AAFP President Explains Importance of Title VII in Improving Patient Care

Title VII funding could serve as a major catalyst in promoting and implementing the patient-centered medical home for the next several years, said AAFP President Rick Kellerman, M.D., of Wichita, Kan., before a federal advisory panel convened by the Health Resources and Services Administration, or HRSA.

Kellerman said the United States needs to place a greater emphasis on primary care in general and the patient-centered medical home in particular to improve care, enhance health care access and save costs.

"But to get from where we are now to where we want to be requires innovation in medical education," he told HRSA's Advisory Committee on Training in Primary Care Medicine and Dentistry. Yet, according to Kellerman, medical schools and residency programs focus more on training medical students for careers as subspecialists, ignoring many of the tenets of the new model of practice, such as the coordination and integration of care, management of populations and the development of patient registries.

Section 747 of Title VII in the Public Health Service Act provides the only federal grants for training family physicians and should be used to teach students, residents and faculty about practice improvements and innovations in primary care and the patient-centered medical home, said Kellerman. In this way, Title VII could have a profound effect on the nation's health care system, transforming the system of care from an acute-care model to a preventive and patient-centered model.

Kellerman, who is a professor and chair of the department of family and community medicine at the University of Kansas School of Medicine-Wichita, oversaw a Title VII grant five years ago that dealt with chronic care management, a component of the patient-centered medical home.

"We found that chronic care management was a new concept for residents," Kellerman said. "Furthermore, the organized chronic care management model was a new concept for the faculty."

Family medicine has taken the lead in responding to this challenge. The American Board of Family Medicine, the Association of Family Medicine Residency Directors and the AAFP's TransforMED are collaborating on a program known as Preparing the Personal Physician for Practice to prepare family medicine residents for practicing in patient-centered medical homes. The project, which involves 14 residency programs, also is addressing innovations in the measurement of physician competency.

The AAFP, meanwhile, has invested $8 million in TransforMED and its demonstration project that seeks to convert family physician practices into medical homes. "There are a lot of working parts to the medical home," Kellerman explained. "TransforMED will take all of the different parts of the medical home, put them together and incorporate them into practices."

Kellerman also called for increased Title VII funding, pointing out that the country continues to suffer from family physician workforce shortages.

"Fewer than 8 percent of medical students last year went into family medicine," said Kellerman. "That is less than half of what it was 15 years ago."

At the same time, a large segment of family physicians are nearing retirement age, a trend that will exacerbate the shortage of family physicians, making Title VII even more important, Kellerman said. Yet, Congress granted only level funding for the program in 2007, providing $48.85 million for Title VII physician training in the current fiscal year, far short of the $92 million allocated for the program in 2003. Every administration since the Reagan administration has sought to eliminate Title VII funding, turning the program into a "political football," said Kellerman.

"There is no doubt in my mind how important Title VII funding is at the medical student level, the residency level, and to faculty development and departments of family medicine," Kellerman told the committee.