The recognition process for the patient-centered medical home, or PCMH, inspired spirited debate during the 2010 AAFP Congress of Delegates, as delegates voted on streamlining that process. Delegates also referred a number of other resolutions to the Board of Directors.
Members who testified in a Sept. 27 hearing of the Reference Committee on Practice Enhancement hotly debated a resolution from the New Jersey AFP that called for the AAFP to consult with the National Committee for Quality Assurance, or NCQA, to streamline the PCMH recognition process by introducing simpler assessment and documentation tools, increasing transparency and feedback, and lowering the cost.
Several members said the NCQA recognition process is too burdensome and time-consuming for small practices.
Small practices have "great difficulty in submitting documentation for the process of qualification," said Mary Campagnolo, M.D., of Lumberton, N.J. "We want to make it easier by streamlining the process."
Others disagreed, saying the recognition process is meant to be difficult, and adoption of the resolution could weaken requirements for achieving PCMH recognition.
"We are raising the bar," said Brian Bachelder, M.D., of Akron, Ohio. "Most family physicians don't understand what it takes to get here."
Wanda Filer, M.D., of York, Pa., warned about the dangers of "watering down the (recognition) process." And, she noted, the NCQA represents a "business model" whose PCMH goals may not align with the goals of the Academy.
Delegates also referred several resolutions to the Board of Directors, including parts of a resolution on automated prescription refill systems and a resolution on licensing exemptions for out-of-state health care professionals.
A North Carolina resolution calling on the AAFP to adopt a policy opposing automatic prescription refills sparked a great deal of discussion among the delegates, who ultimately divided the resolved clauses of the resolution and referred some of them to the Board.
The first and second parts of the resolution called on the Academy to express strong concern regarding patient safety to national pharmacy chains that use automated prescription refill systems and to express similar concerns to the appropriate regulatory agencies. The third part of the resolution said the AAFP should adopt a policy opposing automated prescription refill systems.
The COD, acting on the recommendations of the Reference Committee on Practice Enhancement, referred the first two resolutions to the AAFP Board of Directors for further review, and delegates did not adopt the third resolved clause.
Testimony before the reference committee focused on problems with pharmacies automatically refilling prescriptions, calling patients and providing patients with medications without proper oversight from a physician.
These systems have led to medication errors in North Carolina and are now one of the leading causes of rehospitalizations in that state, said Michelle Jones, M.D., of Hampstead, N.C.
Other members, however, testified that automated refill systems can help ensure patients actually fill prescriptions, thus reducing nonadherence to a medication regimen.
Delegates also referred a resolution that called on the AAFP to provide constituent chapters with "a template of a proposed state law that would provide licensing exemptions to out-of-state health care professionals who work in free clinics."
Daniel Spogen, M.D., of Reno, Nev., who is the medical director of a free clinic in Reno, described the issue as "huge."
"We have lot of trouble getting physicians to come and serve in these free clinics," said Spogen. "A lot of them are retired from other states, and they want to come in and donate their time." But they are prohibited from doing so, he added, because they are not licensed in that state.
Other members testified, however, that the practice could lead to marginal or predatory health care professionals volunteering at free clinics. In addition, members noted that this issue is being addressed by the Federation of State Medical Boards, which led delegates to agree that the issue should be referred to the Board for further review.