AAFP Convenes Expert Group to Reassess Value of Primary Care

Will present the recommendations directly to the Centers for Medicare and Medicaid Services

Wednesday, July 20, 2011

Megan Moriarty
Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237 Ext. 6052

LEAWOOD, Kan. — The American Academy of Family Physicians has formed a new Primary Care Valuation Task Force to review the methods for valuing health care services and make recommendations about more accurately valuing and paying for primary care physician services.

At its inaugural meeting in Washington, D.C., Aug. 22, the task force will begin a six- to nine-month project to identify ways to appropriately appraise evaluation and management services provided to patients. E&M services are provided by physicians — most often primary care physicians — to evaluate patients and manage their care.

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 (Current Procedural Terminology team)
  • Randall Curnow, Jr., M.D., MBA, American College of Physicians
  • Thomas A. 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 (observer)
  • 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., Family & Community Medicine, 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, Social & Scientific Systems, Inc.
  • 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

While the current AMA/Specialty Society Relative Value Scale Update Committee’s — commonly referred to as the RUC — input is important, the review process would benefit if supporting evidence was collected and analyzed not only by medical specialty societies but also by experts who were less invested financially in the outcome.

"Increasingly, research suggests that the complexity of primary care physicians' evaluation and management services are different and more intense than the E&M services provided by other specialties," said Lori Heim, M.D., board chair of the AAFP and chair of the new task force. "As a matter of fact, CMS recognized in their 2012 proposed Medicare Physician Fee Schedule the need to review primary care codes and asked the RUC to prioritize the review of these E&M codes."

"The long-term and ongoing actions of the RUC are overly influenced by subspecialist procedures, and give short shrift to primary care and its complexities," said Brian Klepper, Ph.D., WeCare TLC Onsite Clinics. "The valuation process would benefit substantially if CMS had an alternative, more modern and transparent means of identifying misvalued services and calculating RVUs."

The typical patient encounter varies across specialties and likely underestimates the intensity of the primary care physician’s work.

“The current system has for too long been biased toward acute care and procedures and not primary care and prevention,” said Helen Darling, president and CEO of the National Business Group on Health. “It’s time to more accurately reward the complex and comprehensive care primary care physicians provide to all patients.”

The new task force will focus its attention on alternative payment methods that could work within the current fee-for-service model.

"The fee-for-service payment system will continue to be the foundation of the payment system while alternative methods are developed," said Robert Berenson, M.D., Institute Fellow at the Urban Institute. “As such, fee-for-service payment needs direct and urgent attention so primary care services are properly valued and the system ends the current payment inequities when new models of payment are fully applied."

Additionally, other data sets besides the RUC survey data might be revealing in more appropriately valuing all physician services, including those delivered by primary care physicians.

The task force will present its findings to the AAFP Board during the first quarter of 2012. The AAFP Board will then present the recommendations directly to the Centers for Medicare and Medicaid Services for its consideration in assessing the appropriate work relative value units that measure the worth of a service and determine Medicare fee-for-service payment to primary care physicians.

Formation of the task force comes on the heels of another AAFP announcement about primary care physician payment. Last month, the AAFP strongly requested that the RUC make specific changes in its structure, process and procedures so that primary care services are more fairly assessed and valued.

Editor’s note: Short biographies for each of the task force members are available here.

About the American Academy of Family Physicians

Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).