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From the President
Helping Small Practices Survive Health System Change
If this describes you, I want you to know the AAFP hasn't forgotten you -- not in the programs and services we offer, and definitely not in the national debate about health care reform and ACOs.
I personally can empathize with what you're going through. I started in a small practice years ago but had to leave it because our local hospital couldn't survive the new diagnosis-related group payment method. So I've known firsthand the heartache and uncertainty of trying to run a practice in the midst of system change.
The dynamics and the needs of members with small and medium practices and those who are employed or in large groups are considerably different, with only moderate overlap. There's not an AAFP Board of Directors meeting at which we don't challenge ourselves on how we can do more for these demographic groups -- indeed, for all of the Academy's membership segments -- with the finite resources available to us. The plight of private practices is also a personal issue for many Board members because their own practices fit this model.
'No One Size Fits All'
A good case in point is our response to CMS' recently proposed rule for ACOs under the Medicare Shared Savings Program. The proposed rule was, in our view, simply not supportive of small practices. Most troubling was that it created a set of regulations that these practices just couldn't meet.
We were blunt in our comment letter to CMS, urging it to "drastically reconsider its proposed Medicare ACO policies and instead offer greater flexibility so that small- to medium-sized primary care practices will be more eligible to participate." Failure to do so, we warned, would "deny the potential benefits of the ACO model to patients throughout the country, most of whom receive care from small and medium size physician practices."
We also criticized the proposed rule's over-regulation of ACOs. "If CMS focuses only on the essentials and allows ACOs to take shape in ways that make the most sense in their respective markets," we wrote, "then small- to medium-sized practices will have more opportunity to participate, and Medicare patients will reap the rewards of their doing so."
Another good example of standing up for small practices was my testimony (12-page PDF; About PDFs) during a May hearing of the Health Subcommittee of the House Energy and Commerce Committee. The subcommittee was exploring alternatives to the sustainable growth rate formula for Medicare payment.
In my testimony, I advocated a blended payment system that would support broader use of primary care. I noted that the AAFP supports moving the health care system to a PCMH base, but I also told the subcommittee that transforming to a PCMH is expensive and time consuming. "Without payment reform," I said, "it is probably beyond the economic reach of many small- and medium-sized practices, especially in rural and underserved areas that do not have the resources that may be in place in other parts of the country."
Helping Your Practice
When your practice needs help, I encourage you to search the AAFP website first -- you might find exactly what you need, and chances are it's free. (Don't forget that you can also call (800) 274-2237 to talk with Academy staff, especially regarding coding and insurance issues that often plague smaller practices.)
I'd like to draw your attention to a few website offerings that might be especially relevant for you right now:
- If you feel overwhelmed by the advent of ACOs, watch the webinar "Accountable Care Organizations and You: How ACOs Affect Your Practice," presented by the AAFP and TransforMED, AAFP's subsidiary. The webinar, which occurs live on June 22, will be archived and available online. The Academy has developed other ACO references as well, including a list of frequently asked questions about ACOs, an ACO "blueprint for success" and a practice affiliation guide prepared in collaboration with six constituent chapters.
- Not sure how to transform your practice into a PCMH? Check out step-by-step projects that break the process into doable chunks. Or join Delta Exchange, the online social network for practice transformation offered by TransforMED.
- If you need assistance with the basics of practice operations, visit "Running a Practice" for extensive resources on such topics as practice finance, coding, staff development and health information technology. The Academy journal Family Practice Management is another good source of help.
- Feeling the frustration of a "scope of practice" battle in your own state? The AAFP provides a comparison of the training of NPs and FPs that can help you explain why one professional cannot substitute for the other.
In advocacy and in practice support, the AAFP hasn't forgotten the small and solo practices that so many Americans rely on for health care. And we never will.
Family Practice News: "Physicians, Health Care Industry Examine Promise of ACOs"
(April 27, 2011)