June 2, 2022, 12:40 p.m. Scott Wilson — “Family medicine is advocacy. Advocacy is family medicine. Period.”
That’s how Andrea Anderson, M.D., of Washington, D.C., says she approaches her work as a family physician — and it’s the spirit she took to the AAFP’s Family Medicine Advocacy Summit last month as the annual event returned to in-person convention after two pandemic years.
Anderson can now count her FMAS experiences on two hands and has taught advocacy and leadership skills herself in classroom settings. The word she offered AAFP News when asked to describe her most recent day on the Hill: “Exhilarating!”
FMAS, held May 22-24 in Washington, D.C., brought together more than 240 Academy members, who met with 220 members of Congress and their staffs to rally behind three top AAFP policy priorities: increasing access to telehealth, addressing the mental health crisis and finally ensuring Medicaid payment parity. As usual, those attending were offered the latest information on these topics and guidance on how best to advocate for their practices. (New this session was the availability of up to 3.75 AAFP Prescribed credits.) Leading into the event was the first in-person State Legislative Conference since before the pandemic.
COVID-19’s long shadow looms over Medicaid patients as the public health emergency draws toward a close, while the ongoing pay disparity between Medicaid and other payers continues to threaten primary care practices (especially in rural and underserved communities) with financial instability. These factors, members told Congress during FMAS, mean that Medicaid payment rates must be raised and federal Medicaid regulations strengthened.
To do these things, the Academy continues to press for passage of the Ensuring Access to Primary Care for Women and Children Act (S. 1833) and the Kids Access to Primary Care Act (H.R. 1025), and an increase of Medicaid payment rates to at least Medicare levels, and to urge that the Biden administration enforce and strengthen federal Medicaid access regulations.
In advocating for improved behavioral health care integration in primary care, FMAS participants reminded lawmakers and their staffs that family physicians are often the first point of contact for patients navigating the health care system. One-third of the care for serious mental illness and a quarter of prescriptions for serious mental illness take place in a primary care setting.
To support primary care practices undertaking this work, the Academy is calling for a Medicare add-on code for primary care physicians who have the capacity to provide integrated behavioral health services. It also seeks passage of the Supporting Children’s Mental Health Access Act (H.R. 7076/S. 3864) to reauthorize for five years and expand to all states the Pediatric Mental Health Care Access program, which supports the integration of children’s behavioral health services using telehealth; the Improving Access to Behavioral Health Integration Act (S. 4306), bipartisan legislation to support behavioral health integration into primary care physician practices; and the Collaborate in an Orderly and Cohesive Manner Act (H.R. 5218), a bipartisan bill that would provide grants to primary care practices implementing the Collaborative Care Model and promote research to identify additional evidence-based models of integrated care.
Dovetailing with these pushes is the Academy’s advocacy to ensure that the 90% of family physicians now practicing telehealth not face an automatic return to pre-COVID telemedicine policies. To avoid such a setback, members repeated the AAFP’s support for legislation to permanently remove Medicare geographic and originating site restrictions, allowing all Medicare patients to access virtual care, and to allow federally qualified health centers and rural health clinics to permanently provide telehealth services. Telehealth policy also must address the digital divide, FMAS participants said, and be informed by studies to ensure that access to care for underserved communities, patient safety and health equity continue to get better as telehealth evolves.
In the dozens of meetings between Academy members and lawmakers about these complex issues that were FMAS’ culmination, the common thread among these physician advocates was simple: leveraging the opportunity to share unique stories from their practices.
“In my state, payment for telehealth services after the PHE ends will no longer be full unless criteria that are more archaic are met,” said Sarah Nosal, M.D., of the Bronx, N.Y. A veteran FMAS participant and experienced statehouse advocate for her chapter, she went into this year’s legislative appointments with a strong point of view on telehealth.
“An 80-plus-year-old, strong-willed, amazing patient of mine who refused to leave her apartment for nearly a year into the pandemic was willing to see me on video,” she said. “Thanks to those visits, the need for a critical ophthalmologic evaluation was revealed when I asked the patient to get up and walk around. Via video I was able to note that she was holding onto the walls and furniture to get around. She could no longer see clearly. I think about her all the time when I first get a video glimpse into one of my patient’s homes.”
“This is probably my eighth D.C. visit for FMAS over the last 15 years,” said Renee Crichlow, M.D., of Boston. “It’s always been a worthwhile experience. This year it was so much more appreciated, as we haven’t been together since the pandemic.
“In our group, we had six folks, including a resident physician — some first-timers and some experienced folks. We connected with both of our senators and five Massachusetts congressional representatives. The discussions about funding and reimbursement for integrated behavioral health and continued telehealth support were two of the big conversations, and congressional staff really engaged with us. We are well respected, and our input is clearly appreciated.”
Madison Healey, M.D., of Syracuse, N.Y., was an FMAS first-timer — and nervous about it.
“I was a fortunate recipient of an Association of Family Medicine Residency Directors scholarship to attend,” she said. “I worried I would not be qualified or up on the issues to be able to fight for family medicine effectively, but the conference was very well organized and got me up to speed on the things I needed to know prior to our meetings.”
As Healey and her fellow chapter members met with Sens. Kirsten Gillibrand and Chuck Schumer and Rep. Adriano Espaillat, she gained confidence.
“Even as a resident physician, I have experience that is valuable,” Healey said. “Lawmakers see us as experts and trust our opinions, which can be incredibly powerful. I learned to make the issues at hand personal and how to use my experience to illustrate how policy affects access to care for our patients.
“I have seen how many challenges Medicaid patients face when it comes to accessing care. I have also seen many of my colleagues choose to leave New York to practice, or opt to join practices that do not accept Medicaid, simply because the reimbursement is so low, and many of us have seemingly insurmountable student debt at this stage in our lives. All of these things negatively impact patient care and could be mitigated by increasing reimbursement.”
Nosal agreed. “The best thing about it is coming together as a team and really sharing our stories, and those of our patients, all for the betterment of the care of our patients and communities,” she said. “As family physicians, we find facts and numbers convincing. The rest of the world finds themselves most convinced and deeply moved by the shared experiences of our students, residents, physicians and our patients.”
Such advocacy is the type of effort that FMAS participants are well acquainted with.
“As family physicians, we are always advocating with our patients to maybe increase compliance with a medication or make a behavioral change,” Anderson said. “We advocate on behalf of our patients with insurance companies, administrators, schools, families, etc. We need to see lobbying our elected officials is the same thing — just an extension of our existing skill set and expertise.”