AAFP to AMA:

Make Primary Care-Based Medical Home Focus of Health System Change

By Cindy Borgmeyer
7/10/2007

The Academy recently sent the house of medicine a clear message: Any national health care policy agenda the AMA promulgates should be founded on the primary care-based medical home, and it should incorporate a payment model that comprises both a fee-for-service component and a per-patient, care-management stipend.

The primary care-based medical home is the cornerstone on which the AMA should build its national health care policy agenda, AAFP Board Chair Larry Fields, M.D., tells participants at an AMA open forum. Fields was first to the microphone at the forum, which was held during the June 23-27 annual meeting of the AMA House of Delegates.

Members of the AAFP delegation to the AMA House of Delegates delivered that advice during an open forum held here during the annual meeting of the AMA house. More than 300 delegates, alternates and other stakeholders participated in the June 25 forum which was convened to solicit comments on a draft policy agenda document the AMA plans to finalize by this fall.

Of the dozens of attendees who spoke out at the forum, AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., was first to the microphone. He credited the work the AMA has accomplished to date in examining the issue of health system reform, but warned against overlooking some key issues.

Primary Care-Based Medical Home

"There are a lot of excellent ideas" in the current draft of the AMA agenda document, Fields noted in a recap of his testimony. "If they will hang those ideas on the frame of a primary care-based medical home, we have a great starting point."

Another essential part of that framework, Fields added, is fair payment for all services rendered. "That's not only higher payment for primary care services," he stressed, "but also an additional payment for coordination of care and disease-management services."

"We really need to expand how we think about the way we pay physicians," AAFP President-Elect Jim King, M.D., tells forum attendees, "especially in the primary care world, especially when the patient's in (his or her) medical home." He advocated payment reform that includes a care-management fee.

AAFP President-Elect Jim King, M.D., of Selmer, Tenn., likewise addressed the payment issue during the forum, urging delegates to "think outside the box" when it comes to paying physicians for the care they provide.

"We really need to expand how we think about the way we pay physicians, especially in the primary care world, especially when the patient's in (his or her) medical home," King said.

"When I go into my office in Selmer, Tenn., and I start looking at the work I do -- almost 40 percent of the work I do in my practice, I can't get paid for under the present system," he said. "Things like arranging for referrals, doing paperwork for other people and calling my patients.

"So we'd like you to expand your thought process a little bit about how we should be paid, especially in certain areas. And one thing we feel needs to be in a payment system is a payment for the management of our patients."

Overview of Draft Policy Agenda

In its current form, the draft agenda is divided into five main content areas, each with its own complement of specific issues. The five areas are

health care environment -- including universal coverage and access to care under a pluralistic and patient-driven system, medical liability reform, patient choice, and transformation of Medicare and Medicaid;
clinical excellence -- including further integration of health information technology into medical practice, voluntary adoption of quality measures, improved patient safety, elimination of health care disparities and better care for the elderly;
health of the public -- including disaster preparedness, boosting immunization rates, improving mental health services, raising awareness of global health issues and advocating healthy lifestyle behaviors;
physician practice viability and patient access -- including antitrust issues, payment for true costs of care and the proliferation of consumer-driven health care; and
physician education and professionalism -- including workforce analysis and planning, transformation of the U.S. medical education system, education and training funding, and improving medical self-regulation.

The AMA plans to present the final policy agenda to President Bush, the U.S. Congress, the American public and the nation's major political parties by Aug. 31.

Campaign for Uninsured

In related news, during the opening session of the AMA house on June 23, AMA leaders announced the association would launch a three-year campaign to engage patients and lawmakers in the fight to provide health coverage to millions of Americans who don't have it. Dubbed "Voice for the Uninsured," the campaign, which is timed to coincide with the 2008 election cycle, dovetails with ongoing efforts by the AMA, AAFP and other health care stakeholders to shine a spotlight on the plight of the nation's uninsured residents.

HCCU Proposes Coverage Solution

The Health Coverage Coalition for the Uninsured, or HCCU, an alliance that includes the AAFP and the AMA, earlier this year announced a proposal designed to extend health care coverage to more than 45 million Americans without health insurance. The coalition estimates that the plan, which relies on a mix of public programs and tax credits, would, if fully implemented, cover more than half of the nation's uninsured residents.

Of the 16 diverse stakeholder groups who are members of the coalition, the Academy is the only medical specialty organization.

HCCU's proposal advocates first focusing on expanding coverage to the nation's 9 million uninsured children by boosting Medicaid and State Children's Health Insurance Program enrollment. The proposal also calls for a tax credit to help families with more income purchase private health insurance for their children.

The second phase of the HCCU plan would give states the flexibility and funds to expand Medicaid eligibility to cover all uninsured adults with incomes below the federal poverty level. Those with incomes between one and three times the federal poverty level would get a tax credit to help them pay for private insurance.

Delegates at the annual meeting got a sneak preview of the new campaign, which will debut this fall. Sporting the tag line "Because 1 out of 7 is 45 million too many," the campaign's ads feature stark images of physicians and patients, often teamed together. The ads decry the fact that uninsured individuals -- 80 percent of whom are from working families -- receive less preventive health care than their insured counterparts, often seeking care only after their health problems are severe and intractable.

The campaign will include print, broadcast and online media ads; a dedicated Web site where uninsured patients can share their experiences and others can learn more about the issue and how it affects all Americans; and a series of special events.

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