Delegates Adopt Resolutions to Strengthen Role of Family Physicians in U.S. Health Care System

Passage of the health care reform law spurred action on a number of resolutions at the 2010 AAFP Congress of Delegates as members sought to protect and strengthen the role of family physicians by adopting measures that would put family physicians in a position to drive systematic changes in the nation's health care system.

Language regarding accountable care organizations, or ACOs, in the health care reform law led the Indiana and Nevada chapters to introduce two resolutions regarding ACOs. The Indiana resolution called on the AAFP to study the effect ACOs would have on family physician practices, and the Nevada resolution directed the Academy to ensure family physicians will have leadership positions in these organizations.

In testimony before the Reference Committee on Practice Enhancement, members noted that they were concerned ACOs would not be able to deliver high-quality care at an affordable price without family physician participation and leadership.

Family physicians need to be in leadership roles in ACOs, but "I don't know how that is possible in a hospital-based system," said Justin Bartos, M.D., of North Richland Hills, Texas.

According to Charles Holt, M.D., of Indianapolis, many payers and health care providers do not understand the concept of ACOs and how they are supposed to work.

In response to this testimony, reference committee members reviewed the final report prepared by the AAFP Accountable Care Organization Task Force (15-page PDF; About PDFs) and determined that the report answered many of the questions raised during testimony. Accordingly, they suggested a substitute resolution that asked the AAFP to "take a leadership position in educating members in various practice settings about the formation of ACOs" and "encourage and facilitate strong family physician leadership in ACO development and governance."

The substitute resolution was adopted by the COD.

Delegates also voted to direct the AAFP to develop a statement that supports the rights of physicians to collectively negotiate with health insurance plans. The measure was part of a resolution introduced by the Colorado, Arizona, Florida, Indiana, Montana and Oregon chapters.

In testimony before the Reference Committee on Advocacy, members said such a policy statement is needed to attempt to level the playing field in negotiations with health insurance plans. Federal antitrust laws prohibit most businesses, including physicians, from engaging in collective bargaining, meaning physicians currently have little negotiating power when working with health insurance companies.

Promulgation of this policy would "strengthen and perhaps even ensure the survival of primary care," said Aris Sophocles, M.D., J.D., of Denver, in testimony before the reference committee. If such a policy were to be enacted at the federal level, he noted, "It would enable us to negotiate issues relating to plan design as they pertain to patient coverage, benefits and deductibles so we can effectively advocate for our patients with private insurance plans."

In the long run, Sophocles added, "it would improve the care we are able to deliver to our patients."

Although members were overwhelmingly in favor of the clause of the resolution calling for the development of a policy statement on collective bargaining, they were less enthusiastic about the second resolved clause, which called on the AAFP to find a legislator who would draft the statement into federal legislation.

"We recommend modifications (to the resolution) particularly for resolve number two," Javette Orgain, M.D., of Chicago, testified. "We feel that the draft policy statement is too extensive. We don't necessarily recommend all of the provisions that are in the draft policy statement, but we do support the resolution."

Dennis Saver, M.D., of Vero Beach, Fla., also testified that changes to the second resolved clause were needed. "We would recommend that the (Congress) refer the second resolve to the Board to go through commission process," he said. In the end, the delegates agreed, voting to send the measure to the Board.

A resolution jointly submitted by multiple chapters called on the AAFP to actively oppose any legislation mandating physician participation in health plans as a condition of licensure.

The resolution was developed in response to a bill in the Massachusetts legislature that would require physicians to participate in health plans in order to be licensed to practice in the state.

In testimony before the Reference Committee on Advocacy, Michael Wulfers, M.D., of Cape Girardeau, Mo., said "this an issue we should take a stand on."

According to Jose David, M.D., of Albany, N.Y., the decision to participate in a health plan is an economic issue, not one that should be determined by the state.

Russell Breish, M.D., of Fort Washington, Pa., said health insurance plans could make the issue go away by paying physicians adequately so that physicians will "want to join their networks."

Delegates ultimately adopted a substitute resolution recommended by the reference committee that deleted the words "state or federal" in regard to legislation. Although the committee agreed with the intent of the original resolution, committee members wrote in their report that they decided to amend it "because the Academy traditionally does not instruct state chapters on which legislation they should support."

Delegates also addressed CMS' Recovery Audit Contractors, or RAC, program, which is designed to recover Medicare overpayments to physicians and other providers.

Although the AAFP already has created a number of online educational resources on the RAC program, delegates adopted a substitute resolution that called on the AAFP to expand its educational resources on the program and to promote the resources to members.

"This will be money well spent," said Drew Edwards, M.D., of Prospect, Conn., in testimony before the Reference Committee on Practice Enhancement.