AAFP members engaged in lengthy debates regarding contentious issues during the Congress of Delegates held here Sept. 23-25, but they found plenty of common ground in a move to build support for the Interstate Medical Licensure Compact.
Bradley Fox, M.D., a delegate from Fairview, Pa., testifies Sept. 23 before the Reference Committee on Advocacy in Philadelphia. Fox spoke in favor of a resolution on the Interstate Medical Licensure Compact that was considered during the 2019 Congress of Delegates.
Family physicians who spoke before the Reference Committee on Advocacy showed unanimous support Sept. 23 for a resolution that calls on the Academy to formally support the compact and encourage state chapters to advocate for its adoption in state legislatures.
"Where has this been all my life?" asked Ian Jackson, M.D., a general registrant from St. Joseph, Mich., which is less than 40 minutes from the Indiana state line. "This is great!"
The compact is an agreement among 29 states -- so far -- that allows licensed physicians to practice across state lines if they meet certain eligibility requirements.
Bradley Fox, M.D., a delegate from Fairview, Pa., also testified in favor of the resolution. Fox, a team doctor for the Detroit Tigers' Minor League Baseball affiliate in Erie, Pa., said he holds licenses in multiple states because of his work in sports medicine. He noted that Florida, a state where many professional baseball teams go for spring training, is not yet a member of the compact.
Hospital Discharge Summaries
Members also showed largely enthusiastic support for a resolution that calls on the Academy to petition CMS to reevaluate its policy on time requirements for hospital discharge summaries and require hospitals to provide primary care physicians with such summaries within seven days of discharge to allow for high-quality transitional care.
- The 2019 Congress of Delegates adopted several resolutions that were discussed during the Reference Committee on Advocacy hearing.
- Among the measures that delegates supported were actions to support the Interstate Medical Licensure Compact, quicker discharge summaries and more complete claims databases.
- Delegates referred to the AAFP Board of Directors several complex resolutions that failed to generate consensus.
The Congress ultimately adopted a substitute resolution that expanded the scope of the measure. Arnold Pallay, M.D., a delegate from Montville, N.J., testified in the reference committee hearing that the resolution also should include nursing homes, and language was added in the substitute resolution to include post-acute care facilities.
The original resolution pointed out that CMS requires discharge summaries to be completed within 30 days. Randy Rice, M.D., a nursing home director and general registrant from Moose Lake, Minn., said in the reference committee hearing that when his facility requests discharge summaries, hospitals typically cite the 30-day rule currently in place.
"That's unacceptable," Rice said.
Rice was one of several physicians who called for time requirements as short as 48 hours, but James Taylor, M.D., an alternate delegate from Zachary, La., pointed out that although he supported the resolution's intent, cutting the time limit too short could put increased burden on physicians -- including AAFP members -- who work in hospitals.
Health Claims Data
The COD also adopted a resolution that calls for the AAFP to support the adoption of a standardized set of health claims data and implementation of a Department of Labor pilot program to collect health care claims data in cooperation with all-payer claims databases.
Multiple physicians testified that too many payers and employers have been exempted from the process, leaving data incomplete.
"What we're asking for is an all-claims database that actually includes all claims and all patients," said Evan Saulino, M.D., delegate from Portland, Ore. "There are enormous gaps. States get it. The federal government needs to act."
Other Measures Adopted
The Congress adopted several other resolutions and substitute resolutions recommended by the reference committee, including the following:
Delegates adopted a substitute resolution that calls on the AAFP to urge CMS to change its rules for cardiac rehabilitation programs to allow such programs to operate without the general supervision of a physician if an automated external defibrillator is immediately available and patients are attended by nursing staff trained in basic life support and use of an AED. The change is needed, several members testified, to ensure access to these programs in rural communities.
Anita Ravi, M.D., M.P.H., M.S.H.P., a general registrant from New York, N.Y., testifies during the Reference Committee on Advocacy hearing. Ravi spoke in support of a resolution regarding the decriminalization of people who are solicited for sex.
They also adopted a substitute resolution that urges the Academy to advocate for the enforcement of existing federal law regarding breastfeeding to protect working mothers.
Delegates adopted a resolution that calls for the AAFP to petition CMS, payers and pharmacy benefits managers to include all generic drugs in health plan formularies, as well as to implement systems that provide prescribers with alternatives when coverage for medication is denied and a mechanism for prompt appeal of denials.
Delegates adopted a substitute resolution that directs the Academy to disseminate model legislation to chapters based on a Kentucky law(www.beckersasc.com) that makes screening colonoscopies free of co-insurance and deductibles even if they are ordered after positive screening tests.
Delegates also adopted a substitute resolution calling for the AAFP to support policies that provide employees with job security, wage replacement and health insurance during medical and parental leaves. The substitute measure added financial protections for small business, including small family medicine practices.
Delegates adopted a substitute resolution that urges the Academy to support the right of physicians to organize and collectively bargain.
They adopted a substitute measure that calls on the AAFP to support legislation that "decriminalizes people who are solicited for sex or sexual activities in exchange for money or goods," as well as legislation that would provide resources and support for people exiting the sex industry, and to oppose legislation that would decriminalize sex buying and third parties who promote or profit from such activities.
Finally, delegates adopted a resolution that directs the AAFP to support equal funding for Medicare Advantage across the United States, its territories and Washington, D.C., and to ask CMS to address funding disparities. David Cevallos, M.D., an alternate delegate for the Puerto Rico AFP who lives in Hollywood, Fla., said during the reference committee hearing that physicians in Puerto Rico receive significantly lower payment than their peers in the states, which leads to reduced access and fewer services.
Resolutions Referred to Board
Delegates referred to the AAFP Board of Directors multiple complex resolutions that failed to generate consensus opinions, including
- a resolution calling on the Academy to advocate to ensure payment of medically necessary covered benefits -- such as prescriptions and tests -- regardless of whether a physician is in a patient's insurance network;
- resolutions regarding use of the terms "physician-assisted suicide" and "medical aid in dying";
- a resolution that calls for the AAFP to support the "medical appropriateness of gender affirmation care" for children and adolescents and to oppose legislation that limits the decision-making ability of patients, parents and physicians regarding such care;
- a resolution that directs the Academy to support the implementation of a single set of administrative rules and procedures in health care system reform, which the reference committee said was too broad to be actionable.
Resolutions Not Adopted
The Congress followed the reference committee's recommendations against adoption of
- a resolution that sought Academy support for legislation that would give individuals ages 55 to 64 the option to buy into the Medicare program and
- a resolution that called on the AAFP to affirm single payer as its preferred option for health care system reform.
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