AAFP President Larry Fields, M.D., of Ashland, Ky., wants to revolutionize the health care system. How? By making family medicine its base. In this interview, Fields focuses on access to health care for all, family physicians' bottom line and a new model of care for the specialty.
Q. As you travel to chapter meetings, what issues are AAFP members discussing with you?
Q&A With Larry Fields, M.D.
AAFP President Outlines His Vision for Specialty, U.S. Health System
By News Staff
11/30/2005
A. Members' main concern is keeping their practices solvent to maintain their patients' access to health care. Part of the solvency problem is the way payment is currently structured. The liability crisis also impacts the bottom line. Members see a lot of uninsured people and are concerned about the need for access to health care for all.
Payment minus overhead equals access. When payment gets lower than overhead, patients' access to care goes down or goes away. I call this equation "Fields' physics."
Making sure our patients maintain access to care is really what we're concerned about. Most of us could go work for someone or work somewhere else, but right now, we're working where the need is, and that's where we want to be. If we're not available, our patients won't have access to the best health care they can get. All the data show that family physicians provide better outcomes at less cost.
Unfortunately, some family physicians are contemplating bankruptcy. At the Assembly, two members told me they're considering that option. Five years ago, members were not coming up to AAFP leaders to talk about bankruptcy.
Q. In your president's address at the AAFP Assembly this fall, you presented what you called family medicine's pledge to America. It ends, "We will deliver to you a health care system the likes of which the world has never seen." What's your vision for the health care system?
A. Family physicians are the health care system we promised at the Assembly. If Americans each had a personal medical home in a family physician's office, they would automatically get quality care that's readily accessible -- family physicians go where the people are. And the care would be at a much more reasonable cost than if the medical home were in the ER or the cardiologist's office.
Q. How can family physicians demonstrate the value of their services?
A. We've got much more data now than we had a few years ago. We've got the work of the Future of Family Medicine project and the work of the strike forces on payment and liability (the AAFP Board of Directors' reports include Board reports H on reimbursement [PDF file: 13 pages / 52 KB. More about PDFs.] and I on liability [PDF file: 9 pages / 46 KB. More about PDFs.]). The Academy -- and its leaders -- have to demonstrate family physicians' value. We have the resources and the people to do it.
We're the big dog. We've got to get off the porch and start hunting.
Q. What will it take to achieve what the Academy has been committed to since 1989 -- health care coverage for all?
A. It will come closer to reality if we get a family medicine-based health care system and if we tie it to liability reform -- that way, we're going to save a ton of money. If you combine the inherent efficiency and cost-effectiveness of family medicine with a decreased likelihood of getting dragged into the courts, that's going to make the environment much better for everybody. Employers will save a bunch of money, government will save a bunch of money, people will be happier and their health is going to be better.
Q. How do you think the Academy is doing in encouraging FPs to adopt electronic health records?
A. The Academy is leading the charge in the field of EHR implementation, especially in trying to make people comfortable adopting EHRs. But the Academy needs to push insurance companies and the government to stop studying EHR issues and start paying to put EHRs in physicians' offices.
We need to push the standardization/interoperability issues that Dr. Henley (EVP Douglas Henley, M.D.) is working on with CMS. The certification process is what is really needed. We have to know which EHR systems can meet the ACID principles: affordability, compatibility, interoperability and data stewardship.
Up until the last couple of years, there have not been any products that have really been ready for family medicine. But now, people are paying more attention to how our records should be, so we can get products that will work.
Q. Short of EHRs, how are electronic technology and other innovations facilitating patient care?
A. I use an online database that gives the average price of a drug per month. The most frequent question I get from patients when I prescribe a drug is, "How much is this going to cost?" They're pushed to the wall right now.
Also, many aspects of the new model of care proposed in the Future of Family Medicine report can be implemented without an EHR. We can make lots of changes internally, such as open-access scheduling. However, for interaction with the world -- the lab, the pharmacy, the hospital -- the EHR is the linchpin for our future.
Q. What are your hopes for TransforMED, AAFP's new subsidiary that will help family physicians transform their practices into the new model of care?
A. We hope TransforMED will be a turnkey operation. For example, TransforMED needs to come into my office, tell me what I need, tell me how much it will cost, assist me in getting it and make sure it works.
TransforMED's initial start-up validation process for 20 practices (to begin in 2006) is just to get the bugs out of the system, to make sure everything in the new model works that we think works.
Q. During the Assembly, you issued your President's Challenge -- to members, asking them to contribute to a Physicians' Disaster Assistance Program to help FPs affected by hurricanes Katrina and Rita. What are your goals for the fund?
