Epperly Spells Out Academy Priorities

The United States needs to transform its health care system by using the patient-centered medical home, or PCMH, as a key building block in a system built around primary care. And that transformation needs to include payment reform, which, in turn, would lead to workforce reform in a system that does not have enough primary care physicians to support universal health care. That is according to AAFP President Ted Epperly, M.D., a practicing family physician and CEO and program director of the Family Medicine Residency of Idaho in Boise, who recently sat down to talk to AAFP News Now.

Q. You have talked to a lot of members during the past year. What do you think they're feeling, and what are their concerns or expectations?

A. I think that as a specialty group we've been devalued by the system, but we're realizing that recognition, relief and respect for the specialty is just around the corner. Even though a lot of the members feel beat down, they also have this sense that change is afoot and better days are coming. In regard to their major concerns and why they feel beat down and somewhat demoralized -- it's around payment. It's around not being valued for everything that they do in a health care system that values procedures and diagnostic imaging to the exclusion of health care. The system is focused more on sick care than on health care. That's the major concern. The major expectation is again around respect, recognition and relief. That relief is going to come in the form of better payment for the services that family physicians provide.

Q. What kind of progress is being made on the PCMH, and could you talk about how the AAFP is working with the Patient-Centered Primary Care Collaborative, or PCPCC, to move the idea forward?

A. First, excellent progress is being made on the PCMH. I'm very impressed. It's gained major traction all across the United States in multiple groups, from large employers to legislators -- both at the state and federal levels -- to insurance companies to consumer organizations -- like the AARP and the National Association of Community Health Centers -- and to unions. I can't possibly tell you how big a deal it was when the AMA adopted the Joint Principles of the Patient-Centered Medical Home (3-page PDF; About PDFs) on Nov. 10 in Orlando.

As for the PCPCC, in my 28 years of being a family doctor I've never been as excited to see an organization pick up our cause and trumpet it. It's one thing to have family doctors tooting their own horn and trying to say, "Hey, what about us?" But when another organization does that, it's a big deal. They've just been a marvelous partner, and they very much have been pushing the whole concept of primary care and the PCMH and better payment for family doctors. To get a group of that stature aligned with our efforts is priceless.

Q. What would you say are the Academy's top priorities?

A. The biggest one by far is advocacy around the following items:

If we were to give health care insurance to everybody -- universal coverage -- without workforce reform to increase the number of primary care doctors, especially family physicians, out there, we wouldn't have a functional system in which everyone could then have access to care. We just don't have enough people to provide access points. It's kind of like giving out free bus passes to people, but you only have one bus in town. It just doesn't cut it.

Q. Can you tell us more about what you think should be the future of the U.S. health care system and how family physicians and the Academy can help make it happen?

A. The future of the U.S. health care system should be a transformed system based on primary care. That's what every single country in the industrialized world has already discovered. When you look at those countries, you see very robust, well-designed and well-paid primary care workforce teams. What we have in America is just the opposite.

The big future change of our system is a primary-care-based system with the PCMH as the basic building block in that system.

How family physicians can help that future become a reality is to transform their practices to a PCMH. They must see where this movement is going so they can get on board and become part of the solution. If you were to ask me what my biggest nightmare is, it's that we're out there advocating for this stuff, and we look behind us, and there's nobody there; our own troops haven't followed, and they're not transforming their practices to meet the PCMH concept. Then, suddenly, there's this big disconnect between what we're promising America and what we're delivering.

Q. You mentioned advocacy. How can the Academy leverage its influence in Washington to help shape health policy that will benefit patients and physicians?

A. We have some really good programs our members can be part of. First, there's the Key Contact program, (4-page PDF; About PDFs) which means that all legislators -- be they in the U.S. Senate or the U.S. House of Representatives -- have a family doctor from their legislative district who knows them personally or has a relationship with them and can contact them, their legislative assistants or staff member about critical items. Not only does that work at the federal level, it also works at the state level.

Every state should have a key contact program so that a family physician can be married up with each legislator in the state for similar reasons. If we just finally got our act together and used our voice in a unified way to touch all these people, what a powerful tool that could be.

The second thing is the Speak Out function on the AAFP Web site. The site contains template letters on a lot of hot topics. Often we'll reach out to members and say, "Please contact your representatives or senators on this particular item." We have enough members that you can imagine the result. For example, during the debate on the Medicare bill this summer, we had 10,000 members sending letters to their congressional representatives. That's pretty powerful.

The third thing is FamMedPAC, which has given us access to be at the table where health care discussions are being held. I'm telling you as one who has been at those tables, it makes a huge difference.

Another thing to add is trips to Capitol Hill. If we have members who go to Washington, D.C.; Baltimore; or Richmond, Va., we ought to be coordinating with them to take a couple of hours out of their day to get up to the Hill and see their senator or representative to advocate on something.

Q. Regarding FamMedPAC, how can the Academy get more members involved?

A. We can certainly continue to publicize FamMedPAC both nationally and at state chapter meetings. We must do a better job of just looking people in the eye and saying, "Look, we're at a critical moment in our nation's health care system, and you have to step forward and become part of the solution." For a dollar a day, or $365 a year -- the Club George level of FamMedPAC -- you can have a major influence on health care transformation, Medicare, workforce issues, student interest in family medicine and new health care policies in America. Would you pay $1 to have your voice heard? Family physicians have always been a bit meek about getting out and trumpeting our cause. We have to get out and play this game the way others are playing the game, or we're just going to have our lunch eaten.

Q. Where do you stand on pay-for-performance?

A. I think it's absolutely imperative that our members buy into this big time. It's the right thing to do for patient care, and it's the right thing to do for quality of care. We might as well get paid to do it. What it means is you have to invest in some system that will track the data for you, mostly electronic health records, or EHRs. But you can still do it as long as you have a stubby pencil and someone in the office -- a nurse, medical assistant or even yourself -- to keep track of the data.

Q. What about EHRs?

A. I'm a big proponent. We've had an EHR in our practice here in Boise for four years. It's revolutionized my practice. I'm more efficient. I make fewer errors. My data are more retrievable. I can give feedback to both my practice and that of my colleagues and the residents I'm fortunate enough to be able to train.

Q. You mentioned your residents. How can we attract more students into the specialty and retain them?

A. If we get our vision right of what we're trying to create for America -- and that's a transformed system with the PCMH as the building block -- and they see the vision, they will be inspired because many of them go to medical school to be just this kind of doctor -- to give of themselves to a community, to be of service to others and to make differences. Most of them don't see family medicine as being lucrative enough to pay back their medical school debt or their loans. If they see the vision of what we're creating and the payment reform that comes with it, I think we're going to see an explosion of interest of students into the discipline of family medicine.