President's Message

Fighting for Family Medicine Is More Important Than Ever

January 19, 2018 01:31 pm Michael Munger, M.D.

As we enter 2018, we face a remarkable and unpredictable time for our country, our patients and our profession. Lawmakers are weighing important decisions that impact access to health care for all Americans, while physicians are coping with more administrative burden than we've ever seen before.

Michael Munger, M.D.

The AAFP strives to provide value to its members by advancing our specialty, strengthening our collective voice, and providing solutions to enhance the care we give our patients. Now more than ever, it is critical that the AAFP meets your needs. To that end, I want to share some of the key issues the Academy plans to focus on in the new year.

Back in September, I shared results of the AAFP's Member Satisfaction Survey, including some of the top priorities members asked us to address. Two of those issues, increasing physician payment and reducing administrative burden, will factor into much of our work to fight for today's family physicians and help fill the family physician pipeline.

Payment Reform

The AAFP has developed and proposed an important alternative payment model for family medicine and primary care that includes risk-adjusted prospective monthly payments to cover evaluation and management visits, a separate risk-adjusted prospective monthly payment for care management services for non-face-to-face patient care and coordination, quarterly performance-based incentive payments, and fee-for-service payments as needed. In addition to enhancing overall payment, the upfront bundled monthly payments are expected to reduce claims-related administrative burden by eliminating the need for billing documentation requirements. Such alternative payment models also are important to another AAFP goal of increasing the overall annual spend on primary care -- which now stands at about 6 percent of total spend -- to as much as 15 percent.

Last month, the AAFP achieved a major success when a special CMS technical advisory committee recommended that HHS test the payment model, and we will be advocating that HHS accept that recommendation in the coming months.

In addition to our efforts to implement this alternative payment model, the AAFP is working to help prepare members for success in new payment models, including the Merit-based Incentive Payment System (MIPS). We have developed resources such as the MIPS Playbook, which is free for members and provides a step-by-step guide to MIPS participation. Also, educational supplements have been, and will continue to be, published in FPM (formerly Family Practice Management) to highlight specific aspects of the Quality Payment Program and explain how members can realize payment now and be successful in these new models going forward.

Shaping Legislation and Regulation

Administrative burdens, such as prior authorizations, not only are a source of great frustration, they reduce patients' ability to access our care in the current fee-for-service environment and adversely impact our practice margins and ability to deliver comprehensive care. The Academy meets regularly with regulators, legislators and public and private payers to discuss issues related to payment and administrative burden. This month, for example, I was on Capitol Hill with representatives from five other primary care organizations advocating on a wide range of issues that are important to our members' practices and patients. Representatives from the AAFP also attended a meeting with the Office of the National Coordinator for Health Information Technology to discuss issues related to electronic health records.

We'll also be keeping a close eye on two initiatives CMS launched late last year that are intended to reduce administrative burden.

Affordable Health Care for All

Another issue members asked us to prioritize in our 2017 survey was affordable health coverage for all. This remains consistent with AAFP policy first adopted in 1989. Coverage not only affects patient outcomes, it also impacts physician payment. Just before the end of the year, Congress included funding for the Children's Health Insurance Program (CHIP) in a short-term spending bill intended to keep the program going through March. The reality is that some states will run out of CHIP funding this month. Consistent with our policy, the AAFP will continue to fight for this vital program, which covers roughly 9 million children and must have stable, long-term support.

Protecting Physician Well-being

Regulatory and administrative burdens are also major contributors to physician burnout. Although the Academy is working on long-term strategies to address these issues, we also are developing tools to help provide more immediate relief. In September, the Academy launched its Physician Health First initiative. A web portal includes free resources to help physicians develop individual practices that address burnout and improve well-being, including content related to physician health, financial tools and practice tips. The site also offers free CME for members, as well as access to the Maslach Burnout Inventory.

New content is being added to the portal each month, and a well-being planner will launch in the spring before the Family Physician Health and Well-being Conference, which is scheduled for April 18-21 in Naples, Fla. That meeting will allow attendees to earn up to 18 AAFP Prescribed credits and develop an individualized plan to address their well-being.

The AAFP also is one of more than 50 organizations supporting the Action Collaborative on Clinician Well-Being and Resilience. The initiative, which was launched by the National Academy of Medicine, plans to introduce new resources this month.

Building the Future

While the AAFP is working on a myriad of fronts to help our members in daily practice, we also are working to build our specialty's pipeline for the future. The AAFP and other stakeholders are working on a new, long-term goal to increase student choice of family medicine to 25 percent of all U.S. medical graduates by 2030.

We will work toward that goal by

  • expanding the influence of the AAFP National Conference of Family Medicine Residents and Medical Students,
  • supporting family medicine interest groups to be active champions for family medicine,
  • working with medical school faculty and staff to better understand the most effective strategies to increase student choice, and
  • building relationships and new partners in pipeline workforce development to help strengthen pathways to family medicine for students from groups that are underrepresented in medicine.

Increasing student choice by itself will not be enough to address the projected shortage of primary care physicians. The Academy will continue to advocate for graduate medical education reform that leads to more residency slots for family medicine.

Spotlight on Health Equity

The Academy is committed to taking a leadership role in addressing diversity and social determinants of health and striving for health equity. The AAFP launched its Center for Diversity and Health Equity last year, and the center is working on many fronts to assist our members in their practices and communities in this important area by

  • raising awareness of the effect of social determinants of health and establishing best practices for screening;
  • developing strategies for coordinating with social services and behavioral health resources;
  • developing workflows that incorporate the primary care practice team;
  • advocating for initiatives that support relevant policy at the local, state and federal levels;
  • supporting CME; and
  • producing topic issue briefs to engage multisector stakeholders.

It's clear that the AAFP has important priorities in the coming year, which is a direct reflection of the vital importance of the work we do as family physicians. As I said, we live in remarkable times. Our membership, much like our country, has differing views on the current status of our health care system. But I assure you that the AAFP, its Board of Directors and its staff are constantly and passionately working on behalf of all our members and our specialty. We are committed to delivering results that create a better health care system based on foundational family medicine and primary care while ensuring it is a system that pays our members differently and better.

I am proud to serve as president for the AAFP in the coming year. I am also proud of our members and the work we do for our communities. But most importantly, I am proud of the common ground we share as family physicians. We are called to heal. We must fight to protect our ability to answer that call.