State Advocacy Efforts on Menu at AAFP Town Hall

Academy Ready to Respond to Chapters' Requests for National Support

April 30, 2013 04:40 pm David Mitchell Kansas City, Mo. –

Cathleen London, M.D., a women's constituency delegate from New York, asks for the Academy's help in state legislative issues that concern women's health during an April 26 Town Hall meeting at the Annual Leadership Forum and National Conference of Special Constituencies.

The AAFP is willing and able to help family physicians advocate on state-level issues, but it cannot get involved without a request from a constituent chapter. That clarification was made multiple times during a Town Hall meeting at the Annual Leadership Forum and National Conference of Special Constituencies here on April 26.

"We don't swoop into state issues on our own even with the best of intentions," said AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash. "You need to reach out and see how we can work together." The reason, Stream said, is that efforts by the Academy and its constituent chapters need to be coordinated.

For example, according to AAFP President Jeff Cain, M.D., of Denver, when the Florida AFP was lobbying against a bill that infringed on a physician's ability in that state to counsel patients about gun safety, the chapter asked the AAFP to not make a statement on the pending legislation.

When the bill passed, the AAFP, after a request from the Florida AFP, agreed to join a friend-of-the-court brief in a lawsuit seeking to overturn the law.

story highlights

  • AAFP leaders clarified during a recent Town Hall meeting that the Academy does not get involved in state-level advocacy efforts unless help is requested by the state chapter.
  • Recent examples of the Academy responding to such requests include a scope-of-practice issue in Illinois and efforts to stop privatization of a successful Medicaid program in North Carolina.
  • Other issues discussed during the Town Hall were graduate medical education, ICD-10 implementation, member segments, and evaluation and management codes.

In recent weeks, the Academy has responded to requests for help from two other state chapters: in Illinois, the Academy sent a letter to legislators objecting to efforts by psychologists in that state who are seeking authority to write prescriptions for psychotropic medications, and the AAFP recently wrote a letter in support of efforts to preserve the successful Community Care of North Carolina program. Governor Pat McCrory has announced intentions to privatize the Medicaid program.

The conversation about state-level lobbying was prompted, in part, by a question from Cathleen London, M.D., a women's constituency delegate from New York. The week before ALF/NCSC, governors in Kansas and North Dakota signed into law bills that put new restrictions on women's access to health care.

London asked what the Academy is doing about it. "Women want to know, where are we on this?" she said. "Where are the docs?"

AAFP leaders reiterated that constituent chapters need to make a specific request for help on state issues. "We are there for you," Stream said, "but you need to ask."

Members also asked AAFP leaders about graduate medical education cuts, including cuts in President Obama's 2014 budget proposal. Stream said the Academy already spoke out against potential cuts that would jeopardize family medicine residencies.

In response to questions on ICD-10, leaders noted that CMS has delayed implementation of ICD-10-CM code sets for outpatient diagnosis coding several times. The new code set will increase by nearly fivefold the number of diagnosis codes available to health care professionals.


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.

The AAFP has opposed ICD-10 since the transition was originally proposed in 2008, but Stream cautioned members that another delay is highly unlikely. "Have no doubt," he said, "it will not be pushed out further. The AAFP is committed to assisting our members in this transition."

According to Cain, employed physicians now account for more than 60 percent of the Academy's membership, and that number is projected to be above 70 percent within the next five years.

Stream said that trend has left solo and small practice physicians feeling underrepresented by the AAFP. A member task force is expected to report to the Board of Directors early next year on ways to "broadly improve the voice of various member segments" and offer a "comprehensive strategy for segments that feel underrepresented and to address their unique needs."

Cain also said Academy leaders and staff will continue to meet with the nation's largest payers. The Academy recently met with representatives from Cigna, and meetings are scheduled with WellPoint, Humana and Aetna in the next four months.

Stream pointed out that the Academy recently sent a letter to CMS recommending that the agency create new evaluation and management codes exclusively for primary care physicians.

"There's an emerging body of evidence that our work is different than other specialties," Stream said. "The work we do is inherently more intense and more complex. Payment needs to reflect that."