Kansas FPs Concentrate on Improving Access, Filling Pipeline

Kansas legislators searching for solutions to the challenges posed by the growing number of the state's uninsured residents likely will follow other states' leads, with a focus on incremental changes that improve access to health insurance. That was the word from Kansas Speaker of the House Melvin Neufeld during the Jan. 24 Kansas AFP Family Medicine Advocacy Day here.

But meeting those challenges depends on input from family physicians, according to Carolyn Gaughan, C.A.E., executive director of the Kansas AFP. That's why the chapter brought 42 physicians and three medical students to the state capital to learn more about issues facing Kansas family physicians and to meet with their legislators.

The day was established to "get people involved, to inform them of the issues and to build relationships between them and their legislators," according to Gaughan. The event also reinforced the "already strong relationship" between Kansas AFP and the Kansas Medical Society, she said.

Family Medicine Advocacy Day speakers generally agreed that health system reform in Kansas will come in increments, most likely starting with a plan to redirect the flow of funds from institutions to patients.

"The proposal to expand Medicaid for children is a wrong-headed approach," said Neufeld. "That's the old model. Simply putting more children into the welfare system doesn't drive us toward a health system. We should expand Medicaid funding and use it to help families buy insurance. If you have families buying their own policies, they can have a medical home, and when people have medical homes -- that's what drives us to a healthier population."

Kansas family physicians agree with the idea of shifting to a model that focuses on medical homes, said Mike Kennedy, M.D., of Kansas City, president-elect of the Kansas AFP. But the success of such a model depends on restructuring the physician payment system to reward primary care physicians for the medical home services they provide.

"If we're trying to get more family physicians into rural areas, the problem that must be solved is to pay them" appropriately, he said.

Neufeld agreed that appropriate payment for all primary care was needed. He said he supported an idea that -- though yet to take the form of legislation -- would establish a CPT code to pay a physician to contact patients when patients fail to follow prescribed regimens and to schedule follow-up visits to reinforce the need to comply with the doctor's orders.

"If we prevent one stroke or one heart attack, that would pay for the program for a year," he said.

State legislators aim to ensure access to medical homes by improving the state's medical student loan program, according to Kansas Sen. Jim Barnett. S.B. 24 (PDF file: 2 pages / 26 KB. More about PDFs.) would improve the state's medical student loan forgiveness program by allowing second-, third- and fourth-year medical students to apply for and retroactively receive tuition and a monthly stipend of as much as $2,000, an increase from the current $1,500, he told participants at the advocacy event.

"I like the bill," said Barnett. "I think there's a good chance for passage. Anything that gets more physicians across the state is good legislation."

The Kansas AFP and University of Kansas School of Medicine, Kansas City, developed the recommendations for the bill during meetings after the last legislative session. Kansas AFP President Brian Holmes, MD, of Abilene testified in support of the bill on Jan. 22.

Kansas legislators have filed 25 health-related bills and will consider legislation on topics ranging from health care access to scope of practice issues, according to Diana Ewert, AAFP senior manager for state legislative affairs. The number and range of health-related proposals have skyrocketed nationwide, and proposals that affect medical education, family physician payment, scope of practice and hospital privileges can appear in legislation that affect the tax code, insurance industry, allied health licensure and a number of other nonmedical areas, she told Kansas AFP members.

"What we're seeing in the political environment is a broadening of legislation, depending on the legislators and their interests," said Ewert. "You have broad health care legislation going through many different committees these days. It's not uncommon to have nonphysician professions introducing bills" that affect physician practice.

That explosion increases the importance of family physician participation, said Kansas AFP lobbyist Pat Hurley.

"Nothing is more important than personal contact with your legislator," he said. "It's a great value if they are hearing from their constituents in their district." Legislators will tell Hurley, "We're not hearing from anyone on this issue" when he urges support of a family medicine-friendly bill. "And then they vote against it," he said.