The Academy takes reimbursement for family physicians seriously. A case in point: The AAFP assisted the Michigan AFP in a 10-year lawsuit to win FPs equal pay for equal work.
A Medicare regulation allowed the government to reimburse different specialties different amounts for the same services throughout the country. In a lawsuit that went to the Supreme Court twice, the Academy and the constituent chapter won a case that has had repercussions ever since for federal reimbursement.
In 1976, the Michigan AFP challenged the prevailing charge screening system of the Department of Health and Human Services (HHS). Blue Cross and Blue Shield of Michigan, administrator of the state's Medicare Part B program, had devised the system according to the Medicare regulation allowing dual fees. The system set higher fee levels for other specialists than for family physicians performing the same services. The AAFP provided substantial financial and legal assistance in the case.
A district court and an appellate court favored equal fees for the same service. Then HHS appealed the case to the Supreme Court, which remanded the case to the appellate court for reconsideration. The appeals court remanded it to the district court with an order that the case be dismissed--threatening an end to the suit and failure for fair reimbursement.
But the AAFP and the Michigan AFP asked the appeals court to reconsider its decision, which it did in 1985. On reconsideration, the appeals court ruled against the federal regulation allowing specialty differentials, and by this action ruled in favor of equal fees for the same service. Predictably, the federal government appealed the case again to the Supreme Court.
Finally, in 1986, the Supreme Court affirmed the appeals court's decision, and family practice emerged victorious.
"We sued the government, and after many years and several hundreds of thousands of dollars in legal expenses, the Supreme Court struck down the dual fees regulation," says R. Michael Miller, JD, AAFP's deputy executive vice president and, during the time of the lawsuit, AAFP's general counsel.
He adds, "As a result of this case, Medicare has never since utilized specialty differentials."