AAFP Congress tackles problems ... nothing new to Mac Cahal, CEO from 1948 to 1971
Mac F. Cahal, JD, the Academy's CEO from 1948 to 1971, paid a visit to the AAFP Congress of Delegates on Sept. 17. He walked slowly up the central aisle of the huge ballroom as delegates, alternates, and hundreds of observers cheered.
"You have drunk from wells you did not dig and been warmed by fires you did not build," he told the delegates, using an American Indian aphorism. "This is my accolade to the old leaders of the Academy who sat in the seats you sit in now."
Mr. Cahal laced his words of wisdom with stories from the Academy's youth. He advised, "If you don't have problems, you won't have an organization. You have problems now, but they're not anything compared to the past. We were in court in four states at one time over the denial of hospital privileges to GPs!"
Delegates applauded that statement -- and they confronted today's scope-of-practice problems throughout their meeting. They also laughed at Mr. Cahal's irrepressible good humor and surprised him with the John G. Walsh Award.
Then they continued wrestling with problems, including:
Hospitalists. These physicians (including internists, family physicians, and others) devote themselves to inpatient care. Incoming President Neil Brooks, MD, of Rockville, CT, called for a task force to study hospitalists and their impact on family practice and patients. Delegates approved his idea and said the task force should explore such issues as continuity of care and reduced capitation rates for physicians who provide primary care.
Denial of privileges. Delegates passed a resolution on procedural training, calling on the AAFP to develop evidence for what constitutes adequate training and to devise rational numerical standards where possible.
Norman Rosen, MD, of Orange, CA, California AFP president-elect, listed the unusually high quotas some hospitals set for eligibility for privileges, such as proctoring in 250 Caesarean sections, in 100 sigmoidoscopies, or in assisting at 20 laparoscopic cholecystectomies. "These demands are bargaining chips," he said. "We try to negotiate."
Representation of FPs in the ER. Delegates reviewed the needs of FPs practicing in emergency rooms, noting that the American College of Emergency Physicians might limit future membership to physicians residency-trained in emergency medicine.
The AAFP will keep trying to meet with the ACEP, will communicate with AAFP members in emergency medicine, and will report back to the 1998 AAFP Congress on the topic.
Disease-specific certification. A resolution from the National Congress of Family Practice Residents said some groups offer credentials for exorbitant fees -- for example, a charge of $1,200 to be credentialed to treat people with diabetes.
Delegates referred the residents' resolution to the Board and adopted Dr. Brooks' recommendation that the AAFP study disease-specific certification and educate members about its existence and how to respond to it.
Fraud, abuse. The Congress adopted a revised policy statement: "The AAFP deplores abuses of Medicare/Medicaid or any health assistance programs by anyone. The AAFP urges and expects that due process be followed."
Delegates discussed the proper coding needed in light of new federal anti-fraud measures, including the Health Care Financing Administration's prepayment reviews of claims, beginning this month. Delegate David Filipi, MD, of Omaha said, "We need to prepare our members so they can withstand an inspection from the inspector general. We all know the government is out to balance the Medicare/Medicaid budget on our backs."
Mac F. Cahal, JD, the Academy's first executive director, greets a well-wisher after receiving the John G. Walsh Award for dedicated and effective leadership in furthering the development of family medicine.
- FP Report is published by the AAFP News Department.
