Family physicians are helping transform an uncooperative health care system into a patient-centered care delivery model that really works. But helping is not enough. It's time to start leading. That was the message delivered Sept 26 during the "Panel Session: Real Answers" at the AAFP Scientific Assembly here.
Panelists John Bender, M.D.; Marci Nielsen, Ph.D., M.P.H.; and Sam Nussbaum, M.D., offer "real answers" to some of the major issues facing family medicine during a panel discussion at the AAFP Scientific Assembly.
Panelists John Bender, M.D., senior partner and CEO at Miramont Family Medicine in Fort Collins, Colo.; Marci Nielsen, Ph.D., M.P.H, CEO of the Patient-Centered Primary Care Collaborative (PCPCC) in Washington; and Samuel Nussbaum, M.D., EVP and clinical health policy and chief medical officer for insurer WellPoint Inc., told a standing-room-only crowd of family physicians that they are a central cog in the transformation process. The panel took questions electronically from AAFP members during the discussion.
"We haven't yet made the patient the real center of the medical home because, all too often, we stop at patient," said Nielsen. "We need to elevate the role of consumer in this process, because (consumers) are not yet demanding this model of care. If you want the (insurers) and Congress to pay for this model and reimburse primary care, you've got to start with patients and explain to them why it is so important."
AAFP Leaders Continue Panel Discussion
During the "Panel Session: Real Answers" at the AAFP Scientific Assembly in San Diego, panelists took questions from the audience that were submitted electronically. The volume of questions meant that some questions did not get answered.
However, the AAFP captured the questions the panelists didn't have time to answer, and the Academy's officers have agreed to respond to these questions via the AAFP Leader Voices blog. You also can sign up to receive e-mail notification when the Leader Voices blog is updated.
That is critical, Nielsen said, because, although groups like the AAFP and PCPCC are working hard in Washington and elsewhere to push for reform, insurers are only going to make real changes when employees begin demanding that employers pay for the patient centered medical home (PCMH) model.
"All of this can happen based on your leadership, but that means you can't just talk about this in your offices, you have to go out into your communities and talk about it, as well," said Nielsen. Primary care physicians "have got to keep leading and stepping outside of their comfort zone on this issue, because if not, we won't continue to be the 'it girl' of public policy that we are now."
Good evidence is another part of the payment equation, said Nussbaum. "We are developing different payment models for different (regional) settings, all based on performance and quality-of-care criteria," he said. "Family practice physicians can expect to see a 40 to 50 percent increase in total revenue based on value provided instead of patient volume."
Bender said he has found this to be true in his own practice, which is recognized as a PCMH by the National Committee on Quality Assurance (NCQA). "After we attained NCQA (recognition) for our PCMH transformation, we saw serious changes in quality," he said. "Hospitalization rates for our patients declined by 83 percent compared to our peers, while emergency room utilization by our patients was -218 percent compared to other practices in our area."
Bender said it is all a good story, but he cautioned that recognition or certification is not an end in itself.
"NCQA (recognition) is like a high school diploma -- you've accessed something, but it is not your career," he said. "Now you're licensed to go out and do it."
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