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Tuesday Jun 20, 2017

AAFP Delegation Gives Family Medicine Voice at AMA Meeting

"This is my kind of town, Chicago is."
-- Frank Sinatra


Chicago is not only home to the 2016 World Champion Chicago Cubs, it also is home to the AMA's House of Delegates(www.ama-assn.org) meeting.

This past week, the AMA HOD met in Chicago to discuss and debate policies aimed at improving our health care system. The HOD brings together physician leaders from the 50 states and District of Columbia, all disciplines of medicine, and representatives from the armed forces and public health corps. Family medicine is well represented through our delegation and through the numerous family physicians who serve as delegates from their respective states. The AAFP delegation, under the leadership of Dan Heinemann, M.D., of Canton, S.D., plays the important role of representing family medicine during the many policy debates that takes place.  

The HOD discussed a wide-range of issues impacting patients, physicians and our health care system. The AAFP delegation was influential in shaping many of these policies and played an instrumental role in defeating a policy that could have done serious harm to Medicaid. The strong influence of family medicine and primary care inside the HOD is an important check on those that seek to diminish the role of primary care in favor of policies that benefit subspecialists and their interests.

The issues that were most prominent at this year's meeting were what I am now referring to as the "Trinity of Physician Dissatisfaction" -- maintenance of certification (MOC), electronic health records (EHR) and reporting of health data. Together, these three issues are those that are top-of-mind for physicians when they discuss administrative or regulatory burden. They also are the leading drivers of physician burnout and professional dissatisfaction among physicians of all specialties.

The discussion around maintenance of certification has been building during the past few years, and the debate this year was passionate. There clearly is widespread frustration (if not outright anger) regarding MOC and its expanding application in the health care system. Physicians from every state and every specialty expressed broad frustration with the process. There were several frustrations listed -- the high-stakes exam, the cost (time and money) associated with meeting MOC requirements, and the use of MOC as a sole criterion to reject or eliminate physicians from insurance networks or hospitals.

There also were counter-arguments made regarding the need for physicians to "self-regulate;" the importance of life-long learning and evaluation; and why it is important for physicians, through a well-established process, to demonstrate continued competency to the public. 

Despite the presence of pro-MOC comments, the overwhelming opinion of the physicians was MOC has to be reformed and soon.

AMA delegates debated several resolutions that aimed to establish policy prohibiting state licensure boards, hospitals, insurers and other health care organizations from using participation in MOC as exclusionary criteria. The AAFP supports this type of policy. Our opinion is that board certification and MOC are elements that can be used in licensure and privileging processes, but they should not be the sole criteria. A physician's education, training, experience and demonstrated competency during a defined period should be the primary factors used. The AMA ultimately chose to further study the issue, but the writing is on the wall. MOC needs to change, and physicians of all specialties are demanding that it happen soon.

The other two issues in the "Trinity of Physician Dissatisfaction," EHRs and data reporting, are equally frustrating for family physicians and contributing to burnout. At its most recent meeting, the AAFP Commission on Quality and Practice (CQP) had a productive conversation regarding the need for immediate and impactful reforms aimed at reducing the administrative burden facing physicians -- primarily those associated with EHRs and data reporting. The CQP recognized that administrative burden impacts all physicians, in all practice settings and sizes, but they stressed the importance of ensuring that AAFP work paid special attention to solo and small group practices -- settings where the burden is higher due to fewer financial and human resources. 

The CQP has formed a work group that is charged with developing a list of administrative reform priorities within the next six months. If you have thoughts or recommendations on what issues you think the work group should prioritize, please email them to AAFP commercial health insurance strategist Brennan Cantrell.

In addition, the AAFP is working with other primary care organizations to form a cross-specialty advocacy campaign aimed at reducing administrative burden. Much more to come on both efforts, but I wanted to make certain that you were aware of these accelerated efforts on this important issue.

AAFP advocacy efforts also have been heavily focused on the issue of administrative burden. In January, the AAFP wrote to President Trump outlining our agenda for administrative and regulatory reforms. In April, we sent a letter to CMS Administrator Seema Verma detailing several steps that should be taken to simplify the Medicare Quality Payment Programs to lessen the administrative burden on physicians. 

In addition to our written communications, the AAFP has met with CMS and Office of the National Coordinator leadership on several occasions to press our recommendations on this important issue.  Next week, AAFP President John Meigs, M.D., will be in Washington, D.C., to meet with HHS Secretary Tom Price, M.D., to discuss the negative impact of administrative and regulatory burdens on patients and physicians.

Wonk Hard
On June 13, David Barbe, M.D., M.H.A., a family physician from Mountain Home, Mo., was inducted as the 172nd President of the AMA. As he noted in his inauguration address(www.ama-assn.org), Barbe, upon completion of his training, established a practice in his hometown (population 5,000) and has practiced there for more than 30 years. Congratulations to Dr. Barbe. The AAFP looks forward to working with him on the many important issues facing family medicine.

I also would like to congratulate family physician Gerald Harmon, M.D., of Pawleys Island, S.C., on his re-election to the AMA Board. He and Barbe will join fellow family physicians William Kobler, M.D., of Rockford, Ill., and Albert Osbahr III, M.D., of Hickory, N.C., in representing family medicine on the AMA Board. 

Finally, I would like to recognize and thank Stephen Permut, M.D., J.D., of Lewes, Del. Permut served eight years on the AMA Board and was a strong voice for family medicine on the Board and across the country.

Posted at 07:00AM Jun 20, 2017 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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