AAFP Meets With Health Plans About Policies Affecting FPs

By Sheri Porter
7/23/2007

This spring and summer have seen a steady stream of meetings between the AAFP and the nation's largest health insurance companies, as the Academy works to ensure that payers are aware of the family physician viewpoint when setting policies.

Between April 30 and July 6, the Academy hosted representatives from

WellPoint Inc.,
UnitedHealthcare,
Humana Inc.,
CIGNA HealthCare, and
Aetna.

Semi-annual meetings with health plan executives were initiated by the AAFP in 2005 as an opportunity for Academy leaders and staff to work directly with health insurers to shape or amend the insurers' policies on issues that deeply affect family physicians.

AAFP President Rick Kellerman, M.D., of Wichita, Kan., was on hand at Academy headquarters in Leawood, Kan., for nearly every one of this latest round of meetings.

"It's important for me to attend these face-to-face discussions because the Academy is actively addressing, with some of the country's largest health plans, issues of major importance to family physicians, their practices and their patients," said Kellerman.

"These conversations keep the issues alive and in front of the very people who have the power to make changes that can help us continue to provide quality care to our patients and be paid fairly to do so," he said.

Issues that were discussed during the meetings included several hot-button topics.

Payment for same-day preventive and acute care services. "This payment issue is a common complaint the Academy hears from members," said Trevor Stone, a private sector advocacy specialist in the AAFP's Practice Support Division who also attends the meetings with insurers. "The Academy argues that preventive care and significant acute care services should be paid as separately reportable services, even when given on the same day," said Stone. In addition, that position aligns with CPT guidelines.
Fair payment for the purchase and administration of vaccines. "Immunizations are cost-effective preventive care and should be administered in the patient's medical home," said Kellerman. "Making sure that physicians are fairly paid to provide that care is vitally important."
Physician performance programs. The Academy continues to direct insurers to AAFP's policy on performance measures criteria and asks that they use evidence-based quality performance measures identified by a consensus of national organizations involved in quality measurement. Another approach -- which has been taken by at least one insurer -- is to avoid a "ranking" approach when measuring physician performance and instead focus on quality indicators, such as a physician's attainment of board certification, participation in maintenance of certification programs, or participation in National Committee for Quality Assurance physician recognition programs, said Stone.
Retail health clinics. The Academy continues to press health plans to institute patient copayments that encourage patients to use their medical home for nonemergent care. "Some health plans have designed benefit plans to provide financial incentives for their members to seek care from a retail health/convenient clinic instead of from their personal medical home," said AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., in a recent letter to insurers. "Such incentives are contrary to the value of the physician-patient relationship and the continuity of care offered by family physicians to their patients."

The next round of meetings with insurers will be scheduled late in the fall.

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