The Teaching Health Center Graduate Medical Education program has increased the number of primary care physicians who train to care for underserved populations since the concept was introduced as part of the Patient Protection and Affordable Care Act in 2011. And although physicians who train in teaching health centers are more likely to continue working in safety net clinics than residents who don't train in such centers, funding for the program is in peril.
AAFP Board Chair Wanda Filer, M.D., M.B.A., answers a question from an Academy member during a Town Hall meeting at the AAFP Leadership Conference along with (from left) EVP and CEO Douglas Henley, M.D.; President-elect Michael Munger, M.D., and President John Meigs, M.D.
Congress extended funding for two years as a provision of the Medicare Access and CHIP Reauthorization Act (MACRA), but without congressional action, that extension will expire on Sept. 30.
"They are hearing from us on a regular basis," Academy President John Meigs, M.D., of Centreville, Ala., said of legislators on April 28 during a packed Town Hall meeting at the AAFP Leadership Conference -- the combined Annual Chapter Leader Forum and National Conference of Constituency Leaders. "Teaching health centers are one of our top priorities. We need a stable funding source, not just a two-year extension to fund a three-year residency. That's 'government-think'; that isn't thinking."
Funding for teaching health centers will be one of the primary "asks" when hundreds of family physicians visit Capitol Hill as part of the Family Medicine Advocacy Summit May 22-23.
- Academy officers discussed advocacy, administrative burden and other issues important to family physicians at a Town Hall meeting at the AAFP Leadership Conference.
- President John Meigs, M.D., said funding for teaching health centers will be a major focus at the upcoming Family Medicine Advocacy Summit.
- Physicians heard about a wealth of resources that the Academy offers to help members succeed under the Medicare Access and CHIP Reauthorization Act.
Meigs and other AAFP officers addressed this and several other critical issues during the wide-ranging, hourlong Town Hall.
Meigs urged members to participate in the Academy's latest Speak Out campaign, which addresses flaws in the latest proposed version of the American Health Care Act (AHCA). The Speak Out platform allows family physicians to contact their legislators using prewritten letters that can be edited and personalized.
Pushback from the AAFP and other physician and patient organizations in March helped force legislators to delay a vote on an earlier version of the AHCA, which the Congressional Budget Office said would have caused millions of Americans to lose health insurance. Legislators need to hear from physicians again, Meigs said.
"It only takes a few minutes," he said.
Jenny Butler, M.D., of Osceola, Iowa, president of the Iowa AFP, asked how the AAFP can balance representation of a diverse group of family physicians who have differing political views.
Meigs reiterated his message that the AAFP's priorities haven't changed.
"We will continue to work with whoever is in power," he said. "We might have to tailor our message, but health care for all has been Academy policy since the 1980s."
AAFP Board Chair Wanda Filer, M.D., M.B.A., of York, Pa., addressed two issues related to administrative burden, or "administrivia."
The Core Quality Measures Collaborative -- a group that includes the AAFP -- released core measures sets aimed at harmonizing quality measurement for seven select areas of medical practice last year. The measures were created with input from CMS and America's Health Insurance Plans (AHIP). Payers participating in the collaborative represent about 70 percent of the combined population of health plan enrollees and fee-for-service Medicare beneficiaries in the country.
Zita Magloire, M.D., of Cairo, Ga., asks a question about the Medicare Access and CHIP Reauthorization Act during the AAFP Leadership Conference Town Hall.
Filer said family physicians who are negotiating new contracts with payers should insist that those standardized measures be used.
"If they hear it from every family physician, they'll get the message," Filer said. "If they pretend like they don't know what it is, tell them to go back to their own house -- which is AHIP -- and use it."
The AAFP also was part of a coalition that recently released 21 principles aimed at reforming prior authorization. The average medical practice completes more than three dozen prior authorization requests per week, per physician, according to the AMA.
"Unfortunately, we probably will never get away from prior authorizations completely," Filer said, "but we at least need standardization to decrease workload and reduce disruptions that take us away from the care of our patients."
President-elect Michael Munger, M.D., of Overland Park, Kan., said increased student interest in family medicine is reflected in the Academy's growing student membership (currently more than 30,000 individuals), but he added that it's time to seal the deal with a higher Match rate.
Although there are many factors involved in student specialty choice, one that is especially important is mentoring. Munger said preceptors with a broad scope of practice make students more likely to pick the specialty. He encouraged members in such practices to connect with their local medical schools and help expose students to the breadth of family medicine.
The AAFP recently launched the Center for Diversity and Health Equity, an initiative that will focus on addressing the social aspects of health care.
Academy CEO and EVP Douglas Henley, M.D., said the AAFP needed to take a leadership role on social issues that affect patients. That, he said, includes encouraging medical schools to accept more diverse classes that reflect the diversity of our country, which would lead to better health outcomes.
During a Q&A session, Sterling Ransone, M.D., of Deltaville, Va., asked how family physicians can stay up to date on the latest information about MACRA.
The Academy has a wealth of MACRA-related resources, and Filer said members should familiarize themselves with the law and its requirements.
"When we go out to state chapter meetings and ask people if they know about MACRA, the silence is a little bit scary," she said.
In a session immediately following the Town Hall, Shawn Martin, AAFP senior vice president of advocacy, practice advancement and policy, said the Academy is working to inform members about MACRA and its requirements while also advocating in Washington to address the law's shortcomings.
Amy Mullins, M.D., AAFP medical director for quality improvement, said the most important thing family physicians can do this year regarding MACRA is to "pick your pace." At the lower end of that pick your pace scale, physicians can avoid a negative payment adjustment in 2019 merely by submitting data for one quality measure or one improvement activity.
"There's no reason for anyone to get a negative adjustment in 2019," Mullins said.
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