Diverse Valuation Task Force Calls for Immediate Improvement in Primary Care Payment

Change urgently needed to serve patient needs, build primary care physician workforce

Tuesday, August 23, 2011


WASHINGTON — Immediate improvement in payment for primary care medical services got strong support from business, patient, health plan and medical organizations today when the American Academy of Family Physicians’ Primary Care Valuation Task Force convened for its inaugural meeting.

“This is a really energized group that is committed to doing the right thing for the patient,” said Lori Heim, MD, AAFP board chair and chair of the Valuation Task Force. “They want to create a system that serves patients’ needs.”

Task force members “agreed on the need to pay primary care physicians better; they see the need for immediate payment improvement,” Heim continued. “They recognized that primary care has been undervalued, that the primary care workforce depends on appropriate payment for their services, and that we’re facing a crisis in the primary care workforce. Given that, everyone agreed we need both immediate actions on an across-the-board improvement in payment for primary care and we need a sustainable, improved model for delivering primary medical care.”

The Valuation Task Force was formed by the American Academy of Family Physicians in July in an effort to identify solutions to a system that, over time, has contributed to inequitable and devalued payment for primary care medical services. Twenty-one organizations and individuals — ranging from the Urban Institute to Harvard Massachusetts General Hospital to the Commonwealth Fund to CIGNA Healthcare — joined the task force.

During their inaugural meeting, task force members identified four work groups that will focus on specific questions to be answered.

  • Workgroup 1 will define primary care, its components and the professionals who provide primary care.
  • Workgroup 2 will identify and discuss short-term solutions that can improve the payment environment for primary care physicians, using a separate conversion factor for primary care to evaluate the impact and viability.
  • Workgroup 3 will review evaluation and management codes — the codes most commonly used by primary care physicians — and identify data on the types of codes currently paid, whether codes should be expanded to include care management, multiple services and non face-to-face requirements for providing high-quality patient care, and whether E/M codes should be redefined.
  • Workgroup 4 will look at long-term issues such as the structure of the future system, consideration of comprehensive payment for comprehensive care, differentials for high-performance practices, and other mechanisms that enable primary care practices to sustain high-quality, patient-centered care.

Heim noted that the non-physician groups brought valuable perspective to the discussion. In addition to task force members who represent patients, business, policy analyst, hospital and health plan organizations, the meeting included observers from the Centers for Medicare and Medicaid Services, the Medicare Payment Advisory Commission, Rep. Jim McDermott’s congressional office, the American Osteopathic Association, the Society for General Internal Medicine, and the American College of Physicians.

“This is not physician-driven,” she said. Members of the task force “are people for whom — from a policy standpoint — this really matters. It was gratifying to hear these other organizations voice the concerns that we’ve expressed for years. I was really pleased with the members’ energy, commitment and desire to be a part of something that can fundamentally change payment for primary care.”

The AAFP formed the Valuation Task Force after prolonged negotiations with the AMA/Specialty Society Relative Value Scale Update Committee — commonly known as the RUC. During those efforts, AAFP called for

  • more seats for family medicine, general internal medicine and general pediatric medicine;
  • the addition of three new seats for external representatives such as consumers, employers and health plans;
  • a permanent seat for geriatric medicine;
  • the elimination of existing rotating subspecialty seats as the current representatives ‘term out;’ and
  • greater voting transparency on all RUC votes.

The task force consists of 22 thought leaders with extensive health care system and policy expertise:

  • Christine Bechtel, National Partnership for Women and Families
  • Robert Berenson, M.D., Urban Institute
  • Robert J. Carr, M.D., American Academy of Family Physicians (CPT team)
  • Randall Curnow, Jr., M.D., MBA, American College of Physicians
  • Thomas Felger, M.D., American Academy of Family Physicians (board member)
  • Paul Ginsburg, Ph.D., Center for Studying Health System Change
  • John Goodson, M.D., Society of General Internal Medicine
  • Veronica Goff, National Business Group on Health, Institute on Health Care Costs and Solutions
  • Allan Goroll, M.D., Harvard/Massachusetts General Hospital
  • Edith Hambrick, M.D., Centers for Medicare and Medicaid Services
  • Lori J. Heim, M.D., American Academy of Family Physicians (board chair and task force chair)
  • David F. Hitzeman, D.O., American Osteopathic Association
  • Ronnie D. Horner, Ph.D., Department of Public Health Sciences, Center for the Study of Health, University of Cincinnati
  • David A. Katerndahl, M.D., University of Texas Health Science Center at San Antonio
  • Brian Klepper, Ph.D., WeCare TLC Onsite Clinics
  • Walter L. Larimore, M.D., American Academy of Family Physicians (RUC team)
  • Katie Merrell, The Commonwealth Fund
  • Kavita Patel, M.D., Brookings Institution
  • Richard Salmon, M.D., Ph.D., CIGNA Healthcare
  • Glen R. Stream, M.D., MBI, American Academy of Family Physicians (president-elect)
  • Jeffrey Susman, M.D., American Academy of Family Physicians (chair, Commission on Quality and Practice)
  • Richard Harrison Tuck, M.D, American Academy of Pediatrics

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Founded in 1947, the American Academy of Family Physicians represents 136,700 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

To learn more about the AAFP and family medicine, visit www.aafp.org/media. Follow us on Twitter,(twitter.com) and like us on Facebook. For information about health care, health conditions and wellness, visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).