National Conference of Constituency Leaders

2021 NCCL Tackles Telehealth, Coercive Employment Practices

May 12, 2021, 4:13 p.m. News Staff ― Family physicians from around the country weighed in on a wide range of issues important to family medicine during the 2021 National Conference of Constituency Leaders, held virtually April 29-May 1.

One of those measures highlighted multiple problems that have plagued widespread adoption of this technology to date, including

• inadequate or no access to broadband to support EHRs offering integrated telehealth functions in some areas,
• wide variations in telehealth platform features,
• lack of interconnectivity and interoperability between existing and new technology platforms,
• lack of standardized requirements for payer-agnostic claims submission, and
• a burgeoning number of vendors providing telehealth service with a range of pricing options.

Even as physicians have come to recognize the importance of telehealth technology in optimizing performance in payment reform models that utilize a team-based model of care, these obstacles have persisted to one degree or another, according to the resolution’s authors.

In light of these and other factors “inhibiting the success of telehealth” in some communities, the resolution asked the AAFP to “actively study the role of barriers in preventing telehealth from becoming a mainstay in the repertoire of family physician practice settings across diverse communities.”

In addition, it called for the Academy to collaborate with other entities to mitigate those factors and work toward achieving universal telehealth access in keeping with the overarching goal of providing health care for all.

Testimony was overwhelmingly in support of the resolution, and reference committee members put forward a slightly streamlined substitute measure, which delegates adopted without further discussion.

The second resolution focused on the need for telehealth education, asking the AAFP to “expand on existing telehealth education resources to develop continuing medical education courses on safe, effective, high-quality telehealth care.”

Again, participants strongly supported the measure, stressing the importance of providing physicians with CME that highlights telemedicine best practices. Testimony also cited the challenges involved in providing care to diverse communities that may lack safe, private spaces to access care or have limited broadband capabilities when it comes to offering video services.

After considering the testimony provided, along with the AAFP’s existing and planned CME activities on this topic, the reference committee offered a substitute resolution that called for the Academy to “continue to develop telehealth education resources and continuing medical education courses on safe, effective, high-quality telehealth care across diverse communities.” Delegates summarily adopted that substitute.

Coercive Contracting Practices

Noncompete clauses and other restrictive employment-related actions have long been hot-button issues among physicians, who have all too often found themselves on the short end of the stick when seeking to change their employment circumstances.

So when a multifaceted resolution addressing these issues came before the reference committee, participants threw their support behind it.

The resolution asked the AAFP to

• develop policy opposing forced arbitration clauses, class-action waivers, nondisclosure agreements and noncompete clauses, including for its own employees;
• survey organizations that wish to present at AAFP job fairs on whether they promote or adhere to such agreements and share the results with job fair attendees;
• advocate against arbitration clauses, class-action waivers and nondisclosure agreements and support legislation to end these practices at the state and federal level; and
• develop a position paper and guidelines for reasonable noncompete agreement expectations that will ensure “family physicians and their patients are not unduly burdened or left without proper medical care.”

In often impassioned testimony, hearing participants highlighted such problematic issues as role discrimination in employment contracts, damage caused by restrictive covenants and difficulties posed by arbitration clauses.

Reference committee members weighed those considerations, along with current policy and additional background Academy staff provided, as they assessed the feasibility of each of the four resolved clauses. Noting the emotional nature of the issue for many members, they stated that although part of the measure’s first resolved clause reflects current policy, that policy doesn’t go far enough. Therefore, they recommended adoption of the resolution in its entirety. Delegates unanimously agreed.

Other Actions

Delegates took the following actions on other measures considered by this reference committee:

• They adopted a substitute resolution asking the AAFP to urge CMS to accurately identify and track all billing health care professionals, including nonphysician practitioners, by specialty to foster accurate data collection.
• They adopted a resolution calling for the Academy to develop and disseminate criteria for evaluating practices based on their support of comprehensive family medicine practice, as well as to assign an AAFP commission to assess the feasibility of establishing a database to house information that practices enter about certain attributes so it can be easily accessed and reviewed by family physicians seeking to join those practices.
• To supplement previous Academy policy acknowledging the role of family physicians as primary care team leaders, they adopted a substitute measure that asked the AAFP to support standardization of nonphysician education and appropriate physician oversight of nonphysician practitioners.
• In an effort to minimize employment bias, they adopted a resolution calling on the Academy to advocate that the Society of Hospital Medicine recognize family medicine-trained hospitalists as equally qualified as their internal medicine counterparts.
• Finally, they reaffirmed as current policy a resolution asking the AAFP to “support the financial viability of solo practices struggling to compete with larger physician groups/hospitals through advocacy efforts, including but not limited to, equal reimbursement rates and streamlining prior authorization processes for solo practices with minimal bandwidth.”