Leveling the playing field between retail health clinics and medical homes. Helping ensure payment for point-of-care testing. Those are among the bottom line issues the AAFP will tackle in upcoming months in response to resolutions approved on Sept. 27 by the Congress of Delegates.
The resolutions are among several that focus on pragmatic financial issues that, taken together, address the types of services provided by family physicians in their practices.
The AAFP will talk with insurance companies to “ensure that there are no financial incentives for patients to seek care outside of their medical home, such as in a retail health clinic.” The resolution comes on the heels of recent insurance company decisions to waive copayments for retail health services.
Insurance companies cite lower costs of services, which most often are provided by nurse practitioners, as justification for waiving copayments. That position, said delegates, is shortsighted and inaccurate.
“Retail health probably should have a higher copayment than the physician office, because they ultimately will cost more” to the insurer, said Commission on Quality member Erica Swegler, M.D., of Keller, Texas, during committee hearings.
Meanwhile, delegates approved a resolution that asks the Academy to advocate payment for point-of-care testing to manage chronic illnesses. Among those for which family physicians should be paid are lipid panels, urine microalbumin tests and hemoglobin A1c tests.
Point-of-care lab tests can improve patient care and save money, said speakers during reference committee hearings. For many tests, family physicians can order the labs, receive results and counsel patients during a single visit, they noted.
“I don’t know how they would not save money” with paying for point-of-care tests, said New Jersey AFP President Jeffrey Zlotnick, M.D., of Somerville. “If we have point-of-care testing paid for, we can talk to the patients at the time of the test instead of sending them out for the test and calling them back in for the lab review and counseling.”
In other action, the Congress of Delegates adopted a resolution directing the AAFP to speak against future Medicare payment moratoriums and referred two resolutions to the Board of Directors. The resolutions:
Delegates Address Bottom Line Issues Affecting FPs
By Leslie Champlin
• AAFP Assembly, Washington, D.C.
9/29/2006
- ask the Academy to seek federal legislative and regulatory policies that would require high deductible insurance plans to have infrastructure allowing point-of care electronic verification of eligibility and benefits coverage, availability of funds, and claims adjudication; and
- call on the Academy to work with the AMA to change documentation guidelines and establish billing codes that reflect “the reality of management of multiple medical conditions,” to seek a change in the current compensation for outpatient care to a system that reflects the acuity and complexity of outpatient services provided by family physicians, and to take the lead in changing the relative value units system.
