2009 Annual Meeting

AMA Reaffirms PCMH, Wants Savings to Fund Medicare Pay Increases

By Barbara Bein • Chicago
6/24/2009

The AAFP gained just about all it wanted when the AMA reaffirmed its support of the patient-centered medical home, or PCMH, and came out for beefed-up Medicare incentive payments to primary care and other physicians whose practices qualify as medical homes that would be funded by savings from throughout the entire health care system, not just Part B.

During its 2009 annual meeting June 13-17 here, the AMA House of Delegates adopted, with amendments, a report on the PCMH developed by the AMA Council on Medical Service. AAFP member David Barbe, M.D., M.H.A., of Mountain Grove, Mo., was chair of the council at the time the report was created.

Recommendations in the report the delegates adopted direct the AMA to

support the PCMH model "as a way to provide care to patients, without restricting access to specialty care";
amend current AMA policy to add a statement saying that medical home participation criteria should allow any physician practice to qualify as a medical home, provided the practice can fulfill the principles of a PCMH; advocate that CMS and all health plans use a single standard to determine whether a physician practice qualifies as a PCMH;
urge CMS to work with the AMA and national specialty societies to design incentives aimed at enhancing care coordination among providers who give medical care outside the medical home;
urge CMS to assist physician practices seeking to qualify for PCMH status with financial and other resources; and
advocate that Medicare incentive payments associated with the PCMH model "be paid for through systemwide savings -- such as reductions in hospital admissions and readmissions (Part A), more effective use of pharmacologic therapies (Part D), and elimination of government subsidies for Medicare Advantage plans (Part C) -- and not be subject to a budget-neutrality offset in the Medicare physician payment schedule."

Joseph Zebley III, M.D., of Baltimore, vice chair of the AAFP delegation to the AMA, told AAFP News Now that the report's recommendations address almost everything the AAFP has been seeking. The first recommendation, in particular, "reassures our proceduralist and subspecialist colleagues that (FPs) are not trying to act as gatekeepers," he said.

The report resulted from actions by the AMA House of Delegates during the 2008 interim meeting, when the delegates adopted as AMA policy the Joint Principles of the Patient-Centered Medical Home developed by the AAFP, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association. At that time, the delegates asked the AMA to continue to study the medical home concept, emphasizing funding sources and payment structures.

The adopted report says explicitly that the AMA "opposes 'budget-neutral' policies. Accordingly, the Council (on Medical Service) believes the AMA should work to ensure that support for the medical home model is funded through sources other than Medicare Part B" for physician services.

According to Zebley, the AAFP's position consistently has been that although enhanced Medicare payments would, ideally, be funded through systemwide savings, "if budget-neutrality is the only way to achieve our goals on the PCMH, the AAFP will stand up for our physicians."

New Workforce, Training Policies

In other action, the House of Delegates adopted resolutions and report recommendations that call for the AMA to

ensure that actions to bolster the physician workforce are part of any comprehensive federal health care reform plan;
work with CMS to explore ways to increase the number of graduate medical education, or GME, slots -- as well as GME funding -- to accommodate the need for more physicians now and in the future;
collaborate with stakeholder groups to rescind GME funding caps imposed by the Balanced Budget Act of 1997;
advocate expanded funding for training positions in specialties and geographic regions with medical workforce shortages;
advocate that the economic hardship loan deferment known as the 20/220 pathway be reinstated; and
study the impact of the new Higher Education Opportunity Act on payoffs of medical student loans and on specialty selection by medical students.

AAFP delegate Glenn Loomis, M.D., of Beech Grove, Ind., said of the delegates' actions: "The call by the AMA for comprehensive workforce reform is critical to the needs of the nation, especially for a health care system that relies on a highly specialized physician workforce -- resulting in paying too much for too little in the way of outcomes.

"Comprehensive workforce reform should pave the way toward a system that produces the primary care physicians we need."

The House of Delegates also

adopted recommendations from a Council on Ethical and Judicial Affairs report that call on individual physicians to take steps to promote access to care for individual patients, help patients obtain needed care through public or other programs, and advocate -- as individuals and as members of their professional organizations -- against financial and other barriers to appropriate health care for all people; and
adopted a resolution calling for the AMA to support an increase in the pool of physicians who can provide care for Hispanic patients in areas with documented physician shortages.

Finally, the AMA house adopted a recommendation from a report by the Speakers' Special Advisory Committee on the House of Delegates that calls for the appointment of a task force to determine the most appropriate structure and function of a meeting to replace what currently is the interim meeting of the AMA house. The task force will report its findings at this year's interim meeting, to be held in November in Houston.

Adoption of the committee's recommendation represented a letdown, of sorts, for the AAFP and nine other specialty and subspecialty groups, which had put forth a measure calling for the outright elimination of the interim meeting -- a move that would have realized immediate and significant cost savings for both the AMA and its member organizations.

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