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Wednesday Nov 19, 2014

Primary Care: Defending What it Means and What It's Worth

Medicaid cuts are coming.

Section 1202 of the Patient Protection and Affordable Care Act increased Medicaid payments to Medicare levels for certain primary care services in 2013 and 2014. But unless Congress acts during the lame-duck session Medicaid parity payments for primary care physicians will stop, and payments will return to 2012 levels on Jan. 1.

This issue was debated in depth during the recent AMA Interim Meeting in Dallas. This was an important discussion because there is disagreement within the AMA about what constitutes primary care. In fact, many of our subspecialist colleagues claim that they provide primary care -- and therefore should qualify for parity payments -- because of their involvement in the management of certain diseases such as Parkinson's, diabetes and cancer. 

Jerry Abraham, M.D., M.P.H., of Los Angeles, and Joanna Bisgrove, M.D., of Fitchburg, Wis., represent the AAFP at the AMA Interim Meeting. Abraham, a first-year resident at the University of Southern California, was elected an alternate delegate to the AMA's Resident Fellow Section. Bisgrove is the AAFP delegate to the AMA Young Physicians Section.

The globally accepted meaning of primary care, however, comes from Barbara Starfield, M.D., M.P.H., who defined it as "first contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system." From the AAFP perspective, only family medicine, general pediatrics and general internal medicine are the specialties that train physicians to deliver true primary care. Other specialty physicians might from time to time deliver certain services described as primary care, but they are not trained to deliver comprehensive primary care.

Although some subspecialty groups at the meeting attempted to change AMA policy regarding who should get Medicaid parity payments -- if they, in fact, continue -- the Academy's delegation was able to prevent action by the AMA House of Delegates that would have expanded the Medicaid parity payments well beyond their initial focus on primary care physicians only. This means that the AMA's support for proposed legislation that would extend parity payments for two more years will continue.

Next to repeal of the sustainable growth rate (SGR) formula, this is the most crucial piece of health care legislation the AAFP is focused on for passage during the lame-duck session. The continued cohesive voice of organized medicine on this issue represents an important success.

In addition to Medicaid parity, the AAFP's delegation also testified on other important issues, such as the significant threat to our patients and our members from the increasingly troubling network narrowing that we see impacting practices in more and more states. The AMA recognized that this is a significant challenge, and resolutions were moved forward to address this directly.

It's worth noting that the AAFP, the AMA and more than 100 other organizations recently sent a letter to the National Association of Insurance Commissioners voicing support for model legislation that would serve as a template for revising state provider network adequacy standards.

With strong AAFP support, AMA delegates also passed a resolution asking CMS to halt penalties related to meaningful use(www.medscape.com) (free registration required) and look for ways to continue to incentivize use of electronic health records.

In addition, recognition of the changing landscape in terms of telemedicine was also a focus during the meeting. Related resolutions moving forward are consistent with ones we have acted on in the AAFP's Congress of Delegates.

The AAFP has one of the larger specialty society delegations to the AMA. Moreover, many of the 115,900 Academy members our delegation represents are themselves AMA members. These are dedicated family physicians who advocate for their patients and their communities through involvement with their state medical societies. Having more family physicians from different backgrounds at the AMA creates exciting opportunities for us as we continue to try to find a way to move the house of medicine in a coordinated fashion to recognize and value family medicine and primary care.

Over the years, our delegation has gained a stronger presence within the AMA as we continue to work to inform our discussions and share AMA policies. This is helped by the fact that there are five AAFP members who are on the AMA Board of Trustees:

  • Past Chair David Barbe, M.D., M.H.A., of Mountain Grove, Mo.;
  • Chair-elect Stephen Permut, M.D., J.D., of Wilmington, Del.;
  • Gerry Harmon, M.D., of Pawleys Island, S.C.;
  • William Kobler, M.D., of Rockford, Ill.; and
  • Albert Osbahr III, M.D., of Hickory, N.C.

The Academy greatly values the relationship we have developed with these leaders of the AMA, and we look forward to more opportunities to work together. Your delegation is quite well respected within the house of medicine and is led by Joseph Zebley, M.D., of Baltimore, and co-chair Daniel Heinemann, M.D., of Sioux Falls, S.D.

Recently, we have been blessed by an influx of dynamic family physicians who are early in their careers. This year, our delegation included Uniformed Services chapter member Janet West, M.D., of Pensacola, Fla.; Aaron George, D.O., a third-year resident at the Duke Family Medicine Residency in Durham, N.C., and Ajoy Kumar, M.D., of St. Petersburg, Fla. In fact, we had many people from other delegations praise our organization for being able to bring younger voices to the table.

An impressive accomplishment for our delegation during this meeting was that Jerry Abraham, M.D., M.P.H., of Los Angeles, one of our resident members, was elected as an alternate delegate to the AMA's Resident Fellow Section. A first-year resident at the University of Southern California, Abraham will be sitting in the House of Delegates this summer during the AMA's Annual Meeting. This speaks well to his leadership skills not only within the AAFP but also the AMA.

The Academy continues to work for our members and our patients in every venue we can. The AMA meeting is certainly a different body and culture from our AAFP Congress of Delegates; however, the issues discussed at AMA directly impact our patients, our communities and our members. Thanks to all of the family physicians who are involved in the AMA. This is another important avenue for advocacy, and we appreciate your efforts. As they say at the AMA, together we are stronger!

Reid Blackwelder, M.D.is Board chair of the AAFP.

Posted at 04:28PM Nov 19, 2014 by Reid Blackwelder, M.D.

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