The main ballroom at the 2016 Family Medicine Congressional Conference is packed with family physicians, residents and medical students eager to learn everything they can about top priorities for family medicine before they head out to their legislators' offices the next day.
A full hour of the Family Medicine Congressional Conference morning agenda was devoted to expert panelists' remarks regarding new payment models associated with the Medicare Access and CHIP Reauthorization Act (MACRA). When the session opens up for questions, family physicians immediately jump in line to ask questions.
Samuel Church, M.D., M.H.P., of Hiawassee, Ga., left, encourages Marc Price, D.O., of Mechanicville, N.Y., to reconsider his decision not to use the chronic care management code.
With their notes close at hand, members of the Iowa delegation plan their strategy for Tuesday's trip to Capitol Hill, where they will talk to legislators and their staff members about a number of issues on which they've been briefed.
Surgeon General Vivek Murthy, M.D., M.B.A., discusses with AAFP President Wanda Filer, M.D., M.B.A., future collaboration with the Academy. Filer left the Family Medicine Congressional Conference for a few hours on April 18 to meet with Murthy and told family physicians about the meeting when she returned.
Family medicine arrived on Capitol Hill in a big way recently -- and with record attendance -- when 244 family physicians, family medicine residents and medical students came to town to lobby their lawmakers in support of issues critical to the specialty.
- The 2016 Family Medicine Congressional Conference recently claimed its highest attendance ever as 244 FPs, residents and medical students came to Washington, D.C., to advocate on behalf of the specialty.
- Top discussion topics were prescription drug abuse and permanent funding for the nation's teaching health centers.
- After a day of deep discussions about the issues, attendees headed to legislative offices to meet with lawmakers and their staff members.
They were here for the 2016 Family Medicine Congressional Conference on April 18-19, and as in past years, day one focused on prepping attendees about the most pressing issues and coaching them about how to effectively communicate key points to their senators and representatives.
Finding solutions to the nation's out-of-control prescription drug abuse problem was at the top of this year's discussion list, as was the issue of securing a permanent funding solution for America's teaching health centers (THCs) to ensure that this proven source of graduate medical education continues to thrive.
Another area of focus -- for attendees who planned on visiting House member offices -- was to encourage legislators to join the Congressional Primary Care Caucus -- a bipartisan caucus created in October 2015 to bring greater attention to primary care.
Appropriations requests for fiscal year 2017 also were on the "ask" list distributed to attendees, including a request for millions of dollars for Title VII primary care training, the National Health Service Corps, and the Agency for Healthcare Research and Quality.
"We've got some important messages for you to carry," said AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., in her welcoming remarks to the group. "You're going to learn a lot more about them over the next day. I will tell you that family medicine is deeply committed to advocating for our members and our patients, and your presence today is evidence of that commitment."
Funding Teaching Health Centers
Winston Liaw, M.D., M.P.H., medical director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care,(www.graham-center.org) gave attendees a refresher course on the importance of THCs -- defined as community-based, ambulatory care centers that also operate as primary care residency programs.
He reminded his audience that THCs were created by the Patient Protection and Affordable Care Act, which included five years of funding through 2015. Additional funding -- $60 million a year in 2016 and 2017 -- was authorized by the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015.
Tell lawmakers that THCs serve patients in rural, underserved and primary care shortage areas, said Liaw. Point out that these centers will help relieve the physician shortage and the maldistribution of physicians. And tell them that the demand for THCs is strong, despite funding instability.
Liaw said there were more than 100 applicants for every THC residency slot. However, two thirds of the 80 THCs that responded to a recent Graham Center survey said they would be "unlikely" or "very unlikely" to have the financial means necessary to support current residency positions without continued federal funding.
"It's hard to recruit when you don't know where your funding is coming from in two years," said Liaw.
Andrea Anderson, M.D., pauses for a photo after discussing with AAFP News the difficulty she has had recruiting potential residents to her program when she can't guarantee a funding source for the entire three years of their training.
Andrea Anderson, M.D., of Washington, D.C., agreed. She took a turn at the microphone to tell her colleagues that funding issues were critical. As one of the core faculty members at the Wright Center for Graduate Medical Education in Washington and medical director at Unity Health Care, Anderson knows firsthand the difficulties of recruitment.
She sat down with AAFP News when the plenary session was over.
"I want to emphasize how important long-term funding is to these programs," Anderson said. She added that significant time was spent during her program's last interview season explaining the funding situation to residency applicants.
