University of Texas at Austin Dell Medical School. As the COVID-19 pandemic continues to spread through our communities, frontline physicians like family doctors find themselves having many difficult conversations with patients and their families. That would be tough on its own, but in this situation, all the relevant information seems to be constantly changing. The ability to have those conversations with compassion and comfort is a challenge in such stressful times. Dr. Tatum offers several resources for physicians and their staff members.   Resources mentioned in the showVitalTalk: COVID Ready Communication Playbook VitalTalk is a group of communication specialists who collaborate to offer a communication guide for complex issues that can be shared with office staff, especially phone staff and nursing teams.CAPC COVID-19 Symptom Management Protocols The Center to Advance Palliative Care provides a wide COVID-19 resources. The one Dr. Tatum discusses most is the Symptom Management Protocols.NHPCO COVID-19 Shared Decision-Making Tool The National Hospice and Palliative Care Organization offers this tool to help physicians, patients, and their families discuss risk for seriously ill patients including conversations about advance directives.CPPCD ICU Shared Decision-Making Guide for Life Support The Colorado Program for Patient-Centered Decisions offers a decision aid for patients considering life support in the setting of critical resource shortages.PREPARE for Your Care Medical Planning Guide Among other resources, PREPARE for Your Care provides a COVID-19 advance care planning guide your office team can share with patients who can then complete the guide on their own.Advance Care Planning Conversation Guide The San Francisco VA health Care System Hospice and Palliative Care Service offers this guide for use with outpatients at high risk of developing COVID-19 complications.

TAFP's Jonathan Nelson talks with Dave Chase, creator, co-founder, and CEO of Health Rosetta, about the Marshall Plan for Primary Care and Public Health initiative, which seeks to change America's dominant fee-for-service payment system for primary care services to a prospective payment model. The COVID-19 pandemic makes it painfully obvious that the nation's primary care and public health infrastructure is and has been underfunded and unsupported for decades, leaving it desperately vulnerable just when we need it most. For more information, go to https://healthrosetta.org/marshall-plan/Also check out this blog post at TAFP.org: https://tafp.org/blog/Marshall_Plan_for_health_care

TAFP CEO Tom Banning and Jonathan Nelson speak with three experts from Catalyst Health Network in Dallas. Jeff Bullard, MD, chief medical officer for Catalyst, describes the experience of transitioning to virtual care. Trevor Clifton, senior financial analyst for StratiFi Health, discusses financial models for moving most of your visits to telemedicine. And Stephenie Tollett, director of revenue cycle for StratiFi Health, talks with us about third-party contract and claims payment issues for telemedicine. 

TAFP CEO Tom Banning and TAFP communications director Jonathan Nelson talk to Lance Spivey, co-founder and president of StratiFi Health about what family doctors are facing as they try to keep their practices open during the COVID-19 pandemic.