Fair Pay, PCMH Lead Discussion at Town Hall

October 16, 2012 08:55 pm Matt Brown Philadelphia –

The patient-centered medical home (PCMH) model and adequate payment for primary care services dominated the evening during discussions at the 2012 AAFP Town Hall meeting in Philadelphia on Oct. 14. Although many participants expressed support for the PCMH model, they also expressed concern that payment was not following in the footsteps of the model.

Florida delegate Dennis Saver, M.D., of Vero Beach, expresses concern regarding PCMH accreditation during the Oct. 14 AAFP Town Hall meeting in Philadelphia.

AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash.; Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas; President-elect Jeffrey Cain, M.D., of Denver; Speaker John Meigs Jr., M.D., of Brent, Ala.; and EVP Douglas Henley, M.D., of Leawood, Kan., kicked off the meeting with a series of reports, including presentations on distressed practice environments and payment reform efforts.

Distressed Environments

Cain reported on the Academy's efforts regarding distressed practice environments.

"You're going to hear a lot of good news in the next couple of days," Cain said. "The patient-centered medical home has newfound economic proof that shows that we are at a tipping point with governmental agencies, with insurance companies and with businesses understanding the effectiveness of the medical home in improving care and lowering costs … but when you step back and look at any change that happens in a culture, it's often not a tidal movement, it is often bits and pieces and fits and starts."

Story Highlights

  • AAFP leaders updated members on various activities the Academy is undertaking during a Town Hall meeting that preceded the opening of the 2012 Congress of Delegates.
  • They pointed out that the PCMH model is at a tipping point in terms of governmental agencies, insurance companies and businesses understanding the effectiveness of the medical home in improving care and lowering costs.
  • The Academy has done a considerable amount of work to level the field with regard to payment and continues to advocate for the PCMH model.

Those "fits and starts" equal positive developments in some areas, said Cain, but in other areas it has resulted in a practice environment that doesn't offer adequate payment. For example, in 2011, the practice environment for family medicine in New Jersey was a main focus of the AAFP Town Hall meeting. Family physicians in that region were being offered contracts by private payers that paid only 50 to 60 percent of Medicare rates.

"In the course of the last year, the Academy has done a lot of work around distressed practice environments," said Cain. The Academy convened a group that included chapter executives and used data from the Robert Graham Center to look at issues in four areas: actual private practice environment, public programs such as Medicaid, the pipeline for medical students and workforce issues.

"What we've come up with is that we are going to assist state chapters in three different ways," said Cain. The Academy will be compiling data that will allow chapters to evaluate their chapter and state environments so they can use the information to speak with the press and local governments.

In addition, said Cain, the Academy will rank chapters by their level of distress, which will allow chapters to evaluate their own situation. He said the Academy is aware that many payers are giving lip service to the PCMH model while they also are trying to cut payments.

"The good news overall, is that there is a strong movement toward the patient-centered medical home," said Cain. "What we are trying to do is provide skills and resources for those areas that are facing that 'canary in the coal mine' effect."

Payment Reform

Stream provided information on the Academy's efforts in terms of payment reform. He noted that the Academy's greatest concern at present is to establish adequate payment for family physicians so they can run a practice, transform to a medical home, be successful and recruit new partners.

"Without adequate payment, those challenges often seem insurmountable," said Stream. "So we as an Academy and a Board … have been involved in a multifaceted strategy to improve payments."

In addition to the AAFP's ongoing struggle to get the AMA/Specialty Society Relative Value Scale Update Committee (RUC) to consider decreasing the rate for overvalued codes and improve primary care payments, Stream reminded attendees that the Academy established the Primary Care Valuation Task Force last year. After considering all available data, the task force recommended cutting out the middle man and advocating straight to CMS for creation of primary-care-specific evaluation and management codes, which will take into account the complexity of the care being performed.

Missouri delegate Lawrence Rues, M.D., of Kansas City, Mo., asked what the AAFP is going to do going forward to level the field and make all payers aware that they need to pay for the added value PCMH designation brings to the table.

Stream said he believes the success of the Comprehensive Primary Care (PCP) initiative is the accelerator that the PCMH model needs to go mainstream. "When that initiative is shown to save costs and improve quality … then that strategy can be extended further, and you can look at it with regard to payers without further Congressional action," said Stream. "So you'll get to that critical threshold … and it won't be 10 or 20 or 30 percent of your patients' plans that pay a per-member, per-month (fee), it'll be at least 60 percent because that is the construct of the model. And so that is why we want to encourage our members to make it successful."

Florida delegate Dennis Saver, M.D., of Vero Beach, asked if the Academy had any plans to develop its own accreditation for PCMH.

"One of the major stumbling blocks to getting better care for patients in the PCMH is having to count beans to get your diploma," said Saver. "The folks who are (accrediting the PCMH) aren't practicing doctors, and they certainly aren't generally family doctors. I would encourage you to think about the Academy defining, for family doctors, what is a medical home."

Henley said that while he does not see the AAFP ever handing out PCMH designations, he is aware that TransforMED has considered doing so.

"I do see that TransforMED may take up that charge," he said. "It is important to have more than one designator of medical homes, and the NCQA (National Committee for Quality Assurance) is not it by itself. It is a chaotic market at this point, but time will tell."