President’s Address

Fields Paints Past Year in Broad Brush Strokes of Success

By Jane Stoever • AAFP Assembly, Washington, D.C.
9/28/2006

Breakthrough time. IBM seeks AAFP’s help in figuring out how to get each IBM employee a medical home. Insurance companies discover the value of family medicine. And starting in 2007, about $4 billion a year in Medicare payments will shift from procedural services to evaluation and management services.

Accenting these family medicine successes and more, AAFP President Larry Fields, M.D., gave the annual president’s address to the Congress of Delegates on Sept 26.

“IBM is the most impressive case” among major employers with whom the Academy has had contact, said Fields. “They sought us out.”

IBM leaders, Fields explained, were aware of the Future of Family Medicine project; TransforMED, the Academy’s practice redesign initiative; and research on primary care by Barbara Starfield, M.D., M.P.H., of Johns Hopkins University, Baltimore. IBM officials also had experience in countries with primary care-based systems, said Fields.

He added, “They told us, ‘We want that (a system founded on primary care) for our employees in America. We want you to help design it. We want to take you to the rest of the business community and have you, along with us, tell them about the value of family medicine. And then we want to dictate to the insurance companies that they will provide products to our employees based on the new model and primary care.’”

AAFP leaders have discussed the value of family medicine with IBM, Xerox, GlaxoSmithKline and 30 other Fortune 500 companies, said Fields. “They want to buy it (family medicine) for their employees.”

Encouraging delegates to the AAFP Congress to seize the moment, Fields highlighted other recent advances:

Insurance companies “from UnitedHealthcare to the Blues,” said Fields, “acknowledge the cost-efficiency and quality of what we do.” In an example of progress on the insurance front, an outcry from physician groups including the AAFP and the Ohio AFP helped prompt Anthem Blue Cross Blue Shield of Ohio to stop blending pay rates for levels 3 and 4 E/M codes.
Evaluation and management codes “that you and I use every day” will trigger higher E/M pay beginning in January, said Fields. Referring to Academy members who have served on or advised the Relative Value Update Committee, or RUC, he added, “All praise to our RUC team that brought this about.”
Fields recently visited Rep. Joe Barton, R-Texas, and Rep. Fortney “Pete” Stark, D-Calif., on Capitol Hill and heard from them about the value of medical homes and primary care and “the insanity of our current payment system,” Fields said.
The AMA in June called for increasing the number of primary care physicians and changing the payment system to attract more medical students to primary care careers.

Turning to the future, Fields said any system that can provide quality health care to all Americans requires workforce, pay and liability reforms. The country needs enough family physicians to offer medical homes to all who want them. The payment system should encourage students to choose primary care, sustain practicing physicians and reward patients for using their medical homes. And the liability system should free America “from the crushing burden that defensive medicine imposes on us and the heartbreaking consequences of the loss of access to care that out-of-control liability premiums continue to cause,” Fields said.

He challenged delegates to change the infrastructure of U.S. health care so that everyone could have a medical home.

Laying claim to family medicine’s primacy in a reformed system, Fields asserted, “It is now a matter of scientific fact that a primary care-based health care system is the only system that can affordably provide quality care to everyone in this country, and we are that primary care base.”

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