October 12, 2020, 6:07 pm News Staff – The Town Hall meeting held each year prior to the AAFP Congress of Delegates typically draws a standing-room only crowd as Academy officers provide updates on important issues and answer members’ questions.
The Town Hall held Oct. 11 before the Academy’s first virtual COD had a different feel but a familiar format as hundreds of members joined the online meeting to hear from AAFP officers on topics including COVID-19, physician payment, telemedicine and health equity.
AAFP Board chair John Cullen, M.D., kicked things off by expressing his appreciation for how members have responded to COVID-19.
“I’m incredibly proud,” said Cullen, a full-scope family physician from Valdez, Alaska. “In terms of flexibility, family physicians took over a lot of roles during this pandemic, covering every department in the hospital from L&D to ICU and the emergency room, setting up testing stations and home visit programs. It’s absolutely incredible what family physicians have done.”
Cullen also highlighted what the AAFP has done, including creating extensive clinical resources, CME and a purchasing program for personal protective equipment, as well as efforts to ease members’ burden by extending deadlines for dues and CME requirements. He also touted the AAFP’s advocacy work during the pandemic, which has included hosting a virtual congressional briefing and successfully advocating for financial relief (such as the Coronavirus Aid, Relief and Economic Security Act Provider Relief Fund) and reduced administrative burden (including the elimination of prior-authorization requirements for all COVID-19-related diagnostic services).
“We’ve been extremely active in D.C.,” he said.
AAFP CEO/EVP Shawn Martin said that in March only 13% of AAFP members were providing video or telephone visits, but by May 94% of members were regularly doing so, aided by sweeping, temporary policy changes that eased regulatory and reimbursement barriers that had inhibited the growth of telemedicine. The Academy has created numerous resources to assist members with telemedicine.
A survey of Academy members found that more than 80% of family physicians started providing virtual visits for the first time during the pandemic, and nearly 70% expressed interest in continuing providing virtual care beyond the crisis.
Cullen said successfully advocating for increased payments for telephonic evaluation and management services to match those of regular, in-office E/M visits has been the Academy’s biggest accomplishment related to pandemic thus far.
“That was essential at that moment in time,” he said.
Martin said the Academy is advocating for broadband expansion to improve health care access in rural areas, and the Academy is expressing concern with commercial insurers who are taking steps to reinstate cost-sharing for telehealth visits.
Cullen said the Academy is monitoring companies entering the market that are focused solely on offering telemedicine care.
“I just signed a letter about this yesterday,” Cullen said. “As a new adopter of telemedicine, starting in March, I found that if I know a patient my care for them is much better than if I’ve never met them. We’ve been talking a lot about longitudinal, comprehensive care and how important that is for outcomes. I think we’re going to see that in telemedicine as well. We’ve been very vocal in sharing this viewpoint in D.C.”
AAFP President Gary LeRoy, M.D., of Dayton, Ohio, said CMS revisions to the office visit E/M documentation and coding guidelines – which include a 13% payment increase and are scheduled to take effect Jan. 1 – will be “monumental.”
“These changes are intended to reduce administrative burden as well as increase the amount of time you can spend with patient,” LeRoy said. “This is why we went into medicine in the first place – we want to make a difference and spend time with patients. This gives us added opportunities to do that.”
In addition to an increase in the relative values for office visit E/M codes, there also will be an “add-on code” for visit complexity.
“This code will be used for most primary care visits,” said LeRoy, who added that the AAFP is advocating for uniform adoption of the changes across all payers, both public and private. “Very few of our patients come in for just one thing.”
LeRoy said there are steps family physicians should take now to prepare for the change to ensure they receive increased payments, and the Academy has resources to help both employed and independent physicians related to issues such as working with EHR system vendors, payers and billing staff.
LeRoy said the changes were the result of “a series of small steps in right direction over the course of nearly a decade.”
“CMS has heard what we’re saying,” he said.
AAFP President-elect Ada Stewart, M.D., of Columbia, S.C., offered an overview on the work the Academy is doing to address health equity.
“This is a pivotal time in our nation’s history,” she said, “and it is ripe with opportunity for family physicians to make an important impact. As our country continues to battle racism and health inequities, it is more important than ever that we stand together to advocate for our patients, communities and also our members.”
The AAFP and the AAFP Foundation founded the Center for Diversity and Health Equity in 2017 at the direction of the COD. Its mission is to establish the AAFP as a leader in advancing diversity and achieving health equity in primary care. The center has assisted in the development of new policies, including those related to maternal mortality, race-based medicine, implicit bias and institutional racism.
The center also developed The EveryONE Project, which offers a variety of resources to help physicians identify and address the social determinants of health:
Stewart said the Health Equity Fellowship offered by the AAFP and the Association of Family Medicine Residency Directors continues to grow, which has allowed the center to add tracks for rural health and academic medicine.