AAFP Task Force Takes Steps to Better Value Primary Care

The newly formed AAFP Primary Care Valuation Task Force reached consensus on two key points during its first meeting here on Aug. 22: Medicare should pay more for primary care services, while also taking steps to better compensate high-functioning primary care practices.

The task force, which comprises 22 members representing employer and patient groups, as well as the medical community and health plans, agreed that primary care continues to be undervalued. That fact creates an immediate need for "an across-the-board improved payment for primary care," said AAFP Board Chair Lori Heim of Vass, N.C., who chairs the task force.

"We know the workforce depends on payment for primary care and that this country is facing a crisis with its primary care workforce," said Heim in an interview with AAFP News Now. "We were all in agreement on that point. The question is how to increase the primary care workforce."

Task force members also called for the development of a payment model that would better reward and sustain high-functioning primary care practices for the care and services they provide, Heim said.

"When you have a practice that is delivering more value to the patient and to the employer, that practice should be compensated differently," said Heim, who added that a "high-functioning primary care practice" is not necessarily synonymous with a patient-centered medical home.

"The medical home is the model we have used, but there may be other models that evolve, and there may be pieces of the medical home that would qualify as a high-functioning practice," Heim said. "That is why we are, at this point, sticking with a more generic term than 'the medical home.' But the idea is very much the same."

Heim emphasized that the need to immediately increase payment is why the task force's approach to payment has to be "bifurcated."

"We cannot wait for all of primary care to transform into highly functioning practices," she said. "That process takes time, and practices need to be supported now.We cannot wait if we are going to build the primary care workforce that is needed to take care of our communities."

The AAFP formed the task force in July to identify solutions to a system that, over time, has contributed to inequitable and devalued payment for primary care medical services. The task force will concentrate on finding ways to more appropriately appraise the worth of evaluation and management, or E/M, services, which are the most common services provided by primary care physicians.

"We need to have a strong primary care infrastructure for the health system, and we also think that payment methodology is a linchpin to getting the kinds of changes in primary care that we want," said Veronica Goff, a vice president with the National Business Group on Health and a task force member.

"From a business perspective, we want every individual to have a personal doctor and link into the health care system," she added. "Primary care, when done correctly, is a very efficient use of resources."

The creation of the task force coincided with the AAFP sending a strongly worded letter (2-page PDF; About PDFs) to the chair of the AMA/Specialty Society Relative Value Update Committee, or RUC, which makes recommendations to CMS on the relative values of various CPT codes, including codes commonly used by family physicians. In the letter, the AAFP asked for changes to the RUC that include adding seats to represent outside entities -- such as consumers, employers and health plans -- and implementing voting transparency among RUC representatives.

In a prepared statement, Heim described the task force as an "energized group that is committed to doing the right thing for the patient."

"This group is made up of a variety of participants from the medical community, but also from employer groups and patient groups and the health plans," she told AAFP News Now. "The input from the nonphysicians was incredibly valuable."

Heim also stressed that the work of the task force is and will continue to be "very transparent." Observers from CMS, the Medicare Payment Advisory Commission, the American Osteopathic Association, the Society for General Internal Medicine and the American College of Physicians attended the Aug. 22 meeting, as well as a representative from the office of Rep. Jim McDermott (D-Wash.).

During the meeting, the task force formed four working groups, which will

The charge to that last workgroup is particularly important, according to Heim. "How do you provide enough upfront payment and sustaining payment to help these practices maintain improvement and continue to evolve and be supported?" she asked, framing one of the questions the group will consider.

Although the AAFP has long been aware of the faults and flaws in the payment system, that perspective was fully validated by other task force members at the meeting, said Heim.

"This shows that the Academy has been on track," she said. "It is amazing to me how much work the AAFP has done on this issue over the years, not only working on the immediate payment fix, but also on what the value proposition will be going forward."

Heim also acknowledged that multiple groups are studying payment reform.

"We are all looking at paying physicians in the right way, and rewarding behavior that we want to see exhibited in terms of driving good patient outcomes, which does not necessarily mean procedures and volume," she noted.

In fact, one of the task force's goals is to decrease duplicative efforts and create synergy instead of competition, according to Heim. "Shared knowledge is power," she said. "We are reaching out to any and all groups who are looking at the payment issue."