Delegates Look for Multiple Pathways to PCMH Recognition, Debate Access-to-Care Issues

October 19, 2012 07:05 pm Matt Brown Philadelphia –

During the final session of the 2012 Congress of Delegates here, AAFP delegates voted to adopt a resolution that calls for multiple pathways to enhanced payment for the patient-centered medical home (PCMH), as well as several access-to-care recommendations from the Reference Committee on Advocacy.

Alternate delegate Marguerite Duane, M.D., of Washington, D.C., gives spirited testimony during the Reference Committee on Advocacy at the 2012 AAFP Congress of Delegates.

As more payers see the benefits of the patient-centered medical home (PCMH) model, an unintended consequence, according to delegates testifying at the Reference Committee on Advocacy, is that they are calling on physicians and practices to obtain certain types of PCMH recognition or certification.

For example, according to delegates from New York, their state is giving extra payment in its health plans only to practices that have been recognized as a PCMH by the National Committee for Quality Assurance (NCQA). There are other recognition and certification programs out there, delegates noted, and giving prominence to only one certain program creates problems.

Delegates urged the AAFP to ensure that no exclusive method of determining which practices achieve PCMH status is promulgated in government or payer regulations.

Story Highlights

  • Recognition of the patient-centered medical home model and health care disparities were on display during the Reference Committee on Advocacy hearing at the 2012 AAFP Congress of Delegates.
  • Delegates passed a resolution that calls for multiple pathways to PCMH recognition or certification as long as those pathways conform to the PCMH Joint Principles
  • Delegates also passed resolutions on critical access hospitals and survival of independent primary care practices and resolutions supporting an end to age restrictions on emergency contraception and civil marriage for same-gender couples.

Although the Board agreed with the resolution in concept, they had some concern about calling out the NCQA in particular in the language of the resolution. The reference committee also was concerned that practices would have to meet criteria for a variety of recognition or certification programs, so they urged adoption of a substitute resolution advocating for multiple pathways to enhanced payment for PCMHs. The substitute resolution removed reference to the NCQA and called for using the Joint Principles of the Patient Centered Medical Home to ensure any recognizing or certifying body was using principles written by and agreed upon by primary care.

Delegates also asked that the AAFP investigate developing an AAFP PCMH certifying process and report back to the Congress of Delegates next year.

Delegates also adopted an amended resolution that asks the AAFP to "advocate for emergency contraception to be available without prescription to all women of reproductive age."

Spirited debate for and against this resolution ensued. Delegates against the amended resolution cited HHS Secretary Kathleen Sebelius' earlier decision to countermand FDA approval of OTC access to a specific emergency contraceptive for girls younger than 17. They suggested that making the "day after pill" available without prescription to girls as young as 11 would harm the doctor-patient relationship and deprive young female patients of desperately-needed education on the topic of sex.

Delegates Adopt Bylaws Revisions

Despite some disagreement on territorial definitions, delegates at the 2012 Congress of Delegates in Philadelphia adopted the recommendations from the Reference Committee on Bylaws on Oct. 16.

After passing most of the consent calendar without exception, delegates asked the reference committee to add the word "commonwealths" to the section defining the eligibility of international members. After some discussion on the best phrasing, the amendment to the proposed AAFP Bylaws revisions was adopted.

AAFP Speaker and chair of the AAFP Task Force on Bylaws Revision John Meigs Jr., M.D., of Centreville, Ala. -- who had been working with the task force for three years to revise the Bylaws -- was not shy in voicing his enthusiasm that the process was finally over.

"Glory Hallelujah!" he said.

The final vote on the Bylaws revisions, the first comprehensive review in 65 years, required a two-thirds majority vote to pass.

"This is not in the best interest of our patients, because it is important for patients to receive guidance from family physicians," said Marguerite Duane, M.D., alternate delegate from the District of Columbia. "We need to do a better job as physicians to increase access so they can get in to see us in 24 hours. To fracture the relationship between family physicians and adolescent patients is no way to spend the Academy's money."

Alternate Special Constituency delegate Karla Booker, M.D., of Lilburn, Ga., one of many delegates who rose in support of the resolution, said that unintended pregnancy in adolescent patients is an extremely important public health issue, and although it should be a goal for family physicians to educate every adolescent out there about sex, it is -- especially in rural practice -- not possible.

"Indeed, many adolescents don't even have a primary care physician, and they aren't going to find one in the 72-hour window we are talking about here," she said. "This is about emergency contraception … and at the end of the day, we need to stick to the science."

Delegates also adopted resolutions supporting critical access hospitals and the survival of independent primary care practices. In addition, they passed a substitute resolution focused on increasing the ability of CMS to change payment guideline for immunizations without Congressional legislation.

The Congress of Delegates also considered and approved several policies aimed at reducing health care disparities and inequalities in coverage, including a policy that supports civil marriage for same-gender couples, stating that civil marriage "contributes to overall health and longevity, improved family stability and to benefit children of gay, lesbian, bisexual, transgender (GLBT) families."

Delegates vigorously debated the issue, voting down a motion to refer the resolution to the Board of Directors for further consideration after outgoing Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas, reminded them that the Congress of Delegates, not the Board, is the rule-making body for the Academy. "We will, of course, accept any referral," Goertz said, "but you are the policy-setting body here."

"While there are varying, passionate beliefs on this issue, family physicians recognize that there are important health implications related to civil marriage," said AAFP President Jeff Cain, M.D., of Denver. "Calling for civil marriage equality is not only about eliminating health care and benefit inequities under law; it is also about helping to nurture the social and psychological health of our patients without discrimination."

With passage of the resolution, the AAFP joins several other health professional organizations in publicly supporting equality in civil marriage, including the American Medical Association, the American Psychiatric Association, the American Psychological Association, the American Academy of Nursing and the National Association of Social Workers.

Finally, delegates referred resolutions on the following topics to the AFFP Board of Directors:

  • a second resolve on the survival of independent primary care practices;
  • a cap on Suboxone patients;
  • veterans' access to health care; and
  • a tax credit for rural/underserved physicians.