The future is here!
Future of Family Medicine project releases recommendations

BY TONI LAPP

Topping the list of the project's recommendations: Develop a new model for family medicine. That model of care would be based on a relationship-centered personal medical home to serve as a focal point for patients' care. The transformation to this model would include office redesign, electronic health record systems and a team approach to care.

The project, a collaborative effort of seven family medicine organizations concerned that family medicine needed revitalization, began in 2000. On March 30, the FFM project issued its report and recommendations in a supplement to the March/April Annals of Family Medicine, online at http://www.annfammed.org. AAFP has mailed the supplement to active members who do not already receive Annals; it should arrive in early April.

Team effort

From the outset, the project was a team effort: One elected leader and the chief executive from each of the seven organizations sat on the leadership committee.

AAFP Board Chair James Martin, M.D., of San Antonio, who chaired the committee, called it a "once-in-a-generation opportunity" to fix what was broken with the specialty.

A consulting firm analyzed findings from interviews and focus groups to determine perceptions -- from the public, patients, FPs, medical students and other clinicians -- toward family medicine. The findings were released to five task forces, each with a charge fundamental to the specialty. Those task forces made recommendations, 10 in all.

Now that the report is out, it's time to act, Martin said.

"This report allows us to learn from the mistakes of the first 30 years," he said. "It also helps us affirm what we did that works and is still desired, but also to make the changes we need to make to be viable and properly positioned to lead health care into the future."

Action items

Each organization volunteered to take the lead on one or more of the 10 recommendations; the AAFP is taking the lead on seven items, including the top three -- a new care model, EHR systems and communications.

"We are the predominant member of the 'family' and have more resources to address these recommendations," said Martin. "It is logical for us to have these roles."

John Bucholtz, D.O., an FFM task force chair and immediate past president of the Association of Family Practice Residency Directors, said the project was structured to provide continuity through the officers of the sister organizations.

"Speaking for AFPRD, we have made this a front-burner item," he said. "We'll make that one of the presidency's responsibilities -- for our organization to do what we committed to do."

Bucholtz is residency director at Columbus (Ga.) Family Practice. His program has already begun implementing one of the recommendations -- instituting an EHR system -- and the FFM project was instrumental in gaining support for the implementation from his hospital's board of directors, he said. "I told them that this is going to be a national recommendation to train residents on electronic health records."

Real world

It became apparent by mid-2003 that discussion of the recommendations led to a common theme -- reimbursement. Thus, a sixth FFM task force was born.

"If you can't create a viable business model for the new model of family medicine, then it's not going to work," said AAFP President Michael Fleming, M.D., of Shreveport, La., a member of Task Force 6. "This is not an academic exercise. The focus is on the 'real world' practice of medicine."

Task Force 6 comprises representatives from within family medicine and from employers, insurers, and the Centers for Medicare & Medicaid Services.

"The payers agree" said Fleming, "they must find a way of paying us that values what we do." He predicts the improvements will take place "over a spectrum of about three to five years."

Spring is not only the season of renewal, but also the season of graduations, noted Fleming. "Publishing this report is just the beginning. The leadership committee's work is at an end, and this is the commencement."