A summer surge in private sector advocacy efforts by the Academy has seen letters fan out across the country to 65 health insurance companies on some of family physicians' most searing hot-button issues. The advocacy push included correspondence with high-profile plans, such as Aetna, Anthem, BlueCross BlueShield, CIGNA HealthCare, UnitedHealthcare and WellPoint.
The Heat is On
Summer Brings Surge of AAFP Advocacy Efforts
By News Staff
8/29/2007
In addition to providing payers with written notification of Academy concerns, the AAFP also created template versions of each payer letter. Members are encouraged to personalize the letters to conduct their own private advocacy campaigns with payers.
Retail Health Clinic Copayment
In June, a letter went out from AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., to health plans asking them to refrain from designing benefit plans that offer patient copays for visits to retail or convenience health clinics that are lower than copays patients would pay for a visit to their primary care physician in their personal medical home.
"Such incentives are contrary to the value of the physician-patient relationship," said Fields. The emergence of such clinics reflects a changing health care landscape and could potentially "further fracture the system by interfering with the continuity of care for patients," he added.
The letter included copies of AAFP's Joint Principles of the Patient-Centered Medical Home, (3-page PDF; About PDFs) as well as the Academy's list of desired attributes of retail health clinics.
Fields asked each of the named plans to provide a written response to the Academy detailing its protocol for retail health clinic copayments.
You can download a template of Fields' letter (4-page MS Word doc; About Downloading), personalize it and send it to your payers.
"Such incentives are contrary to the value of the physician-patient relationship," said Fields. The emergence of such clinics reflects a changing health care landscape and could potentially "further fracture the system by interfering with the continuity of care for patients," he added.
The letter included copies of AAFP's Joint Principles of the Patient-Centered Medical Home, (3-page PDF; About PDFs) as well as the Academy's list of desired attributes of retail health clinics.
Fields asked each of the named plans to provide a written response to the Academy detailing its protocol for retail health clinic copayments.
You can download a template of Fields' letter (4-page MS Word doc; About Downloading), personalize it and send it to your payers.
Single Conversion Factor, 2007 RVUs
Also in June, Fields penned a letter asking payers to adopt the increase in relative value units, or RVUs, for evaluation and management, or E/M, services set forth in the 2007 Medicare physician fee schedule.
Fields said family physicians had alerted the Academy to the fact that many payers either were not updating to the 2007 RVUs or were altering their conversion factors for E/M services to "neutralize any increase in payment."
"These actions defeat the intent of revaluing E/M services, and we view it as showing a lack of support for family medicine and other primary providers of E/M services," said Fields.
He added that the Academy is steadfast in its resolve to work for physician payment reform, including new payment models that use a fee-for-service base with an added care management fee and programs that offer positive performance incentives.
He called on payers to provide a written response regarding the Academy's concerns.
Download a template letter on this topic (2-page MS Word doc; About Downloading), personalize it and send it to your payers.
Fields said family physicians had alerted the Academy to the fact that many payers either were not updating to the 2007 RVUs or were altering their conversion factors for E/M services to "neutralize any increase in payment."
"These actions defeat the intent of revaluing E/M services, and we view it as showing a lack of support for family medicine and other primary providers of E/M services," said Fields.
He added that the Academy is steadfast in its resolve to work for physician payment reform, including new payment models that use a fee-for-service base with an added care management fee and programs that offer positive performance incentives.
He called on payers to provide a written response regarding the Academy's concerns.
Download a template letter on this topic (2-page MS Word doc; About Downloading), personalize it and send it to your payers.
Family Medicine Listings in Payer Directories
July brought a letter from Fields to payers asking that health plans recognize -- in physician directories made available to health plan customers -- family physicians with special training, as well as FPs who provide women's health services.
Fields pointed out that FPs can earn -- through the American Board of Family Medicine -- a certificate of added qualifications, or CAQ, in adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine. Thousands of FPs carry those CAQs, said Fields. In addition, he noted, nearly 30 percent of family physicians provide maternity care.
Not only should all physicians be granted clinical privileges commensurate with their training, said Fields, but "health plans must explicitly include family physicians" in any reference to access to health services for women, children and the aged.
Fields requested that each payer supply its written policy regarding the listing of FPs as primary care providers as well as holders of CAQs. He also asked for an accounting of "how you identify family physicians performing health services for children, women and the aged in your physician directories."
In addition, Fields requested that all references to "family practice" made by insurance companies be changed to "family medicine." He noted that the American Board of Family Medicine made the name change more than two years ago, on Jan. 1, 2005.
Download a copy of a template letter (2-page MS Word doc; About Downloading), personalize it and send it to payers.
Fields pointed out that FPs can earn -- through the American Board of Family Medicine -- a certificate of added qualifications, or CAQ, in adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine. Thousands of FPs carry those CAQs, said Fields. In addition, he noted, nearly 30 percent of family physicians provide maternity care.
Not only should all physicians be granted clinical privileges commensurate with their training, said Fields, but "health plans must explicitly include family physicians" in any reference to access to health services for women, children and the aged.
Fields requested that each payer supply its written policy regarding the listing of FPs as primary care providers as well as holders of CAQs. He also asked for an accounting of "how you identify family physicians performing health services for children, women and the aged in your physician directories."
In addition, Fields requested that all references to "family practice" made by insurance companies be changed to "family medicine." He noted that the American Board of Family Medicine made the name change more than two years ago, on Jan. 1, 2005.
Download a copy of a template letter (2-page MS Word doc; About Downloading), personalize it and send it to payers.
Advocacy Success
The AAFP's letter-writing campaign has resulted in insurers issuing policies that are beneficial to family physicians. For example, as of Aug. 27, UnitedHealthcare will reimburse physicians for a preventive medicine service (CPT codes 99381 to 99397, HCPCS code G0344) plus 50 percent of a problem-oriented E/M service (CPT codes 99201 to 99205 or 99212 to 99215) when the E/M service represents a significant separately identifiable service and is submitted with modifier 25.
The Academy has worked for several years to favorably resolve this particular payment issue with UnitedHealthcare.
The Academy has worked for several years to favorably resolve this particular payment issue with UnitedHealthcare.
