April 3, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

It’s been more than three years since family physicians began working through an unimaginable crisis. We had no way to know when the public health emergency that sprang up around COVID-19 would end or what our communities would look like afterward. This pandemic did not start with a plan.

But the public health emergency should end with a plan when it expires on May 11 — a strong plan that reconciles the disruption that COVID-19 created in our health care system without bringing new uncertainty or disorder.

That’s the essence of the recommendations the AAFP gave the White House for winding down the federal PHE with a focus on protecting family physicians’ practices and their patients’ continuous access to comprehensive care.

We began advocating for an equity-focused approach to ending the PHE last spring by repeatedly reminding federal officials how pandemic-related emergency waivers and flexibilities, along with the broadened coverage for patients, have dramatically shifted the entire health care landscape and why they should be preserved.

Some of our key recommendations have already been addressed through legislation or regulation — wins for your practices — and now I want to give you a quick look at three of the areas where we’re putting our energy as the PHE comes to a close.

COVID-19

Patients need equitable, affordable access to COVID-19 vaccines, treatment and testing from the family physicians that are the backbone of their health care. We’re reminding the administration that this depends on ensuring that you can buy supplies at reasonable prices and are compensated fairly by public and private payers.

We also made sure the White House knows that family physicians and other primary care clinicians are playing a central role in diagnosing, managing and treating long COVID, so our voices must figure prominently in any ongoing response. Signaling that we’re well understood here, President Biden’s proposed fiscal year 2024 budget includes investments in research and treatment for long COVID that is very much in line with our advocacy. 

Telehealth

Rules that expanded telehealth flexibility have helped patients access ongoing, continuous care from their FPs during the pandemic, and this important connection must be preserved.

AAFP advocacy has already delivered big on this front with wins including an extension of Medicare telehealth flexibilities through the end of 2024. Building on this, we’re calling for permanent policies that allow patients timely, equitable access to telehealth services provided by or coordinated with their usual source of primary care. We’re also asking HHS to work with the Department of Justice to make permanent the flexibilities that have allowed physicians to prescribe opioid use disorder treatment through telehealth.

Workforce

Finally, there’s room to make permanent one of the PHE flexibilities that has helped our ranks: an expanded “primary care exception.” In response to the pandemic, CMS adjusted the exception to allow all levels of Medicare outpatient evaluation and management visits to be delivered by residents and billed by their teaching physicians who reviewed the care. The agency also expanded the list of services subject to the exception, including an allowance for telehealth services.

This supported vital training for medical residents, more robust access to primary care and better patient-physician relationships — all net goods that helped us fight the pandemic. Particularly when primary care practices will lead the battle against long COVID, primary care training programs should not be disrupted, and patients should not face barriers to high-value primary care. That’s why we’re urging HHS to permanently expand the list of services subject to the primary care exception. 

The expansion of the primary care exception is the very definition of a win-win: good for patients, good for family medicine. As we pointed out to the White House, it’s far from the only example of policy written as triage during the pandemic that actually represents progress.

Your Academy consistently identifies and advocates for these types of policies and warns when going back would be a mistake. As the PHE comes to a close, we’re doing that by pointing officials to a path that highlights and protects family medicine’s foundational role in the nation’s health care system.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.