• 2021 Congress of Delegates

    Delegates Take On Access, Cost Issues and Physician Payment

    February 16, 2022, 9:42 a.m. News Staff —  The 2021 Congress of Delegates has already made history by conducting much of its business during two virtual sessions held months apart — first electing or choosing by acclamation AAFP officers and directors in September, and last month considering proposed policy updates.  

    physicians looking at tablet

    Yet, more work remains, with multiple resolutions singled out for further discussion slated to be considered during the next in-person COD. But for now, AAFP members have had their say — and delegates have cast their votes — on numerous topics important to family physicians and their patients.

    In written testimony submitted to the Reference Committee on Practice Enhancement between Jan. 7 and Jan. 14 and real-time testimony submitted during the virtual hearing of the committee on Jan. 22-23, members addressed topics ranging from working to limit patients’ out-of-pocket insulin costs to facilitating employed family physicians’ ability to negotiate with hospital/health care systems that fail to pass along payment increases intended for them.

    Here’s a rundown of what delegates decided on several of the resolutions voted on to date.

    Reducing Care Restrictions and Cost

    Citing the fact that 44% of all individuals living with HIV hail from Southern states, despite only 37% of the total U.S. population residing in those states, the Georgia AFP introduced a resolution calling for the AAFP to advocate passage of legislation to boost funding for preexposure prophylaxis, with the goal of covering the cost of medications and recommended laboratory monitoring and clinical care for uninsured people. The measure also asked the Academy to press for the elimination of prior authorizations for FDA-approved PrEP options, as well as to encourage adoption of standardized practice workflows designed to improve the PrEP prescribing experience and increase the likelihood that family physicians will adopt this therapeutic option. Delegates reaffirmed this resolution as current policy.

    Story Highlights

    Turning their attention to patients’ treatment costs, delegates also acted on a resolution from the Hawaii chapter that sought the AAFP’s support in advocating that private insurers and Medicare limit patients’ out-of-pocket insulin costs. This measure also was reaffirmed as current Academy policy, with testimony pointing to the Academy’s ongoing advocacy efforts to address the high prices and out-of-pocket costs of medications, including insulin.

    Delegates adopted a measure the Missouri AFP introduced that directed the AAFP to advocate that public and private insurers cover the costs patients pay for self-measured blood pressure monitoring units, as well as those for associated clinical support services. The alternative to using these devices, the resolution noted, “is 24-hour ambulatory blood pressure monitoring, an intervention that is costly, variably available and causes discomfort and sleep disruption for patients, with 67% reporting being awakened from sleep.” Testimony offered during the virtual reference committee hearing pointed out that similar devices, such as blood glucose monitors, are already covered by insurance.

    Bolstering management of chronic diseases such as obesity and diabetes was the primary focus of a resolution from the Oregon chapter that sought to increase use of medical nutrition services. Because these services are covered by public and private insurers only in limited circumstances, members who testified expressed hope that integrating nutrition services into primary care, as has been done with behavioral health services, would improve patients’ health outcomes.

    In light of testimony that language in the original resolution calling for the AAFP to “initiate communication with the Academy of Nutrition and Dietetics to pursue a workgroup focusing on improving nutrition services” seemed overly narrow, reference committee members offered modified wording. Ultimately, delegates adopted a substitute measure that asked the AAFP to work with “appropriate organizations to pursue a workgroup focusing on improving nutrition services and payment for them in primary care,” as well as to advocate that medical nutrition treatment be integrated into Medicaid payment systems and offered in Health Resources & Services Administration health centers.

    Strengthening Access to Care Services

    Another pair of resolutions delegates took up aimed to safeguard patients’ ability to receive care services from a primary care physician where and when they need them.

    In response to recent attempts by the Department of Veterans Affairs to create national practice standards for VA clinicians that would preempt state laws and expand nonphysician health professionals’ scope of practice, a measure introduced by the Illinois chapter urged the AAFP to communicate to policymakers its long-standing policy on the critical need for team-based care led by a physician to prevent erosion of care provided in rural health clinics. Delegates adopted the measure as written.

    The New York State AFP introduced the other resolution dealing with access to care, which asked the Academy to “advocate for and support public policy and public investment to achieve universal broadband access or other technologies that would deliver equivalent results in increasing and improving internet connectivity.” Although the resolution’s authors acknowledged progress the organization has already made toward this goal, the COVID-19 pandemic has made clear the urgent need to expand those efforts to achieve universal coverage.

    In adopting a substitute version of the resolution, delegates rejected a second resolved clause seeking to have the AAFP identify “private, state government or federal government funding programs to help localities, individuals and medical practices access or improve use of broadband internet services,” agreeing with testimony calling it out of scope and overly burdensome to implement.

    Ensuring Fair Payment for Physicians

    A gap in current value-based payment practices prompted the New Jersey chapter to introduce a resolution calling for the Academy to advocate enactment of legislation and/or regulatory policy requiring that value-based programs supplement data submitted by medical practices with claims data when tabulating completion rates for quality metrics required in value-based contracts.

    Patient completion of preventive cancer screenings, for example, is routinely used as a value-based metric in primary care, according to the resolution’s authors. If proof that these screenings have been completed isn’t documented in a patient’s medical record because results aren’t reported back to the primary care practice, however, the practice can incur penalties. Although most health plans already gather such claims data, requiring plans to acquire and utilize data from all available sources to document completion of value-based program quality metrics would help close the gap. Delegates signaled their agreement by adopting the resolution.

    Finally, a resolution from the Georgia AFP took direct aim at a payment issue involving employed physicians that the AAFP has already begun to address.

    The original resolution included three resolved clauses that urged the Academy to

    • develop “legal assistance/tips/tools” to help employed family physicians negotiate with hospital systems that are not passing along payment increases based on updates to the relative values of certain evaluation and management services included in the 2021 Medicare physician fee schedule;
    • seek more transparency from these hospital systems regarding payment of their employed physicians; and
    • direct its delegation to the AMA House of Delegates to bring these issues to the attention of the AMA, along with a call for coordinated national and state advocacy by the AMA.

    Based on concerns expressed in testimony on the measure, the reference committee suggested substitute language to remove the specific reference to “legal assistance” included in the first resolved. Given the number of hospitals and health systems that employ family physicians, committee members also thought it prudent to revise the scope of the second resolved clause by asking the AAFP to “explore advocacy opportunities” regarding health systems’ payment of the family physicians they employ. Delegates adopted that substitute resolution.