Q&A With Brian Forrest, M.D.

FP Brings Family Medicine Perspective to NQF Committee

March 09, 2017 03:40 pm Sheri Porter

Is it your time to step up to the plate for family medicine? The AAFP is always looking for family physicians willing to lend their expertise to external committees and workgroups associated with regulatory agencies -- and even other specialties -- that may lack an understanding of family medicine, but whose decisions can have a big impact on physicians' day-to-day work of caring for patients.  

Brian Forrest M.D., shown here in his practice in Apex, N.C., divides his time between patient care and leadership responsibilities, such as serving on the National Quality Forum's Cardiovascular Standing Committee.

Brian Forrest, M.D., of Apex, N.C., is one family physician who answered the call. Nearly 11 months ago, he agreed to accept an appointment as the AAFP's representative to the National Quality Forum's (NQF) Cardiovascular Standing Committee(www.qualityforum.org).

This multistakeholder committee identifies, reviews and endorses new performance measures for accountability and quality improvement that address the area of cardiovascular care.

Forrest is the founder and president of his practice, Access Healthcare, P.A., and juggles leadership duties in a number of other organizations in addition to his NQF responsibilities.

In the following Q&A, AAFP News talks with Forrest about his experiences with the NQF committee and what he has learned during his tenure.

Q. What piqued your interest in this particular group?

A. I serve on the AAFP's Commission on Quality and Practice, and that's how I found out about this NQF standing committee. I've long had an interest in cardiovascular disease. I have a significant focus on hypertension, hyperlipidemia and diabetes in my practice, and I've done a lot of quality improvement projects and CME programs for other organizations on these topics. This was right up my alley.

Q. How much time do you devote to this committee work?

A. It takes time, but it comes in chunks. There may not be anything for several months, and then preparation for the standing committee meeting can range from 20 to 40 hours total. Committee members are assigned to one specific metric, and one or two committee members are responsible for doing all the homework on that measure -- looking at research, compiling evidence and determining the measure's validity.

The in-person meeting is one day, and that's in Washington, D.C. After that, it's mostly teleconference calls, three or four a year and each an hour long.

Q. Do you get paid for your participation?

A. No, I do not get paid. But my travel and hotel expenses are pretty much covered. And it's really just one day that I'm taken away from my practice.

Q. Why is this committee work worth the time you invest?

A. This group has a lot of impact. This is a voting committee, and how we vote on a measure -- to endorse or not endorse -- has a significant impact on family physicians' daily work no matter if they are in a rural practice or an urban clinic. What we do has a huge impact on the quality measures that dictate how family physicians will get paid.

AAFP Can Match FPs with Opportunities

Sandy Pogones, M.P.A., a certified professional in health care quality and the AAFP's senior strategist for health care quality, helps the Academy fill positions in outside organizations with family physician representatives.

She cited opportunities that frequently become available, including

  • CMS technical expert panels,
  • Physician Consortium for Performance Improvement measures development and
  • specialty society requests for family medicine participation in measures development.

Pogones has also fielded requests from the Agency for Healthcare Research and Quality, the National Committee for Quality Assurance and the National Patient Safety Foundation.

Contact Pogones by email to find the perfect opportunity!

Q. Why is it important to have family medicine representation?

A. The committee is mostly cardiologists and other cardiac specialists. There are two family physicians and one pediatrician. So it's important that somebody with a family physician perspective be there to represent the specialty. There were numerous occasions where if we had not spoken up, the final outcome would have been cardiology and tertiary-care driven, and that wouldn't have been a true representation for those measures, especially the outpatient measures.

Q. Can you give me an example of a quality measure that your group debated where your input and family medicine background swayed the final outcome?

A. There was a smoking measure and it was just based on an outright percentage of your patient population. And I said, "That's going to be pretty unfair to physicians in North Carolina, because in New York, you guys may only have a 10 percent smoking rate, and you may not do near as much smoking cessation counseling. But in North Carolina, I'm talking to people about smoking every time I see them because as many as 30 percent of the people there have smoked at some point in their lives. You can't penalize family physicians just because of where they practice."

That's why it's really important for somebody in the specialty to stay on top of this kind of thing, because if we don't, some unintended consequence might occur if a measure like that sneaks by.

Q. Has there been anything about this experience that surprised you?

A. I'll be real candid. When our commission at the AAFP asked for somebody to be nominated for this, I was a little skeptical. I thought it was going to be a committee where people sit around and talk, and nothing gets done. But I thought maybe it would be interesting since it's cardiovascular and I would learn something from an academic standpoint.

But it turns out that having a family physician on this committee is really important. Because we endorse measures or we don't endorse measures -- and if a measure is endorsed, then it can be used as a carrot or a stick in terms of measuring a family physician's quality of care and determining how they're going to get paid under MACRA (the Medicare Access and CHIP Reauthorization Act). This is going to have a huge impact on practices' finances as value-based payment is implemented.

Q. You are well known as a champion of direct primary care (DPC). Why are quality measures of interest to a DPC physician who doesn't have to file insurance or worry about value-based payment models?

A. You're right, I am first and foremost a DPC family physician. But I have to take off my DPC hat every once in a while and just represent family physicians. And I know what my colleagues are dealing with, and I understand the impact that some of these financial changes are going to have on their practices.

The bottom line is that quality matters for everybody, including DPC practices. We all want to have data to prove that our quality is as good as we say it is.

Q. Why should your family physician colleagues look for opportunities -- and accept appointments if offered -- to work on groups like this?

A. If you don't want other people to pick the criteria for judging your payment, then get out there and be the one making the decisions about what those quality measures look like. Sit down at the table and share your input.

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