A. My most immediate goal is to help family physicians re-establish their practices that were wiped out or damaged. I'd also like to help support residents who were displaced and have to start training in a new area, and I'd like to assist family medicine departments that were displaced.
I hope AAFP members will join me in doing our part to put family physicians back where their patients need them.
Payment minus overhead equals access. When payment gets lower than overhead, patients' access to care goes down or goes away. I call this equation "Fields' physics."
Making sure our patients maintain access to care is really what we're concerned about. Most of us could go work for someone or work somewhere else, but right now, we're working where the need is, and that's where we want to be. If we're not available, our patients won't have access to the best health care they can get. All the data show that family physicians provide better outcomes at less cost.
Unfortunately, some family physicians are contemplating bankruptcy. At the Assembly, two members told me they're considering that option. Five years ago, members were not coming up to AAFP leaders to talk about bankruptcy.
Q. In your president's address at the AAFP Assembly this fall, you presented what you called family medicine's pledge to America. It ends, "We will deliver to you a health care system the likes of which the world has never seen." What's your vision for the health care system?
A. Family physicians are the health care system we promised at the Assembly. If Americans each had a personal medical home in a family physician's office, they would automatically get quality care that's readily accessible -- family physicians go where the people are. And the care would be at a much more reasonable cost than if the medical home were in the ER or the cardiologist's office.
Q. How can family physicians demonstrate the value of their services?
A. We've got much more data now than we had a few years ago. We've got the work of the Future of Family Medicine project and the work of the strike forces on payment and liability (the AAFP Board of Directors' reports include Board reports H on reimbursement [PDF file: 13 pages / 52 KB. More about PDFs.] and I on liability [PDF file: 9 pages / 46 KB. More about PDFs.]). The Academy -- and its leaders -- have to demonstrate family physicians' value. We have the resources and the people to do it.
We're the big dog. We've got to get off the porch and start hunting.
Q. What will it take to achieve what the Academy has been committed to since 1989 -- health care coverage for all?
A. It will come closer to reality if we get a family medicine-based health care system and if we tie it to liability reform -- that way, we're going to save a ton of money. If you combine the inherent efficiency and cost-effectiveness of family medicine with a decreased likelihood of getting dragged into the courts, that's going to make the environment much better for everybody. Employers will save a bunch of money, government will save a bunch of money, people will be happier and their health is going to be better.
Q. How do you think the Academy is doing in encouraging FPs to adopt electronic health records?
A. The Academy is leading the charge in the field of EHR implementation, especially in trying to make people comfortable adopting EHRs. But the Academy needs to push insurance companies and the government to stop studying EHR issues and start paying to put EHRs in physicians' offices.
We need to push the standardization/interoperability issues that Dr. Henley (EVP Douglas Henley, M.D.) is working on with CMS. The certification process is what is really needed. We have to know which EHR systems can meet the ACID principles: affordability, compatibility, interoperability and data stewardship.
Up until the last couple of years, there have not been any products that have really been ready for family medicine. But now, people are paying more attention to how our records should be, so we can get products that will work.
Q. Short of EHRs, how are electronic technology and other innovations facilitating patient care?
A. I use an online database that gives the average price of a drug per month. The most frequent question I get from patients when I prescribe a drug is, "How much is this going to cost?" They're pushed to the wall right now.
Also, many aspects of the new model of care proposed in the Future of Family Medicine report can be implemented without an EHR. We can make lots of changes internally, such as open-access scheduling. However, for interaction with the world -- the lab, the pharmacy, the hospital -- the EHR is the linchpin for our future.
Q. What are your hopes for TransforMED, AAFP's new subsidiary that will help family physicians transform their practices into the new model of care?
A. We hope TransforMED will be a turnkey operation. For example, TransforMED needs to come into my office, tell me what I need, tell me how much it will cost, assist me in getting it and make sure it works.
TransforMED's initial start-up validation process for 20 practices (to begin in 2006) is just to get the bugs out of the system, to make sure everything in the new model works that we think works.
Q. During the Assembly, you issued your President's Challenge -- to members, asking them to contribute to a Physicians' Disaster Assistance Program to help FPs affected by hurricanes Katrina and Rita. What are your goals for the fund?
A. My most immediate goal is to help family physicians re-establish their practices that were wiped out or damaged. I'd also like to help support residents who were displaced and have to start training in a new area, and I'd like to assist family medicine departments that were displaced.
I hope AAFP members will join me in doing our part to put family physicians back where their patients need them.
