Payment, Physician

It is the position of the American Academy of Family Physicians (AAFP) that every reasonable effort should be made to devise a reliable payment system that addresses the following principles:

1. Quality care, access to care and positive health outcomes must be the primary goals of any payment system.
2. The unique partnership embodied in the physician/patient relationship must be preserved.
3. A payment system must be based on continuing, comprehensive care and should encourage treatment on an ambulatory basis rather than in a costly institutional setting. Consistent with the continuous, comprehensive care they provide, primary care physicians should be paid for all of a patient’s conditions addressed, whether done in person or virtually and whether done synchronously or asynchronously.
4. There must be recognition of the value of prevention, health maintenance, early diagnosis, and early treatment, with appropriate incentives to the patient and to the physician.
5. Increased emphasis must be placed on appropriate payment for the cognitive portion of physician services.
6. Physicians should only be paid to perform services for which they have documented training and/or experience, demonstrated abilities and current competence.
7. When certain factors (e.g., medical resources, locales, etc.) that diminish access to needed and quality medical care exist and may arise in the future, national policies that provide appropriate payment incentives may be given to physicians who will serve these underserved needs or areas.
8. There must be substantial physician involvement in determining appropriate values assigned to payment for work done by physicians.
9. Sufficient flexibility must be built into payment systems to recognize individual variation inherent in medical encounters, including the number of patients present, patient's health status or special circumstances, complications which may arise, severity of illness and other reasons.
10. Individual physicians in independent practice must retain the right to set their own charges and the option to have those charges differ from the amounts scheduled for payment. Physicians should be able to explain the basis for their charges. In determining their charges, physicians' considerations should include, but not be limited to:
    1. The amount of skill and/or special training required;
    2. The amount of time spent providing the service;
    3. The risk involved in supplying the service;
    4. Special economic considerations for the financially disadvantaged;
    5. Supplies and equipment used;
    6. The use of ancillary personnel in providing the service;
       
    7. Costs of maintaining an appropriate facility for providing the service; and
       
    8. The complexity of their patients.
11. Assurance of quality and appropriate utilization of services through peer review mechanisms shall remain the responsibility of the medical profession at the local level, with sufficient opportunity for involvement by all specialties.
12. Any payment system must include provisions for annual reevaluation to keep the system current, so it reflects changing economic factors affecting the cost of delivering services.
13. Any payment system that utilizes or contracts for care management services should pay appropriately for these services as necessary to the provision of continuous comprehensive patient care.
14. To the extent that payment for services is established according to Resource-Based Relative Value Scale (RBRVS), it should account for the unique practice expenses and professional liability costs of primary care physicians. Practice expenses include electronic health records; staff time associated with prior authorizations and reporting of quality and performance measures; and additional staff needed for advanced primary care, such as care navigators and behavioral and community health workers. An RBRVS should use a single conversion factor for all physician services. RBRVS limitations or inadequacies may require payment for some primary care services by other means.
15. The value of family physicians' role in diagnosing, managing, and coordinating the delivery of mental health services should be recognized by adequate payment by all payors responsible for mental health coverage. The role and payment of family physicians in the delivery of mental health services should not be limited by plan design or contract.
16. Periodic preventive services should be paid by all public and private insurers when performed in the same anniversary month as they were last performed.
17. In a fee-for-service payment system, physicians should be paid for the care management services they provide for the medical management of their established patients as a separate service from in-person and virtual evaluation and management. (see "Payment for Non Face-to-Face Physician Services" and "Care Management Fees").
18. There should be "equal pay for equal work" and no discrimination in physician payment in any form, including but not limited to, that based on actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus, or national origin of the physician.
19. Family medicine should be paid commensurate with other specialties to help ensure an adequate supply of primary care physicians.

(1993) (October 2023 COD)