September 2002 • Volume 8 • Number 9 |
If White House officials don't get it regarding key family practice issues, including Medicare payment, it's not from a lack of effort on the Academy's part.
On July 11, several AAFP officers and staff members met for almost an hour at the White House complex with Rex Cowdry, M.D., consultant to President George W. Bush's Council of Economic Advisers and former acting director of the National Institute of Mental Health.
Title VII. "As I began to talk about the need for consistent funding for Title VII, it became obvious Dr. Cowdry didn't know what Title VII was, so I explained the funding for family practice training," said AAFP President-elect James Martin, M.D., of San Antonio. Cowdry took notes and asked about types of Title VII grants, Martin said.
"I emphasized that Title VII was zeroed out year after year in the president's budget, and Congress always puts it back into the budget," said Martin. "I said I was frustrated we had to spend time and effort each year to encourage Congress to maintain the funding. I suggested the Office of Management and Budget may not understand the need for Title VII. Dr. Cowdry seemed very interested."
AHRQ. AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis., discussed the need for increased funds for the Agency for Healthcare Research and Quality. "Dr. Cowdry found it compelling that the president's budget proposal would cut in half the funds for existing AHRQ grants," said Roberts.
He told Cowdry that a family medicine department with a $1 million grant for a three-year study could hire from 12 to 20 employees. "If your funds were cut in half, you'd dump your data analyst, dump your statistician, hope to complete data collection and then wouldn't have the means to analyze the data," Roberts told Cowdry. "If you did get it analyzed eventually, your conclusions might come too late to have an impact." Roberts said Cowdry understood the devastating effect the proposed drop in funds could have on ongoing research.
The Academy is seeking a 2003 funding level of $390 million for AHRQ, compared with the current $299 million and the president's proposal of $251 million (with about $50 million reserved for patient safety studies).
Medicare fee schedule. Discussing cuts in the conversion factor affecting the Medicare fee schedule, AAFP President Warren Jones, M.D., of Ridgeland, Miss., said to Cowdry, "The U.S. population is dependent on family physicians to meet their primary care needs. If our Medicare reimbursement keeps being cut and we can't accept new patients, who will take care of them?"
Jones said Cowdry, an economist and physician, got the picture about family physicians being distributed across the country -- in rural, urban and suburban areas -- from Robert Graham Center charts.
He encouraged Cowdry to ask the administration to separate evaluation and management services from procedural services when volume controls kick in, penalizing physicians for adding more services in an attempt to gain more reimbursement. "E/M services should not be subject to the same volume controls as other services," Jones suggested to Cowdry. "All physicians do E/M. Most family doctors can't add more E/M; most of us can't add any more patients during our day. But if it's colonoscopies or exercise stress testing, you can add more of those."
The AAFP leaders also said about one in five FPs are not accepting new Medicare patients (see "Crisis builds: More FPs stop taking new Medicare patients"). "Dr. Cowdry's eyebrows went up when we said that," Jones noted.
Other topics. The AAFP contingent also discussed the need to solve the medical liability insurance crisis. "In Mississippi, there's no neurosurgeon north of Jackson, and no family physician delivering babies at the hospital where my wife and I wanted to have our baby delivered," Jones told Cowdry. The consultant to the Council of Economic Advisers commented, "It's in the hands of the states," but Jones countered, "We need uniform standards, so the situation doesn't differ from one state to the next."
|
As the meeting was coming to a close, the Academy contingent mentioned that the way to get care to the uninsured is spelled out in the AAFP plan, "Assuring Health Care Coverage for All." Cowdry had read the document last year and asked the group to stay awhile longer to discuss it.
"We were planting seeds," said Roberts of the meeting. "We were having a meaningful discussion about what concerns the administration should address.
"You reach as high as you can reach. This meeting was one step in developing a consultative dialogue that can be critical in shaping policy."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.