"Students are aware that these programs do have funding limitations," and they're aware that several programs have had to close.
"So even if they're interested in our program, they want to know how sustainable our program is," said Anderson. "I know many good candidates for my teaching health center program feel pressured to choose other programs because of a lack of guaranteed money.
"My ask of Congress is to authorize permanent funding for the innovative teaching health center GME program to guarantee the future of this crucial pipeline and to close the primary care gap," she said.
Since Washingon does not have congressional representation, Anderson planned to join the Maryland delegation on the trip to lawmaker's offices.
Curbing Prescription Drug Abuse
An afternoon session explored policies aimed at reducing the risk of prescription drug abuse without impeding physicians' ability to appropriate treat debilitating chronic pain.
Christopher Jones, Pharm.D., M.P.H., representing the U.S. Public Health Service, set up the problem with a plethora of sobering statistics.
Jones serves as director of the Division of Science Policy in the HHS Assistant Secretary's Office of Planning and Evaluation. He noted that mortality data "sounded the alarm" when it showed that even as other causes of death in the U.S. were stabilizing or declining, some 28,000 deaths in 2014 were attributed to opioids.
Furthermore, 2.2 million individuals met the criteria for prescription opioid use disorder in 2014.
Family physician Sarah Chouinard, M.D., serves as chief medical officer of Community Care of West Virginia. She told attendees that her state had the highest drug overdose mortality rate in country with nearly 29 deaths per 100,000 people -- a rate that quadrupled from 1999 to 2010.
"Where do they get these drugs? They get them from us," she told her colleagues. "West Virginia clinicians wrote 138 pain prescriptions per every 100 people in 2012."
Chouinard ticked off reasons why those numbers were so high. She included on that list
- legitimate specialty clinics,
- prescription coverage issues including patient copays for a small quantity versus a month's supply,
- lack of access to substance abuse treatment,
- health information exchange limitations -- in particular from one ER to another and
- lack of adequate physician training in chronic pain management.
Sarah Chouinard, M.D., tells attendees at the 2016 Family Medicine Congressional Conference that opioid misuse is rampant in her state of West Virginia and across the country. "Oxy is today's aspirin," she says.
"In West Virginia, it's three hours of mandatory training every two years," she said. Add to that a huge communication gap between physicians, and between physicians and their patients.
"We don't explain how dangerous these drugs are," said Chouinard. Patients need to know that "bumming an oxy off your buddy is probably not a good idea," she added.
Speakers urged attendees to ask their lawmakers to
- authorize and support prescription drug monitoring programs in all states and enable physicians to share such information across state lines in real time to help curb doctor shopping;
- provide greater access to naloxone, an opioid antagonist used to counter the effects of opioids especially in the case of overdose; and
- raise the cap on medication-assisted treatment of addiction from the current 100 patients per physician to at least 200 patients.
Reviewing More Conference Topics
Attendees heard speakers on a variety of other issues at this year's conference, including an afternoon breakout session on chronic care management (CCM) and the Jan. 1, 2015, implementation of CPT code 99490.
Physicians had lots of questions about the practicality of the CCM code, including hassles associated with documentation, staffing expenses, workflow and patient pushback regarding the additional copayment.
Attendee Marc Price, D.O., of Mechanicville, N.Y., told his colleagues that after some consideration, he decided not to take advantage of the CCM code.
"The patients in my practice who would benefit the most can't afford it," said Price, referring to the nominal copay. He added that he already provided chronic care management to all of his patients, "and the extra money I would make didn't offset my moral compass."
But shortly after he made his comments, Price talked to another family physician at the conference who convinced him to think further on the issue.
"People who can't afford $8 probably can't afford the other deductible, either," Samuel Church, M.D., M.H.P., of Hiawassee, Ga., told Price. "Whatever sliding scale or indigent cost program you use in your office can be applied to these patients, too, as long as you are consistent. My patients love this, they ask for it and it's not a hard sale once you realize what you can do with it."
Other topics covered during the information sessions included
- new payment models under MACRA,
- direct primary care,
- mental health reform and
- an update on FamMedPAC activities.
On April 19 from 9:15 a.m. to 5 p.m., the 244 conference attendees began their work as skilled advocates for family medicine. They visited congressional offices, told their personal practice stories and shared relevant data with both lawmakers and their congressional staff members.
Related AAFP News Coverage
White House, HHS Expand Fight Against Opioid, Heroin Abuse