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"Mandatory reading." "Once-in-a-generation opportunity." "A compelling vision for the future." Welcomed with these phrases and more, the Future of Family Medicine report gained family medicine the national spotlight in April. The report called for a new model of care with a "personal medical home" for each patient, open access scheduling, electronic health record systems, professional development and practice-based research. The report garnered praise from groups including the Institute of Medicine and the Council of Medical Specialty Societies. News media, including USA Today, covered the report. A sixth FFM task force, dealing with practice finance, released its recommendations in early December (see story, page 1).
Committed to acting on the FFM report recommendations, AAFP and the family of family medicine started work on implementation plans. AAFP took responsibility for making six of the 10 recommendations reality.
Section 747 of Title VII in the Public Health Service Act struggled to survive through much of the year, but it may have turned the corner thanks, in part, to family physicians' efforts. Family physicians who serve as AAFP key contacts inundated legislators with information on the importance of Section 747, which supports training in primary care medicine and dentistry. By August, the Senate Appropriations Committee recommended $90.7 million -- up from $81.7 million for 2004 -- for Section 747 for 2005. The House Appropriations Committee had recommended $64 million in July. At press time, the legislation awaited reconciliation between House and Senate versions before going to the president for his signature.
Interest in family medicine picked up, according to March 18 National Resident Matching Program numbers: 78.8 percent of family medicine residency slots filled, an uptick of 2.6 percent over 2003. The results bode a potential turnaround for the specialty, said Academy leaders.
Insurance companies threatened the viability of family medicine training when they cited teaching activities as justification for refusing liability coverage to FPs and facilities that taught medical students. Meanwhile, CMS demanded repayment of graduate medical education funds from residency training programs that used volunteer preceptors. Quick action by AAFP constituent chapters reversed insurers' actions, and AAFP and the Association of Family Medicine Organizations mobilized in October to craft a model agreement that would meet CMS criteria for retaining volunteer preceptors.
AAFP coordinated the May 21 - 22 Student Interest Summit to identify strategies that could affect student interest in family medicine. Topics discussed: mentors and role models, medical school admissions processes, and medical school curriculum. Participants devised action plans to tackle the key factors they identified.
Almost 7,000 family doctors from 96 countries gathered in Orlando, Fla., Oct. 13 - 17 for the AAFP Scientific Assembly and 17th World Conference of Family Doctors (sponsored by Wonca, the World Organization of Family Doctors).
AAFP and the American Academy of Pediatrics in March released an otitis media guideline with recommendations on appropriate use of antibiotics and pain management. The guideline offers advice on diagnosis and management of the condition in children from 2 months through 12 years of age.
During a year when vaccine shortages plagued the health care system, the AAFP joined in developing clinical guidelines that helped ensure an adequate supply of pneumococcal conjugate vaccine for infants and children, and it communicated to members the CDC's prioritization guidelines for providing influenza vaccinations.
Family physicians gained access to asthma and allergy point-of-care tools when AAFP posted them and several other valuable resources online at http://www.aafp.org/asthmaallergyguide.xml. The materials, which include a 32-page Asthma and Allergy Resource Guide and updated guidelines from the National Asthma Education and Prevention Program, are part of the Asthma and Allergy Resources for Family Physicians program. The program also developed models for implementing evidence-based medicine in day-to-day practice.
With the number of children's visits to FPs falling, AAFP in August launched a Task Force on the Care of Children by Family Physicians. The Robert Graham Center in Washington conducted an evidence-based study and analysis for the task force to use in its work.
The Annals of Family Medicine received resounding affirmation of its success when the National Library of Medicine selected it for inclusion in Index Medicus and MEDLINE. The NLM action means Annals titles and abstracts are available to people conducting searches in the library's databases.
The Congress of Delegates, during its Oct. 11 - 13 meeting in Orlando, Fla., voted for AAFP to establish a federal political action committee by June 2005. Under bylaws to be created by the AAFP Board, the PAC board would include at least three AAFP directors and would report to the AAFP Board annually, and no PAC funds would be used for political advertising.
Thomas Weida, M.D., of Hershey, Pa., (now) speaker of the AAFP Congress of Delegates, spoke to Medicare's Practicing Physicians Advisory Council Feb. 23 in Washington. Weida called on PPAC -- which issues recommendations about Medicare to the HHS secretary -- to recommend that CMS design a care model in which primary care physicians manage Medicare patients with multiple chronic diseases and that CMS test the use of a care management fee.
Eighty AAFP national and constituent chapter leaders, key legislative contacts, and members made the case for congressional support of Title VII funding, Medicare graduate medical education funding and health care for the uninsured during the AAFP Family Medicine Congressional Conference May 19 - 20 in Washington.
