AAFP President Outlines Requirements for Quality, Efficient Health Care

If Americans are to have a medical home that ensures quality care and lowers costs, health care policy-makers must institute three tenets: medical liability reform, appropriate physician payment and workforce policies that encourage medical students to enter primary care.

That's the mantra AAFP President Larry Fields, M.D., of Ashland, Ky., introduced when he spoke May 5 to members at the AAFP's National Conference of Special Constituencies and Annual Leadership Forum in Kansas City, Mo., and again May 9 to those attending the AAFP's Family Medicine Congressional Conference in Washington, D.C.

"Quality, affordable health care coverage for all depends on medical liability reform, workforce reform and payment reform," Fields told Academy members at the congressional conference. "Those are the three legs of personal medical homes and health care coverage for all.

"Unless we have a sufficient workforce that provides medical homes to people, we can't afford health care coverage for all. If we don't change the liability system, if we don't change the payment system, if we don't change the workforce system, health care coverage for all is a pipe dream."

Fields also takes that message to Capitol Hill as he advocates the Future of Family Medicine report's goal of a personal medical home for all patients and the Academy's position on health care coverage for all.

In doing so, he cites research such as a recent Health Affairs study, "The Effects Of Specialist Supply On Populations' Health: Assessing The Evidence," which indicates that increasing the supply of specialists doesn't improve Americans' health when compared with health measures for other industrialized countries and, in fact, may contribute to greater disparities in health status and outcomes. Fields also points to another study, the Journal of Clinical Oncology's "Randomized Trial of Long-Term Follow-Up for Early-Stage Breast Cancer: A Comparison of Family Physician Versus Specialist Care," which demonstrates parity when comparing outcomes among breast cancer patients receiving follow-up care from family physicians with those receiving care from subspecialists. In addition, he notes data in another Health Affairs report, "Medicare Spending, The Physician Workforce, And Beneficiaries’ Quality Of Care," which shows that states with higher Medicare spending have lower-quality care and states with more primary care physicians have more effective care and less cost than states where more specialists practice.

Grassroots activism and communication with public and private policy-makers do work, said Fields during the congressional conference. Despite a May 8 setback, when the U.S. Senate failed to end debate on medical liability reform, Congress and private insurers are increasingly understanding and responding to family physicians' activism. Just recently, for example, the AAFP gained ground in convincing UnitedHealthcare to pay physicians for both acute care and preventive services provided during the same office visit.

"Keep the faith; things are looking up," Fields told NCSC-ALF participants. "Contact your legislators. Protect and capitalize on the scope of practice for which you've been trained. Help bring up the next generation. It's the right place and the right time."