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2011 Annual Assembly
Distressed Practices, Fair Payment Take Center Stage at Town Hall Meeting
By Cindy Borgmeyer • Orlando, Fla.
Aid to Practices in Distress
- low per capita primary care physician penetration,
- high per capita subspecialist penetration,
- low retention of primary care-trained residents,
- an aging primary care base and
- decreasing numbers of primary care physicians.
While acknowledging that much more information is needed to mount a comprehensive response to the problem, Stream said the Academy already has taken concrete steps to address some of the issues raised by the New Jersey chapter.
- AAFP leaders updated members on various activities the Academy is undertaking during a Town Hall meeting that preceded the opening of the 2011 Congress of Delegates.
- The AAFP is taking concrete steps to address issues faced by so-called distressed practice environments.
- The Academy's latest efforts to improve primary care physician payment include calling for changes to CMS' work valuation system.
- The AAFP has called on Congress' new budget deficit reduction committee to include a permanent fix to Medicare's flawed sustainable growth rate formula.
Meanwhile, AAFP staff members have begun the process of determining what data exist on family physician locations, ratio of primary care specialists to subspecialists, migration of FPs to other states and similar factors. The Academy will examine patterns of distress revealed by the data, said Stream, identify and fill any knowledge gaps, and engage affected chapters in formulating an action plan. The topic also will be referred to the AAFP Commission on Quality and Practice for discussion and recommendations back to the Board.
"We heard that loud and clear from other chapters at ALF," agreed New Jersey AFP President Robert Eidus, M.D., M.B.A., of Cranford, referring to the AAFP's Annual Leadership Forum, which brings together chapter leaders from across the country. "While we think family medicine is trending up in many areas," he added, there remain "family medicine deserts" in others.
"This is very much a cancer," affirmed New Jersey delegate Richard Corson, M.D., of Hillsborough, "and it may metastasize."
Fair Deal for Family Physicians
Composed of 29 members -- 23 of whom represent medical subspecialties -- the RUC acts as an expert panel and makes recommendations to CMS on the relative values of CPT codes. CMS typically has honored those recommendations, which tend to favor procedural codes used by subspecialists over the E/M codes primary care specialists often use.
"We firmly believe that the RUC has to change its structure, change its culture, change its process if primary care is valued appropriately," said AAFP Board Chair Lori Heim, M.D., of Vass, N.C. Still, she noted, the RUC is the only game in town when it comes to valuing physicians' services, which is why the AAFP Board has deliberated long and hard on how to approach the fair payment dilemma.
At the same time, the AAFP announced it would launch a Primary Care Valuation Task Force to review methods used to evaluate health care services provided through Medicare and make recommendations on how to properly value and pay for services primary care physicians provide. That task force held its inaugural meeting last month and, according to Heim, is well on its way to examining the many variables involved in developing a new methodology for valuing physician services.
Some Town Hall participants, however, seemed to favor a more aggressive approach to dealing with the payment inequities perpetuated under the RUC.
Brian Klepper, Ph.D., is a member of the AAFP's newly formed Primary Care Valuation Task Force and a strong activist on the topic of the AMA/Specialty Society Relative Value Scale Update Committee, or RUC. Although not a member of the AAFP, Klepper was invited to speak about his perceptions of the RUC and its effect on primary care during the AAFP Town Hall meeting on Sept. 12 in Orlando, Fla.
Even so, said Fischer, "The problem's not just the RUC. The problem is that the codes just don't work for us." Unlike subspecialists, who often bill and are paid for multiple procedures during a single visit, primary care physicians typically are denied payment for more than a single code per visit. "No other specialty is treated like that," he said.
Lloyd Van Winkle, M.D., of Castroville, Texas, shared that sentiment. "We're the ones who direct patients to the right care, not the most care," he observed.
"If this (the RUC) were a drug, it would have been withdrawn years ago because the deformities it causes are fatal."
Taking On the SGR -- Again
The latest move, according to Goertz, has been to bend the respective ears of the dozen legislators appointed to the congressional Joint Select Committee on Deficit Reduction last month. "As soon as we found out who those 'Super 12' were, we contacted them with our ongoing (SGR) message," he said. The fact that the committee operates under an unusual set of rules -- no amendments can be made to its final recommendations, the recommendations are not subject to filibuster and only a simple majority of both houses is needed to pass them -- may work in the Academy's favor.
"One of the biggest things is going to be getting our members' voices heard," Goertz said, "and we're here to help you do that." The AAFP plans to create a series of videos to illustrate what family physicians do every day, he announced, calling on participants at the Town Hall to distribute the videos as widely as possible.
Some at the meeting, however, noted that "mission fatigue" has become an issue when it comes to enlisting the support of FPs and their patients to fight SGR-mandated pay cuts. "This is living under the sword of Damocles, and it seems to be getting duller because we've been there so many times," said Florida delegate Dennis Saver, M.D., of Vero Beach.
Goertz acknowledged that sense of frustration. "We may be in the position of shooting for everything and hoping we get anything," he said.
"I know we've been doing that for 10 years, but as one politician told me, 'Politics takes patience.'"
Live Streaming of AAFP COD Sessions Allows All Members to Watch AAFP Delegates Set Policy
Town Hall Meeting Focuses on Payment Issues, Distressed Practices