NCSC Engenders Spirited Debate, Passage of Key Resolutions

The National Conference of Special Constituencies, or NCSC, adopted several key resolutions during its recent meeting here, including proposals calling for the Academy to advocate changes to the Health Insurance Portability and Accountability Act, or HIPAA; promote dental care as a part of family medicine practice; support legislation prohibiting insurance company discrimination; and create a database to help military reservists care for patients while they are away on assignment.

Special constituency representatives from various AAFP chapters engaged in a spirited discussion about the merits of HIPAA after introduction of a resolution that called on the AAFP to advocate the repeal of current HIPAA laws.

"HIPAA is a drain on health care dollars," said Kenneth Collins, M.D., a gay, lesbian, bisexual and transgender, or GLBT, constituency representative from Muscle Shoals, Ala., and co-author of the resolution.

George Gay, M.D., a GLBT constituency representative from Cambridge, Wis., agreed, testifying that the act creates problems for nontraditional families by making it difficult for some family members to share medical information.

Mark McLoney, M.D., a GLBT constituency representative from Berea, Ohio, said the act also serves as a "roadblock" for foster parents who are trying to obtain medical information about their foster children.

However, Rebecca Canner, M.D., a GLBT constituency representative from Bozeman, Mont., pointed out that HIPAA does allow patients to designate who they want to share their medical information with, a useful provision for gay and lesbian couples.

"Even though it's a pain in the butt, I don’t think abolishing the law does us or our patients a service," she told conference-goers.

HIPAA is a "huge piece of legislation" that may have some beneficial parts, said Anne Kittendorf, M.D., a woman physician constituency representative from Dexter, Mich. She suggested evaluating the usefulness of HIPAA on a section-by-section basis.

In the end, delegates adopted a substitute resolution proposed by the Reference Committee on Advocacy that calls on the AAFP to advocate "modification of the current HIPAA laws to facilitate communication of health information between health care providers and nontraditional family members."

The Reference Committee on Advocacy also addressed promotion of dental health in family medicine, debating a resolution that called for the AAFP to "provide opportunities for education and training of family physicians regarding dental health, including the prevention of, and screening for, dental caries." The resolution also called on the Academy to "actively encourage appropriate payment for screening, diagnostic and treatment dental services."

The resolution generated a great deal of discussion during reference committee testimony on May 2. Several delegates said dental health is a part of preventive health, making it an important component of primary care. However, current training programs for family physicians include very little information on dental services.

Sarah Lamanuzzi, M.D., a woman physician constituency representative from Klamath Falls, Ore., and a co-author of the resolution, said dental services are "important in promoting life-long health." In some underserved areas, however, there are not enough dentists, leaving patients without dental care and underscoring the need for family physicians to provide dental screening and services. In many cases, children are not able to access dental services, Lamanuzzi said.

Sheila Crowley, M.D., a women physician constituency representative from Starkville, Miss., and another co-author of the resolution, said family physicians also should receive "appropriate payment" for detecting dental problems and referring patients to dentists.

NCSC delegates adopted the resolution on the consent calendar. The delegates also approved a separate resolution that calls on the AAFP to "include preventive dental services in the list of basic services that should be provided to individuals in (the Academy's) plan for Health Care for Everyone."

Conference delegates also adopted a substitute resolution from the same committee that calls on the AAFP to "support legislation prohibiting insurance companies from discriminating against those with pre-existing conditions or chronic diseases."

The resolution, which was adopted on the consent calendar, also urges the AAFP to support legislation that "prohibits discrimination in insurance pricing."

"We really want health insurance for all. … One way to achieve that is to make sure people are not discriminated against," said Susan Kinast-Porter, M.D., a woman physician constituency representative from Monroe, Wis., and co-author of the original resolution.

Testimony offered during the Reference Committee on Organization and Finance hearing covered, among other topics, the dilemma physicians in the military reserves face when they are called up to active duty, with several reservists offering a resolution that called for the AAFP to "develop a resource of names of physicians willing to act as locum tenens to deployed military reserve physicians.". According to those who testified at the hearing, many of these physicians have difficulty finding colleagues who can care for their patients while they are away.

Ada Stewart, M.D., a new physician constituency representative from Columbia, S.C., and a member of the Army reserves, said during reference committee testimony that military reservists are only given a few weeks' notice in some cases before they are deployed, which makes it difficult for them to find physicians to take their patients while they are gone. The creation of a resource list would make it easier for reservists to find physicians to fill this void, she said.

Participants discussed various options for providing such a resource, with some advocating the data be gathered and provided at the state level, and others proposing it be offered at via a national resource, such as through AAFP's Placement Services.

In the end, delegates adopted a substitute resolution from the reference committee that asked the AAFP to "explore the development of" such a resource.