Work to support family medicine in new health care reform environment is just beginning

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By Roland Goertz, M.D., M.B.A.
AAFP President, 2010-2011

Passage of the Patient Protection and Affordable Care Act—commonly known as the Affordable Care Act, or simply PPACA—was an important step toward establishing primary care as the foundation of America’s health care system. The law will have a far-reaching impact on family medicine as the nation begins to rebalance our health care system with more appropriate emphasis on primary care. Once fully implemented, it will focus more on health care and place a greater emphasis on prevention, primary care, and improved health outcomes instead of a predominately sickness care model which has focused on paying for procedures and volume.

The final vote and the signing of the PPACA was a first step. Now the task is implementation. And this is where the real work—and the real debate—begin Since its passage, the AAFP has focused on filling in the holes in the Affordable Care Act, preserving its primary care-friendly provisions, and ensuring support for primary care education that will help increase the number of future family physicians.

The effort has come on several fronts. Your AAFP has worked aggressively with the Centers for Medicare and Medicaid Services, the new Health and Human Services Office of Consumer Information and Insurance Oversight, the Government Accountability Office, Federal Trade Commission, Food and Drug Administration, and several other federal agencies to ensure that regulations support the PPACA’s intent to rebuild our system on primary medical care and the primary care physician workforce.

We are working with Congress and the administration to preserve the modestly increased payment for evaluation and management codes that resulted from the elimination of consultation codes and are pushing for more. We successfully moved to expand the number of family physicians who qualify for Medicare’s 10 percent incentive payment for primary care services. And we continue to focus our efforts on a significant issue that the PPACA does not address—a permanent solution to the flawed Medicare physician payment formula.

Early PPACA insurance reforms concentrated on patient protections against such practices as rescinding policies when patients become ill, denying coverage to children due to pre-existing conditions, and placing caps on annual or lifetime benefits.

Now, policymakers in several federal agencies are focusing attention on accountable care organization regulations, and officials are consulting with your AAFP leadership to develop them. For example, in a recent meeting with AAFP Board Chair Lori Heim, M.D., President elect Glen Stream, M.D., and me, the recently-appointed Richard Gilfillan, M.D., acting director of the CMS Center for Medicare and Medicaid Innovation—and also a family physician— turned to the AAFP for information on the cost efficiencies derived from the primary care patient-centered medical home. While Dr. Gilfillan understands the importance of PCMH as the most effective model for improving patient care and ensuring care coordination, he seeks further information on the model’s cost-effectiveness as the new CMMI develops new innovative payment programs.

Through meetings and correspondence with CMS Administrator Donald Berwick, M.D., we have made progress toward federal understanding that the AMA/Special Society Relative Value Scale Update Committee, commonly referred to as the RUC, should be augmented with an evidence review panel that includes employers and consumers who help identify whether medical services are valued appropriately.

At the same time, we have continued our strong advocacy efforts on Capitol Hill. We continue to take specific messages to key members of the U.S. House and Senate, successfully reducing the reporting requirements for primary care charges from 60 percent to 50 percent in order to qualify more family physicians for Medicare’s 10-percent primary care incentive payment. We also want Congress to maintain existing policy that eliminated consultation codes and, most importantly, permanently address the flawed Medicare physician payment system.

As a result of our meetings and communications with them, every member of Congress has been contacted about the need to stabilize Medicare physician payments and pass legislation to adequately pay for primary care services. They are turning to your AAFP for input into how we can affect these changes without increasing the federal deficit.

Our ultimate success depends on your continued participation with AAFP grassroots messages and with the 112th Congress. As members of the 112th Congress take their oath of office and settle in, we’ll continue to work proactively to ensure that family medicine is supported in all regulations.

This article was first published in the winter 2011 issue of California Family Physician, a quarterly publication of the California Academy of Family Physicians.

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