AAFP Board Chair Spotlights Breadth of Family Medicine Training in Letters to CMS

FPs Well-qualified to Diagnose, Treat Mental Health Problems; Counsel About Alcohol Misuse

August 23, 2011 06:15 pm News Staff

The AAFP took full advantage of a teachable moment recently, when AAFP Board Chair Lori Heim, M.D., of Vass, N.C., reminded CMS Administrator Donald Berwick, M.D., that the breadth of family medicine training includes screening, diagnosis and treatment of patients with mental health conditions.

Heim's comments were part of an Aug. 18 letter(2 page PDF) to Berwick that expressed the Academy's support for CMS' proposal(www.cms.gov) to cover annual depression screenings for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to ensure accurate diagnosis, effective treatment and follow-up.

Heim pointed out that in its proposal, CMS made a number of references to primary care physicians referring patients to mental health clinicians, "as if primary care physicians are not performing as mental health providers themselves."

Story highlights

  • In a recent letter to CMS, the Academy voiced support for Medicare coverage for annual screenings for depression.
  • The Academy pointed out that family physicians screen, diagnose and treat patients with mental health disorders.
  • The majority of patients with mental health issues access the health care system through primary care physicians.
  • The AAFP also supports CMS' proposed annual alcohol screenings and its proposed retraction of certain Medicare signature requirements.

She also noted that the majority of patients with mental health issues "access the health care system through primary care physicians."

Moreover, said Heim, "The desire of patients to receive treatment from their primary care physicians, or at least to have their primary care physicians more involved in their care, has been repeatedly documented."

AAFP Hails CMS' Retraction of Medicare Signature Requirements

In a recent letter to CMS Administrator Donald Berwick, M.D.(2 page PDF), AAFP Board Chair Lori Heim, M.D., of Vass, N.C., commended the agency for re-evaluating its stance on Medicare signature requirements and for "acknowledging that the policy caused an inconvenient and disruptive administrative burden on physicians."

CMS adopted the signature requirements as part of the final 2011 Medicare physician fee schedule. The rule required the signature of a physician or a qualified nonphysician signature on "requisitions," as opposed to orders, for clinical diagnosis laboratory tests. CMS recently proposed another rule that would retract that requirement.

Last year, the Academy opposed implementation of the signature policy(38 page PDF), arguing that it would create "an excessive burden" for physicians. In her recent letter to Berwick on the topic, Heim said, "Through publication of this proposed rule, CMS is taking the first of, hopefully, many steps that acknowledge the need to modify or repeal burdensome regulations."

In a separate Aug. 18 letter to Berwick(2 page PDF), Heim voiced the Academy's support for CMS' proposal to begin coverage for Medicare beneficiaries for screening and behavioral counseling associated with alcohol misuse.

"Specifically, we support the proposal for annual alcohol screenings and, for (patients who) screen positive, up to four brief, face-to-face behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women," said Heim.

As outlined by CMS, counseling interventions would be appropriate for patients who

  • misuse alcohol but who do not meet the criteria for alcohol dependence and
  • display competence and alertness at the time counseling is provided.

Heim also noted that CMS has proposed that counseling be furnished by "qualified" primary care physicians or other primary care health professionals in a primary care setting, and she urged the agency to provide a clear definition of who would be considered qualified.

According to Heim, despite the fact that family physicians would face challenges in integrating the recommended interventions -- two 10- to 15-minute office visits -- into already busy daily practice schedules, they remain the clinicians best positioned to screen for alcohol use disorders.