President's Message

Member Survey Results Focus on Issues That Matter to You

October 24, 2018 09:00 am John Cullen, M.D.

Every year for more than two decades, the AAFP has surveyed members about the issues that matter most to family physicians, as well as their satisfaction with the Academy's work.  

John Cullen, M.D.

This year was the second time that every active member had a chance to weigh in on the Member Satisfaction Survey, and the results were clear: The highest priorities for our members are cutting administrative burden, improving payment and maintaining board certification -- concerns that are reflected in some of the biggest efforts the AAFP is focused on in 2018 and beyond.

Cutting Administrative Burden

For the second year in a row, nearly 60 percent of respondents named reducing administrative burden as one of the top priorities they want the AAFP to address. In fact, getting this problem fixed so FPs can spend more time with our patients is the Academy's No. 1 strategic priority.

So, what is the Academy doing? We're taking every chance we can to tell private payers, regulators, legislators and industry representatives why they must -- and how they can -- immediately reduce the pointless burdens that keep family physicians from the work that really matters: taking care of our patients.

For example, the AAFP is pressing payers to eliminate prior authorization requirements for generic medications, medications for chronic conditions that patients have been taking for more than one year, durable medical equipment, diabetic supplies and more. We have also advocated for an all-payer prior authorization system rather than the multiple systems we deal with now.

We're also going to keep explaining to all payers why they need to rescue the medical system from the hodgepodge of quality measurements that physicians currently have to navigate by adopting the Core Quality Measures Collaborative's single core measures set.  

And because so much of our unnecessary burden is rooted in electronic health records, the AAFP is working on educating the people who build these systems -- including artificial intelligence and machine learning engineers -- about what they can do to help physicians keep their focus on patient care. Just one idea: self-documenting systems with records created by patients and staff, and updated by a physician's voice and actions like ordering a prescription.

This is all work that builds on earlier and continuing Academy efforts.

In December 2017, the AAFP Board of Directors adopted the Academy's "Principles for Administrative Simplification." Crafted by family physicians serving on the AAFP's Commission on Quality and Practice, the document is the foundation of our advocacy work on these issues, covering prior authorization, quality measure harmonization, certification and documentation of medical services and supplies, and medical record documentation.

In February, AAFP Board members were on Capitol Hill to talk to senators, representatives and congressional staff about what they can do to change our health care system into one that better supports family medicine. In all, we had more than 40 meetings with legislators and staff from 15 states on the issues that most matter to family physicians, including administrative burden and physician payment.

AAFP Board members -- and more than 200 other Academy members -- were back on Capitol Hill in May during the Family Medicine Advocacy Summit to repeat those messages. The Academy spearheads this annual event, which includes updates from legislators, advocacy training and hundreds of visits with lawmakers and congressional staff on top member priorities.

Improving Payment

The Member Satisfaction Survey showed that increasing payment ranked second among member concerns, with more than a third of respondents citing it as a top priority.

The Academy has long argued that primary care must be paid better and differently than it has been in the fee-for-service system. Specifically, we are calling for payers to double their investment in primary care to 15 percent of total health care dollars. We regularly meet with private and public payers to explain how this change will actually save them money because it improves patient health.

The AAFP recently gave CMS a 92-page response to the 2019 Medicare physician fee schedule, recommending five major changes that would both increase payment and reduce administrative burden for family physicians. The changes, which range from simplifying documentation to eliminating out-of-pocket payments for chronic care, would turn the fee schedule into something that better reflects the importance of primary care.

The AAFP also has created new tools to make sure family physicians can secure maximum payment and give patients the best care under the Medicare Access and CHIP Reauthorization Act.

Maintaining Board Certification

Members consistently tell us that the American Board of Family Medicine's (ABFM's) continuing board certification process is a huge concern, so let's look at how the AAFP is pressing for the kind of fixes that family physicians need.

First, we're speaking out against the inappropriate -- but too common -- use of board certification as an absolute or sole requirement for credentialing, privileging, employment or payment by hospitals, health plans and medical boards.

At our recent Congress of Delegates, the ABFM announced a new pilot project of an alternative to its high-stakes 10-year certification exam. The announcement was a result of our consistent and intense discussions with the ABFM about the need for improvements and alternatives to the existing process for continuing certification.

We're also moving forward with a new policy on board certification developed by the Academy's Commission on Continuing Professional Development and drafting criteria to be used when evaluating a certifying board. The AAFP Board of Directors established a task force, which I had the privilege of chairing, to build on the work of the commission. The Board ultimately accepted the task force's recommendations this year, leading to new policies that guide our advocacy on making continuing certification relevant to family physicians.

The AAFP also provided comments to the American Board of Medical Specialties' (ABMS') Continuing Board Certification: Vision for the Future initiative and urged members to do the same. The initiative is intended to assess the state of certification systems, get feedback from stakeholders, identify key questions to be answered and deliver final recommendations for consideration by the ABMS and its member boards, including the ABFM.

I'm honored to have been elected to lead the AAFP as the Academy continues to make progress on these efforts and many others to ensure family physicians can stay focused on the vital work we do in our communities.