The Academy provided support to legislative initiatives that began their trek through the subcommittee, committee and floor debate process. Among them: the Medicare Prevention Act, which incorporates AAFP's suggestion to grant CMS the authority to review Medicare-covered preventive services in the light of U.S. Preventive Services Task Force recommendations and to alter reimbursement accordingly.
Likewise, the Academy threw its support behind the Geriatric and Chronic Care Management Act, which endorses the care management fee concept and calls for an upfront payment for assessment and care management of Medicare beneficiaries.
Family medicine saw some progress in convincing legislators of the need for national medical liability reforms. The Academy gave strong support to the Help Efficient, Accessible, Low-cost, Timely Healthcare Act, or the HEALTH Act, approved by the House of Representatives March 31. However, the Senate blocked the companion bill in July.
The Academy didn't wait for tort reform before acting to help members cope with medical liability insurance premiums. In a May 19 letter to CMS Administrator Mark McClellan, M.D., Ph.D., the Academy called on CMS to calculate the Medicare fee schedule so that it accounts for the growing cost of professional liability insurance. The final 2004 Medicare fee schedule increased professional liability insurance relative value units by 21.7 percent.
AAFP leaders met with McClellan July 22 to discuss corrections to the Medicare fee updates, the need for a care management fee, graduate medical education funding and electronic health records. McClellan expressed interest in the concept of a care management fee for family physicians engaged in long-term patient care.
AAFP members took the reins of organizations and agencies. Among them: Bruce "Ned" Calonge, M.D., M.P.H., of Denver was named chair of the U.S. Preventive Services Task Force; J. Edward Hill, M.D., of Tupelo, Miss., was chosen president-elect of the American Medical Association; AAFP Past President Warren Jones, M.D., was named executive director of the Mississippi Division of Medicaid; and Academy EVP Douglas Henley, M.D., was named to the federal Certification Commission for Healthcare Information Technology.
On the leading edge of those working to resolve national health concerns, the Academy's Americans in Motion initiative took aim at obesity by challenging physicians and patients to improve their health with better nutrition and more exercise. The initiative gained national attention when AIM joined with the U.S. Department of Interior's Get Fit With US campaign during the campaign's June 5 kickoff in St. Paul, Minn. The federal government sought AAFP support when Michael Suk, M.D., J.D., M.P.H., spoke during a Robert Graham Center-sponsored primary care forum. A White House fellow, Suk was working on "Meridian 2004: Initiatives in Public Health and Recreation," which links public health with recreation.
Recognizing that childhood obesity is a pervasive problem, the AAFP collaborated with the Agency for Healthcare Research and Quality to develop two educational DVDs, released in September.
BlueCross BlueShield on May 13 agreed to establish a working group on developing projects that test the cost-effectiveness of health care management through a personal medical home. Many BlueCross BlueShield plans might consider working with AAFP, primarily through constituent chapters, to create demonstration projects that test the care management model.
AAFP joined several medical organizations to help plan for rebuilding Iraq's health care infrastructure. During a Sept. 25 - 26 meeting in Washington, Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities, collaborated with Senate Majority Leader Bill Frist, M.D., R-Tenn.; U.S. Surgeon General Richard Carmona, M.D., M.P.H.; and Maj. Gen. Darrell Porr, M.D., a family physician who represents all of military medicine to the Joint Chiefs of Staff.
During the past 12 months, the AAFP became an indisputable leader in promoting electronic health records. Academy efforts to ensure affordable EHR systems for members blossomed as 58 companies clamored to sign the statement of principles undergirding AAFP's Partners for Patients initiative launched in November 2003.
 Having their say at the health information summit, clockwise from top: David Brailer, M.D., Ph.D., HHS' technology czar; HHS Secretary Tommy Thompson; Sen. Bill Frist, M.D., R-Tenn.; Rep. Nancy Johnson, R-Conn.; and Academy EVP Douglas Henley, M.D. |
Some constituent chapters participated in an AAFP survey in May. Forty percent of respondents (all active members) said they were either completely converted to EHRs or were in the process.
AAFP expanded member services in April with an agreement with Medfusion Inc. to provide free Web sites (see story, page 7).
AAFP communicated closely with members of the U.S. Congress as they worked on legislation to encourage physicians to implement EHRs. Among the results: introduction of the Quality, Efficiency Standards and Technology for Health Care Transformation Act and the National Health Information Technology Adoption Act.
National political, regulatory and information technology leaders identified the AAFP as the "go-to" organization for guidance on IT legislation and national certification standards. In May, the HHS National Committee on Vital and Health Statistics' Subcommittee on Standards and Security sought AAFP testimony on developing standards for e-prescribing, and CMS awarded a $100,000 grant to the Academy's EHR pilot project. In July, during a health information summit, HHS' national coordinator for health information technology, David Brailer, M.D., Ph.D., lauded the Academy as "one of the most entrepreneurial associations that I know of," adding, "their Center for Health Information Technology is innovative, experimental and sets the pace."
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