November 2002 • Volume 8 • Number 11 |
The Congress of Delegates pulled out all the stops this year in acting on issues such as prior hospitalization for nursing home placement. The delegates unanimously voted for the Academy to tell the Centers for Medicare & Medicaid Services, "The regulation concerning mandatory hospitalization prior to Medicare-qualified skilled nursing placement is obsolete, wasteful of valuable resources and should be abolished."
No restraint in that statement.
"If my patients are not sick enough to be hospitalized but need placement in the nursing home next door to my practice, I don't know why they need to go to a hospital 50 miles away (for three days) to be eligible for Medicare coverage in the nursing home," Beulette Hooks, M.D., of Midland, Ga., chair of the Committee on Resident and Student Issues, told a reference committee Oct. 14.
Here's how another AAFP member described the hospitalization requirement: "This represents a 'stupid factor.'"
A range of other issues, including those noted below, prompted action from the delegates.
Tobacco settlement funds. Several years ago, states received funds for settling a lawsuit with tobacco companies. The funds, meant for projects preventing tobacco use and helping people stop using tobacco, are being withdrawn. "I sit on the tobacco council for Iowa, and we had been given $9 million, we just lost $4 million, and we'll probably lose more," Iowa delegate David Carlyle, M.D., of Ames told a reference committee. "The tobacco companies were behind the loss."
The delegates voted to have the Academy compile a "national scorecard" showing how states have allocated their tobacco settlement funds. The delegates also decided the Academy would serve as an information resource for states using their funds for tobacco-use prevention and cessation efforts.
Prohibitions on prescribing. Family physicians' prescribing privileges are being curtailed, the delegates said, by the CMS and the Department of Defense -- in rules against the prescription of certain drugs by certain groups of physicians. "There is a persistent effort to wean away the privileges family physicians have," Georgia delegate Tanya Jones, M.D., of Atlanta told a reference committee. "The Academy has to be proactive about this."
The delegates said the AAFP should ask the CMS and the Department of Defense to eliminate the prescription prohibitions if there is no evidence-based research justifying the prohibitions.
Gender equity in health plan benefits. Whatever terms and conditions an employer or health plan applies to prescription drugs, devices and elective surgeries, those same provisions should apply to prescription contraceptive drugs and devices and to elective sterilization procedures, according to a new policy the delegates adopted.
Benefits for family members. The Congress took several actions related to the AAFP definition of family, which reads in part, "The family is a group of individuals with a continuing legal, genetic and/or emotional relationship." Employees' medical benefits should extend to those within the employee's family for whom the employee has assumed responsibility, the delegates decided unanimously. They also voted unanimously for AAFP to support domestic partner benefits for same-gender couples.
Adoption. Several resolutions on adoption also pertained to AAFP's definition of family. After hearing lengthy debate, a reference committee developed a substitute resolution, asking the AAFP to "establish policy and be supportive of legislation which promotes a safe and nurturing environment, including psychological and legal security, for all children, including those of adoptive parents, regardless of the parents' sexual orientation."
The delegates passed the substitute resolution but the next day discussed whether to reconsider it. Florida delegate Thomas Hicks, M.D., of Tallahassee said he believed the reference committee had created a balanced compromise, one representing a variety of viewpoints. Standing by their first vote, the delegates decided against reconsideration.
Mental health care reimbursement. Family physicians should be reimbursed for mental health counseling and treatment, said the delegates. They asked the Academy to inform the American Association of Health Plans about FPs' critical role in identifying and treating mental illness. The Academy should also meet with officials of public and private third-party payers to advocate family physicians' reimbursement for mental health diagnosis and treatment, said the delegates.
Medicare reform. The delegates issued a clarion call to revamp Medicare: "The AAFP is gravely concerned about the viability, fairness and workability of the current Medicare program. Improvement is needed to keep pace with advances in the practice of medicine, changes in the demographics of the Medicare population and other developments in the health care system."
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Copyright © 2002 by
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