Town Hall Meeting Spurs Debate, Discussion on Health Care Reform, Medicare Payment, Consumer Alliance Program

September 27, 2010 06:40 pm James Arvantes Denver –

Questions and answers about health care reform, the need to find a permanent solution to the current formula for calculating Medicare payments and the Academy's Consumer Alliance Program partnership with The Coca-Cola Co., or TCCC, dominated the AAFP Town Hall meeting here on Sunday. The meeting was attended by more than 400 family physicians.

Speaker Leah Raye Mabry, M.D., of San Antonio, who moderated the meeting, reminded Town Hall participants at the beginning of the two-hour session, "this is an opportunity for you to ask questions, seek clarification and tell us what you think. It's also an opportunity for your Board to get your input on issues important to you as members." Members obliged by partaking in a lively give-and-take session with AAFP President Lori Heim, of Vass, N.C.; Board Chair Ted Epperly, M.D., of Boise, Idaho; President-elect Roland Goertz, M.D., of Waco, Texas; and EVP Doug Henley, M.D.

First up for discussion was the recently enacted health care reform legislation, which the AAFP supported. Heim outlined some of the benefits for FPs contained in the Patient Protection and Affordable Care Act, noting in particular that the legislation provides a 10 percent Medicare payment bonus for primary care for the next few years. It also takes other steps to promote the patient-centered medical home and payment reforms that are needed to support the medical home.

AAFP member Daniel Derksen, M.D., of Albuquerque, N.M., however, pointed out that some of the gains for primary care providers in the health care reform act will expire within a few years. For example, the 10 percent Medicare bonus takes effect in January 2011 and ends in December 2015. In addition, said Derksen, although the legislation brings Medicaid payments for primary care services up to the same level as Medicare payments in 2013 and 2014, that provision expires after just two years.

What is the AAFP's strategy for making these types of gains permanent under the law, asked Derksen.

Heim responded that the enhanced payments represent a "good start." But "clearly our strategy is to build onto the successes achieved in the original legislation." she noted.

The cost of the health care law was a concern for another audience member, who noted that he did not understand how the Academy could support a measure that "does nothing to control costs."

According to Heim, however, the General Accountability Office has determined that the Patient Protection and Affordable Care Act will result in cost savings. By relying more heavily on primary care, the legislation should improve quality and control costs, Heim said.

D. Michael Baxter, M.D., of West Reading, Pa., noted that the scope of the law, which turned six months old on Sept. 23, could be getting in the way of seeing the good for primary care in the law. The law itself represents "strong improvements in the way we fund and deliver health care," said Baxter. But he added that there is a general lack of knowledge about what is actually in the law. He asked the leaders whether they thought the AAFP had done enough to promulgate the benefits of the legislation.

The AAFP has posted facts and information about the health care reform law in a number of places on the AAFP website, said Heim, adding that she hoped all members would have marked as their official home page.

Physician Payment and Medical Homes

When the Town Hall discussion turned to Medicare payment, Goertz outlined the Academy's position on the sustainable growth rate, or SGR, formula, which is used to set Medicare payments. The SGR formula has triggered steep cuts in payment during the past eight years, leading to repeated efforts on the part of Capitol Hill, as well as the AAFP, to ensure the cuts did not happen.

According to Goertz, the AAFP supports a permanent fix for the flawed payment formula. The AAFP also wants any fix to include a payment differential for primary care services. Goertz noted, however, that a permanent fix may not be possible because of the current environment of cost containment and deficit reduction on Capitol Hill.

In response to this political reality, the AAFP has launched an intensive campaign to convince Congress to extend the current Medicare physician payment rate for at least the next 13 months and thus block a 23 percent payment cut scheduled to take place Dec. 1.

Consumer Alliance Program

Town Hall participants also weighed in on the subject of the AAFP's Consumer Alliance Program, and, in particular, the Academy's alliance with TCCC.

According to Epperly, the AAFP's alliance with TCCC represents an opportunity to partner with the most well-known brand name corporation in the world to ensure the Academy is able to advocate for the health of the public. The alliance also gives the AAFP an opportunity to take "bold steps" to fight obesity and diabetes, he said.

TCCC makes 200 products; 80 of those products are low-calorie or no-calorie alternatives to sugar-laden beverages, Epperly added.

Some AAFP members were not convinced, however, and they asserted that the Academy's alliance with TCCC is no different from an agreement with a tobacco company in terms of promoting patient health.

According to William Phillips, M.D., of Seattle, "Coca-Cola does not fit into the health of our patients." He also pointed out that the alliance with TCCC has prompted some family physicians to drop their AAFP memberships.

Only 61 family physicians quit the Academy during the past year as a result of the alliance, noted Epperly. In comparison, 250 new members joined the AAFP during the past year. Epperly characterized the consumer alliance with TCCC as "deeply visceral for a small group of people." And he noted that only five constituent chapters out of 55 have addressed the issue in their resolutions to the Congress of Delegates.