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Wednesday Jan 01, 2014

Challenges, Opportunities Await in 2014

Happy New Year! This really should be a good new year.

Of course, there are always challenges. However, things are moving in some outstanding directions for family medicine. It is exciting that people around the country -- the media, policymakers and others -- are continuing to talk about primary care. What is even more exciting is that it seems the understanding of what primary care is and who provides it continues to become more focused. Moreover, seeing family physicians as the foundation of primary care in our health care system is a discussion that is really ramping up now, and it's long overdue.

It may seem hard to believe, but the sustainable growth rate (SGR) formula may finally be repealed this year! As the calendar year changes, support for the current bicameral and bipartisan effort to repeal the fatally flawed SGR remains strong.

This effort is critically important in and of itself. However, it also has been a huge roadblock for discussions about many other issues that are essential to continuing to transform our health care system. Other needed reforms related to things such as payment, graduate medical education and workforce have in many ways been delayed or derailed because so much time and energy has been needed to deal with the SGR.

I am encouraged, and excited, by the possibility of being able to carry our other important messages forward knowing that we can have some meaningful conversations about them on Capitol Hill.

We continue to see increasing interest from medical students in family medicine. We are seeing an increase in applications from U.S. seniors at my medical school, and many of my peers have reported similar trends. It looks to be a strong class.

Now, we need to have the important discussions about continuing to find ways of changing medical school education to emphasize family medicine and better address the social mission that should be a determining factor in a graduate's specialty choice.

We also need to address the problem posed by the combination of increasing number of U.S. medical school graduates and the cap on the number of residency spots that are supported by Medicare. We will continue to move efforts forward to not only increase the cap, but to push for the majority of the new positions to be in true primary care, especially family medicine.

And, I am pleased that payment reform is moving forward. It is certainly not happening quickly enough, and the issues of the salary gap, overvaluation of some procedures, and the inherent difficulties of the fee-for-service system still exist. However, CMS has signaled its recognition of the valuable services we provide in coordinating our patients’ care by creating new care management codes that allow us to get paid for things that we have always done and will always do.

Moreover, we have data from researchers at the University of Texas Health Science Center at San Antonio that demonstrate the increasing complexity of the kind of care we provide. These data, which we are providing to CMS, will help show this difference objectively and drive home the need for further payment reform that better values the care we family  pysicians provide for our patients. As more and more of our patients have multiple medical conditions, the case we make is increasingly critical.

Our unique and comprehensive education and experience is becoming better recognized and appreciated. A recent patient survey has made it clear that patients value and appreciate us. They want to see their family physician for their health care needs, and they want that family physician to be the leader of their health care team. This validates what we have been saying for more than 10 years. The patient-centered medical home (PCMH) succeeds in meeting the quadruple aim: improving patient outcomes, improving patient satisfaction, improving physician satisfaction, and doing so at lower costs. A core contributor to the success of the PCMH is the role of physician-led teams.

In short, the messages that we have been giving for years finally are being heard and understood. There always will be challenges, but those also can be opportunities.

Thank you for all you do, including your dedication to our patients, our communities, our profession and our country. Your efforts have helped get family medicine to where it is and where it will be. It is an honor to serve with you. I look forward to an exciting new year as we continue to move health care transformation forward in our country.

As the way we deliver care to our patients evolves, I’m eager to further define who we are and where we are going as a specialty. Please follow me on Twitter(twitter.com) to see where I think family medicine is going, and use the hashtag #WhereFMisGoing to join the conversation with our colleagues.

Reid Blackwelder, M.D., is President of the AAFP.

Posted at 09:19AM Jan 01, 2014 by Reid Blackwelder, M.D.

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