Help for Solo, Small-Group Physician Practices, Hospital Privileging Among Topics Discussed at NCSC

April 30, 2013 03:45 pm Sheri Porter Kansas City, Mo. –

During a business session of the National Conference of Special Constituencies, Folashade Omale, M.D., a family medicine residency program director from Georgia, says the AAFP doesn't have the authority to require programs to change their names to include "family medicine" rather than "family practice."

At the 2013 National Conference of Special Constituencies (NCSC) held here April 25-27, AAFP members from five constituent groups -- women, minorities, new physicians, international medical graduates (IMGs) and physicians interested in gay, lesbian, bisexual and transgender (GLBT) issues -- adopted a number of resolutions put forth by the Reference Committees on Organization and Finance and Practice Enhancement, including a resolution related to creating a new special interest group to represent solo and small-practice physicians and a resolution on physician credentialing and hospital privileges.

Organization and Finance

In its report to NCSC delegates following participants' testimony on April 26, the Reference Committee on Organization and Finance recommended adoption of a substitute resolution to support solo and small, independent family physician practices. During the April 27 business session, NCSC delegates voted to ask the AAFP to form a new special interest group to represent those physicians and to ensure their concerns were considered.

story highlights

  • The AAFP held its annual National Conference of Special Constituencies last week, and delegates discussed a number of issues related to payment, scope of practice, and insurance.
  • In particular, the Reference Committee on Organization and Finance asked the AAFP to, among other things, support solo and small group practices and to provide data to assist employed physicians with contract negotiations.
  • NCSC delegates also adopted resolutions put forth by the Practice Enhancement Reference Committee that dealt with physician payment, patient benefits and protection of privileges.

During the reference committee hearing, minority delegate Tamaan Osbourne-Roberts, M.D., of Denver, said the issue was timely and relevant because of the current wave of physicians abandoning private practice for employed positions. "We are the people being bought right now," said Osbourne-Roberts. "As we move forward, we need to ensure that all practice environments still have a place at the table. This is an incredibly important thing for us to do."

Ilona Farr, M.D., of Anchorage, Alaska, representing the women's constituency, said she had been in private practice for 26 years. "I want to maintain my solo practice," she said.

The NCSC also concurred with the committee's recommendation to adopt a resolution that asks the AAFP to ensure consistent use of language about the specialty. Delegates asked the Academy to reaffirm its preference for use of the term "family medicine," rather than "family practice," an organizational shift officially made in 2003.

Delegates asked the AAFP to consider changing the name of the journal Family Practice Management to help avoid confusion and also added language during the NCSC's final business session urging family medicine residencies to change their programs' names -- if they hadn't done so already -- to include family medicine rather than family practice.

In addition, NCSC delegates asked the Academy to

  • help employed physicians during contract negotiations by collecting and analyzing compensation and productivity data,
  • encourage constituent chapters to include at least one resident in their NCSC delegation to serve as an observer, and
  • explore ways to meet the needs and concerns of members with physical and/or mental disabilities.

Patients and their physicians need to know when changes are made to insurance coverage because benefit changes can affect a patient's care," says Kimberly Austin, M.D., clarifying during an NCSC reference committee hearing a resolution she co-authored.

Practice Enhancement

The Reference Committee on Practice Enhancement grappled with a variety of resolutions on topics ranging from physician payment to patient Medicare benefits.

For example, during the final NCSC business session, delegates adopted a substitute resolution directing the AAFP to work with CMS on ways to streamline details of patients' insurance benefits. Delegates agreed on the need for coverage information that is "easily comprehended by the patient and is easily accessible to physicians."

Kimberly Austin, M.D., of Westerville, Ohio, a minority delegate, co-authored the resolution and defended it during the reference committee hearing. She said patients were overwhelmed by too much confusing information. "Patients often are coming to us asking what's covered, and then the insurer changes their coverage without letting us (the physicians) know," said Austin. Rather than receiving a book thick with coverage details, Austin said she'd prefer that CMS send "a piece of paper with changes specific to that patient."

IMG delegate Eltanya Patterson, M.D., of Martin, Tenn., is a hospitalist who works in numerous states. She testified that during the past year, some of her patients in Alabama "were not able to be seen for several weeks and had delays in getting medication" due to confusion about their insurance coverage.

Members Tweet ALF/NCSC Events

Many AAFP members who attended the 2013 Annual Leadership Forum/National Conference of Special Constituencies in Kansas City, Mo., April 25-27, were actively communicating with friends and colleagues from the conference via Twitter and other social media channels. To see a selection of member tweets for day 1(, day 2(, and day 3( of the conference, visit the AAFP's Storify collections.

NCSC delegates also agreed with a reference committee recommendation to adopt a resolution aimed at protecting family physician privileges by adding language to an existing AAFP privileging policy statement. Specifically, the NCSC asked the AAFP to add the following sentence to its policy: "Physician credentialing should allow for any and all combinations of competencies in adult, pediatric and obstetric care in both the inpatient and outpatient setting."

New physician delegate Kourtney Houle, M.D., of Sauk Rapids, Minn., co-authored the resolution. She took a turn at the microphone during the reference committee hearing. "This is about protecting our scope of practice and supporting any and all competencies," said Houle. "Family physicians should have the flexibility to choose the type of medicine they want to practice."

Ann Lee, D.O., of St. Cloud, Minn., also a women's delegate, agreed. "This resolution is really speaking to the recruitment and retention of new family physicians and giving them the ability to dictate their practice style in the future," she said in testimony.

"So a credentialing board can't say, 'You must be able to do 'X' in order to do 'Y,' as well,'" said Lee, adding that the resolution also would apply to physicians already in practice.

In addition, the reference committee recommended -- and the NCSC delegates agreed -- to reaffirm existing AAFP policy on hospitalist models of care. The AAFP's current policy encourages the American Hospital Association and the Society of Hospital Medicine to continue to support FPs as credentialed hospitalists.

IMG delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, Wash., spoke in favor of the resolution at the reference committee hearing. He noted his personal experience providing inpatient service in rural areas. Reflecting on anecdotal evidence from others in attendance who suggested an institutional bias against family physician applications for hospitalist positions, Brzezny said it was difficult to collect hard data on the topic.

"This issue has not been well studied," he said. "It's not just hospitalist medicine, but also (a tendency) across the board in other areas where we (FPs) have traditionally been effective in providing care and our privileging is restricted."

Erica Swegler, M.D., of Keller, Texas, speaking as an AAFP member, added another dimension to the issue. She noted that an increasing number of physicians have stepped away from hospital work and see patients strictly in the clinic setting. "That means that there is a lack of family physicians willing to step forward and serve on hospital committees making these decisions," she said.

The Reference Committee on Organization and Finance also reminded delegates that the AAFP encourages member feedback on topics of importance via comments to news stories posted in AAFP News Now, the Academy's online news source dedicated to family physicians.