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Wednesday Sep 18, 2019

Our Wins Are Big Steps Toward Better Health Care Landscape

As my time on the AAFP Board of Directors draws to a close, I am struck by the changes in our specialty and the health care system that have unfolded during the past six years. I am also struck by the Academy's persistent voice and strong advocacy efforts on behalf of our members and patients during this tumultuous time.

[director's chair and film board]

In 2015, we helped bring about the long-sought demise of the Medicare sustainable growth rate formula. The House of Medicine was united in its work to repeal this flawed methodology, which had resulted in 17 temporary budget patches over 12 years to save physicians from significant Medicare payment cuts. A new day dawned when the Medicare Access and CHIP Reauthorization Act of 2015, which the AAFP had championed, was signed into law after receiving overwhelming bipartisan, bicameral support. The law promised a move away from traditional fee-for-service payment to a value-based model with two payment tracks, advanced alternative payment models and the Merit-based Incentive Payment System.

Now the AAFP is advising the administration and Congress how to adjust the Quality Payment Program that governs those payment tracks to better support family medicine -- and explaining why they need to do so. More than 2 1/2 years into the QPP, several things are apparent. There are too few options for family physicians to move to value-based payment through APMs, and the MIPS pathway is unnecessarily complex. Reporting quality metrics continues to be burdensome, adding to the 3.9 hours each week that a primary care physician spends on reporting of such metrics.(www.healthaffairs.org) Measurement of the meaningful use of EHRs remains, albeit in a more streamlined fashion, and a complex move to account for cost is underway. For those who are high performers, the possible bonuses remain small. For others, especially small practices, the penalties are becoming quite real as the size of future payment adjustments is increasing.

The proposed 2020 Medicare physician fee schedule includes some movement to reduce administrative burden. However, much work remains to ensure that family physicians can make full use of value-based models. The AAFP has been advocating strongly for improvement, because these types of payment will be critical for family medicine practices.

The Future of Family Medicine

In addition to the repeal of the SGR, a highlight from my time on the Board was the Family Medicine for America's Health initiative. Stakeholders from the family of family medicine, as well as other sectors of the health care system, came together to lead a broad strategic effort to expand access to medical homes, advance the use of technology in ways that support and strengthen relationships with patients, ensure a strong primary care workforce, and shift to comprehensive primary care payment. A key component of the project was Health is Primary,(www.healthisprimary.org) a communication campaign to advocate for the values of family medicine, demonstrate the value of primary care and engage patients in the health care system.

The five-year program concluded with handoffs of projects from the FMAHealth tactic teams to members of the sponsoring organizations. Overall, the effort was a definite success. Focusing our message inside the Washington beltway to clearly communicate the value of family medicine was extremely effective.

Work started by the tactic teams continues through the family medicine organizations. For example, the America Needs More Family Doctors: 25x2030 initiative seeks to boost the percentage of U.S. medical students who pursue family medicine to 25 percent by 2030. Such work will be critical to the future success of our specialty.

Moving forward, we must consider how we envision the future of our specialty. Whether this is accomplished in an ongoing process by family medicine stakeholders, through a Future of Family Medicine 3.0 project, or as a combination thereof, it will be critical work.

Continuing Board Certification

We've seen significant improvements in the area of continuing board certification. Early in my tenure on the AAFP Board of Directors, I often heard from members about their frustration with the overall process of board certification, from the high-stakes, 10-year proctored exam to performance-improvement modules that didn't seem to add value to our practices and were not aligned with what many of us were already doing.

The Academy heard you and worked on multiple levels with the American Board of Family Medicine to address your concerns. The AAFP Board of Directors commissioned a task force on board certification led by (then) President-elect John Cullen, M.D., to look at all aspects of certification. At the same time, the American Board of Medical Specialties formed a Vision for the Future Commission to make recommendations to all certifying boards on ways to improve the certification process. The AAFP also was a strong advocate of the idea that certification should not be the sole or threshold criterion for credentialing, privileging, employment or payer participation. Your AAFP provided written testimony to the commission, and I provided oral testimony at a commission session last year, making sure I reflected all I had been hearing from our members during the previous five years.

Communication between the leadership of the ABFM and your AAFP was consistently focused on providing value for their diplomates and our members, as well as our patients. I also participated in the ABFM strategic planning process last October, along with many AAFP members and other stakeholders.

The ABFM should be recognized for the subsequent improvements we have seen. A longitudinal continuous knowledge assessment pilot launched this year as an alternative to the one-day exam, and the ABFM announced in July that it was extending the pilot through 2020.(www.theabfm.org)  

In addition, the ABMS' Vision for the Future Commission called for the ABMS to reiterate to hospital and health system leaders(www.abms.org) its policy that board certification should not be the sole criterion for credentialing or privileging decisions, and the organization did so, which is a step in the right direction.

Performance improvement options also are changing, including allowing physicians to be recognized for activities they have already completed. The ABFM is working with the Academy on ways to build more flexible, meaningful ways to complete the performance improvement requirement, such as incorporating performance improvement into live course design.

These are all important and positive steps, and I look forward to more improvements that ensure the continuing board certification process provides value for our practices and patients.

The past six years have indeed been marked by dramatic changes in our health care landscape. I truly believe there has never been a better time to be a family physician. Together we must all continue our leadership role for the health of our patients and communities.

I have been privileged and honored to have the opportunity to represent all of you and to be an advocate for our specialty. I sincerely thank each of you for your trust and support.

Michael Munger, M.D., is Board chair of the AAFP. His term ends Sept. 25 during the Congress of Delegates in Philadelphia.

Posted at 01:38PM Sep 18, 2019 by Michael Munger, M.D.

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