• In The Trenches

    New Year, New Paradigm(s)

    If you still have “In the Bleak Midwinter” playing on a loop in your head, you aren’t alone.

    2021 in the sky

    “Our darkest days in the battle against COVID are ahead of us, not behind us. So we need to prepare ourselves, to steel our spines.”

    So said President-elect Joe Biden on Dec. 22. He went on: “As frustrating as it is to hear, it’s going to take patience, persistence and determination to beat this virus.”

    He is, of course, correct, though if I were his speechwriter I’d have added “primary care” to “patience, persistence and determination.”

    Later in the address, the incoming president added that the effort to distribute and administer the vaccine was not progressing as it should have. This remains true. Here, too, though, I’m obliged to point out that Academy members can and should be integral to this enormous task. Yes, this is going to be a long winter. But family physicians are prepared to mitigate against its harshness.

    The Academy is asking AAFP members to echo this message at the state level by participating in a vaccine-related Speak Out campaign. As Biden prepares to ramp up COVID-19 vaccine access through close collaboration with U.S. governors, we want every state’s chief executive to understand that primary care physicians stand ready as key partners in every element of vaccination and public health strategy and must be prioritized in distribution plans. They are critical to meeting what Biden called, in that same address, “one of the biggest operational challenges the United States has ever faced.”

    Up to now, however, too many of your practices have watched the vaccine’s arrival at a spectator’s remove, waiting to tag in and start helping — and to get vaccinated yourselves.

    “The rollout so far has been heartbreaking to witness from the standpoint of primary care,” Emily Maxson, M.D., chief medical officer of the value-based care network Aledade, said in a Jan. 4 Stat article.

    The Academy also continues to press the current administration to ensure vaccinations for family physicians and improve communication with community practices.

    “The federal government and the individual states must do all they can to facilitate the immediate and broad vaccination of community-based primary care physicians and their practices,” we told HHS Secretary Alex Azar in a Dec. 23 letter signed by AAFP Board Chair Gary LeRoy, M.D., of Dayton, Ohio. “Failure to do so will further compromise the safety of patients who are seeking care for both COVID and non-COVID health issues.”

    Compromise of a different kind came Dec. 21 when Congress passed a fourth round of emergency COVID-19 relief — legislation that included mixed news for the Academy.  

    What’s good: Primary care practices are starting 2021 with the largest Medicare reimbursement increase in decades as payment rises for most office-based evaluation and management services. We’ve been talking about this for a long time, and it’s finally here.

    As we’ve also discussed, however, some other medical specialties pushed hard against maximizing the effects of this overdue improvement. Yielding to budget-neutrality constraints, Congress ultimately directed CMS to delay until 2024 implementation of a planned add-on code acknowledging the unique complexity of primary care E/M visits (proposed as GPC1X and renamed G2211 in the Medicare physician fee schedule final rule). But the core of the raise we fought to secure and protect for you remains in place, and family physicians will benefit from an increase to the Medicare conversion factor resulting from this legislation.

    “The AAFP is dismayed by any action that would deliberately remove primary care financing provisions that stood to improve the health of millions of people,” AAFP President Ada Stewart, M.D., of Columbia, S.C., responded in a statement.  

    Still, the legislation offered a few uncomplicated wins, including one for which we’ve long and loudly advocated: an extension of mandatory funding for community health centers, the National Health Service Corps and the Teaching Health Center Graduate Medical Education program at current levels through fiscal year 2023.

    The bill also provides for the distribution of 1,000 additional Medicare-funded GME residency positions meant to benefit rural and underserved areas and extends until Sept. 30 the Conrad 30 J-1 visa waiver program for physicians working in such communities. The Academy pressed for an extension of the latter program last May.

    And in a victory for pretty much everyone, the bill at last answered calls by the Academy and a chorus of other medical societies and health care advocates to end surprise billing.

    These advances suggest that greater opportunities for change lie ahead in the new year. That’s why the Academy is a founding signer of the recently formed advocacy charter New Primary Care Paradigm.

    “The time has come to unshackle primary care from historical models of funding and regulation that have limited the full realization of its potential and contributed to burnout and practice instability or closure,” the Academy and the American Board of Family Medicine said in a Dec. 22 statement introducing the effort.

    Joining the Academy and the ABFM in this united front working to bring about major payment and regulation reforms are the American College of Physicians, the American Board of Internal Medicine, the American Academy of Pediatrics, the American Board of Pediatrics and the Society of General Internal Medicine. Together (and with convening and facilitation support from the Larry A. Green Center and X4 Health), we’re extending a hand to other medical groups and stakeholders to sign aboard what promises to be a robust and collaborative movement.

    We believe it’s time to change the way primary care is financed, and that doing so will achieve better health through the seamless integration of care, health equity and lower costs. That’s one way to avoid another winter like this from ever happening again.

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.


    Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.  Read author bio »


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