Family Medicine Disappointed HHS Doesn't Specify Role of Primary Care Services in Essential Health Benefit "Guidance"

Federal officials instead to allow states to develop benefit packages based on existing plans

Monday, December 19, 2011


LEAWOOD, Kan. — Family medicine physicians today expressed concern that the U.S. Department of Health & Human Services chose not to guarantee primary care and preventive services be included as essential health benefits for state-based exchanges in 2014. Rather than establish a robust national standard, HHS instead issued a bulletin( recently that allows states to choose one of several existing state plan types.

“The AAFP hopes that HHS follows up this bulletin quickly with an actual proposed regulation and that HHS specifies that primary care services performed by family physicians are essential,” said Glen Stream, MD, MBI, president of the AAFP. “Studies show that health systems that incorporate the elements of the patient-centered medical home reduce medical fragmentation and duplication and ultimately are found to better control costs. Primary care physicians form the foundation of the team and therefore patients receive the right preventive and chronic care management services at the right time from the right professional. As a result, illnesses are prevented, complications of chronic conditions are avoided, unnecessary hospitalizations are reduced, patients have better outcomes and costs are constrained.

“Clearly much more work is needed and the AAFP is committed to working with HHS, the states, and prospective exchange entities to continue developing their benefit packages so that the state-based exchanges offer a reliable and comprehensive range of services in 2014.”

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Founded in 1947, the American Academy of Family Physicians represents 134,600 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.

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