2014 NCSC Delegates Debate Issues Vital to Physicians, Patients

Medical Practice, Advocacy Topics Take Center Stage

May 07, 2014 01:45 pm Sheri Porter Kansas City, Mo. –

AAFP members representing five constituency groups gathered here May 1-3 to write, debate and vote on a number of resolutions related to physician practice issues, as well as social issues that affect the health of patients.

Regarding insurance company preauthorization requests and formulary changes, new physician delegate Jessica Triche, M.D., of Bath, N.C., tells colleagues, "We need a unified front; we should flood these companies with faxes."

Members of those constituencies -- women, minorities, new physicians, international medical graduates (IMGs), and physicians who self-identify as gay, lesbian, bisexual or transgender (GLBT) or who support GLBT issues -- as well as some members simply representing themselves discussed a number of issues introduced during hearings of the Reference Committee on Practice Enhancement and Reference Committee on Advocacy on May 2.

Practice Enhancement

Testimony before the Reference Committee on Practice Enhancement covered issues ranging from patient access to care to durable medical equipment to support of part-time physician practice.

For example, a resolution that sought to increase Medicaid recipients' access to physicians brought many to the mic. Resolution co-author Tess Garcia, M.D., of Grain Valley, Mo., and a delegate from the GLBT constituency, said she was frustrated to learn the Patient Protection and Affordable Care Act (ACA) added millions of patients with higher incomes to the Medicaid rolls "but did nothing to increase the number of physicians who accept Medicaid."

Story highlights
  • National Conference of Special Constituencies delegates gathered in Kansas City, Mo., last week to write, debate and vote on a number of resolutions related to medical practice and patient health.
  • The Reference Committee on Practice Enhancement heard testimony on a variety of issues ranging from patient access to care to durable medical equipment to support of part-time physician practice.
  • The Reference Committee on Advocacy also wrestled with various resolutions ranging from male contraception to employment nondiscrimination.

Susan Osborne, D.O., of Floyd, Va., also a GLBT delegate, testified that she was having difficulty securing "needed care, not elective care" for her patients.

Ultimately, the NCSC delegates adopted an amended resolution asking the Academy to advocate at the federal level for permanent Medicaid-Medicare payment parity and for incentive programs to encourage all physicians to participate in Medicaid; the delegates also asked for additional resources to support state chapters in their efforts in this regard.

Delegates also adopted a resolution asking the AAFP to educate members about a "confidential communications provision" of the Health Insurance Portability and Accountability Act (HIPAA) aimed at protecting endangered patients, including minors, spouses and victims of domestic violence.

According to testimony from Alan Schwartzstein, M.D., a general registrant from Oregon, Wis., and a co-author of the resolution, a provision of the HIPAA privacy act allows patients to submit a confidential request form requesting that the explanation of benefits form go to an alternative location rather than to the address of the policy holder.

Delegates agreed that the little-known provision had particular implications for the health of teens. GLBT delegate Ravi Grivois-Shah, M.D., of Oak Park, Ill., testified that in his former position as lead physician of a high-school-based health center, he had difficulty finding legal and confidential services for his young patients. "I just found out about this HIPAA provision; this would be helpful and important to our members," he said.

On the topic of dealing with insurers, new physician delegate Jessica Triche, M.D., of Bath, N.C., generated a lot of enthusiasm during the hearing when she testified about her own particular method of dealing with the multitude of faxes and letters she receives from insurance companies about formulary changes and requests for prior authorization.

Triche explained how she created a template letter to allow her to quickly respond to what she sees as an administrative burden that is detrimental to the health of her patients.

"Every time I am forced to make a medication change because I received one of your letters, it puts a patient's health at risk," reads a portion of the letter that Triche shared with AAFP News. She said in an interview after the hearing that she had faxed the letter to insurers 15 times in the past few weeks and experienced a quick and patient-positive resolution each and every time.

NCSC delegates also asked the Academy to, among other things,

  • support family physicians who practice medicine on a part-time basis,
  • work with CMS to find ways to reduce inappropriate and wasteful distribution of durable medical equipment, and
  • engage with appropriate stakeholders to "further the creation of robust interoperability between electronic health record companies across the nation."


Members of the Reference Committee on Advocacy wrestled with a variety of resolutions that ranged from male contraception to employment non-discrimination.

International medical graduate constituency delegate Mary Moon, M.D., of Minneapolis, testifies about a resolution on the relationship between patient experience surveys and physician quality metrics, saying, "Don't let other industries dictate how we practice medicine."

The committee heard passionate testimony about the difficulties family physicians face in their attempts to meet the federal government's meaningful use criteria for electronic health records (EHRs).

"I'm one of those overwhelmed doctors from the hinterland," said Mary Anne Curtiss, M.D., of Cincinnati, who testified as a general registrant. "I had no choice but to use the computer system my employer chose for me. And every time new meaningful use guidelines come out, we docs in the trenches are faced with the fact that there are new glitches involved," she said.

Ultimately, NCSC delegates voted to adopt a resolution that directs the AAFP to "strongly encourage" the Office of the National Coordinator of Health Information Technology to consider a more "incremental approach" to implementation of future meaningful use criteria.

One of the unintended consequences of the ACA was another issue raised during the reference committee hearing. John Cullen, M.D., of Valdez, Alaska, speaking on behalf of himself, said the resolution he co-authored addresses the need for local family physician practices to be included in state and federal health care exchanges.

"The lowest-cost plans are the most popular, and insurance companies are taking advantage of this and creating networks where physicians are not even close to where patients live," said Cullen. "This is a really big issue and is creating a barrier to care."

Karen Smith, M.D., of Raeford, N.C., a women's constituency delegate, pointed out that physicians want to see patients accountable for their own health. "But anything that creates a barrier and lessens access to care interferes with accountability," she said.

Karen Smith, M.D., of Raeford, N.C., a women's constituency delegate, speaks about meaningful use, saying that family physicians need to "communicate with members of our own community to let them know that the AAFP is proactively working to slow down the process so as to achieve success."

In the end, delegates adopted a substitute resolution that asks the Academy to advocate for the inclusion of local FP practices in state and federal health care exchange networks.

Access to naloxone also generated spirited discussion during the reference committee hearing and again during the May 3 general business session, with delegates eventually adopting a substitute resolution on use of the drug.

Specifically, the resolution asks the AAFP to support programs that allow first-responders and nonmedical personnel to possess and administer naloxone in emergency situations and to support policies that allow licensed health care professionals to prescribe naloxone in all forms to patients who use opioids or to other individuals in close contact with such patients.

Arthur Ohannessian, M.D., a new physician and general registrant from Santa Monica, Calif., testified that, as prescribers, physicians play a role in the increased use of long-acting opioids. "We need to take action on this public health policy," he said.

NCSC delegates also asked the AAFP to, among other things,

  •  support efforts to create legislation that would prohibit a rapist's ability to sue for visitation rights or custody of any offspring conceived through rape,
  • work with the U.S. Preventive Services Task Force and AAFP state chapters to ensure that male contraceptive services are covered as preventive care services in accordance with the ACA,
  • create a comprehensive policy statement on employment nondiscrimination, and
  • lobby for public policy guaranteeing paid parental leave for a minimum of eight weeks.