White House Seeks AAFP Input on Health Policy

Acknowledging the Academy's leadership role in shaping health care policy, the Bush administration recently invited AAFP President Larry Fields, M.D., of Ashland, Ky., and AAFP EVP Douglas Henley to a meeting at the White House concerning President Bush's plans for health care.

Fields and Henley met with Allan Hubbard, the president's assistant for economic policy, on Feb. 14. Also invited to the meeting were representatives from the AMA, American College of Physicians, American Hospital Association, Catholic Health Association and Federation of Independent Hospitals.

Hubbard previewed Bush's Feb. 15 speech on health care with meeting participants and then turned to the administration's interest in ensuring information about physician performance measures and medical costs is easily available to everyone.

"Mr. Hubbard wanted to enlist our help in providing transparency to medical cost and quality data," said Fields during an interview after the meeting. "We said we could do this, but it's important that we do it the right way. We made the case for using performance measures that have been vetted by the Ambulatory care Quality Alliance (AQA) and the National Quality Forum."

Contributions to Standards

Fields cited the Academy's involvement in the formation and work of the NQF, the Physician Consortium for Performance Improvement and the AQA. Progress to date includes the AQA's Recommended Starter Set for Clinical Performance Measures for coronary artery disease, heart failure, asthma, diabetes, depression, prenatal testing, and preventive care and screening.

The White House meeting continues a trend of recognition that AAFP has received for its work in developing performance measures. During a Feb. 6-9 national summit on pay-for-performance, several speakers, including Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality, and Margaret O'Kane, president of the National Committee for Quality Assurance, applauded the Academy's work in establishing performance measures that could serve as a blueprint for implementing pay-for-performance and reporting formats that enable physicians to collect measurement data during a patient visit.

Price Transparency

Although he acknowledged that price transparency has merit, Fields said he warned Hubbard against an expectation that full transparency about prices would be possible for office visits. The final price of an office visit, Fields said during the meeting, depends on the physical examination and tests required for accurate diagnosis.

Fields followed the meeting with a letter to Hubbard that further explained the process by which prices are determined. Physicians can post the price for CPT codes, he said in the letter; but neither the patient nor the physician can know in advance which code will actually be charged because "the final charge is dependent upon the degree of history and physical examination required by the patient's condition, the intensity of the medical decision-making and appropriate tests ordered."