AAFP Strives to Stay Focused on Reform

BOSTON — Bolstering advocacy efforts to pass a health reform bill that's acceptable to family physicians and their patients was by far the leading item on the agenda at the annual Congress of Delegates of the American Academy of Family Physicians.

Having met twice with President Obama to discuss family medicine's role in health care reform, outgoing AAFP President Ted Epperly urged members to stay “laser focused” on the academy's role in shaping health reform policy. Yet he acknowledged that the AAFP was taking a “yes, if approach” in Washington in an attempt to balance some concessions against the need for better payment for primary care services.

For members of the academy, however, staying focused meant a variety of things.

At least a dozen members testified before the Reference Committee on Advocacy in favor of the AAFP lobbying on behalf of a single-payer system, but the resolution was rejected due to a consensus that “now was not the right time” to support an objective that clearly did not align with the current political situation, according to a statement from the committee.

At a town hall meeting held during the congress, Dr. Michael Baxter of West Reading, Pa., expressed disappointment at the shift from what he had hoped was going to be meaningful health care reform to what is now turning out to be health insurance reform.

“We all have had a bit of a reality wake up,” said incoming AAFP President Lori J. Heim. “Going forward, I think there is the expectation that [health reform] will be incremental changes. And that's why … we can't lose the faith. And we have also said that we are not going to walk away from a bill. There's a long way to go yet and so what we finally come up with is not going to be perfect. But I think that what we are seeing is that it really is moving us in the right direction for our patients.”

With a nod to the shortcomings of health reform in Massachusetts, where the Congress was being held, Dr. Epperly warned against the worsening shortage of primary care physicians if incentives are not put in place immediately to draw physicians into primary care.

But opinions about how to fix the payment system varied.

Significant debate erupted about a proposed resolution for the AAFP to disengage from the Relative Value Scale Update Committee (RUC), the body that advises the American Medical Association on the values that should be assigned to CPT codes. The RUC has long been perceived by many as setting unfair payment rates for primary care services.

Dr. John L. Bender of Wellington, Colo., testified in support of the resolution, saying that it was time to walk way from a table where family physicians were not getting fed.

Dr. Neil Brooks of Manchester, Conn., who spent 4 years representing AAFP on the RUC, noted that it would be “a serious error to withdraw from the RUC … because we need to participate even when we don't like the outcome.” While it “would feel emotionally great [to withdraw], what would happen is that someone else would take our place saying they are family medicine and they are not family medicine. We are family medicine, so we need to be there.”

Dr. Lee Mills, currently the AAFP alternate representative on the RUC, agreed. “I am all for grand gestures and it would be fun to throw a bomb. But there is no other means to assign values” for medical services, he said.

Furthermore, attempts to build a coalition with other medical groups to create an alterative means of setting values have not worked. “So if we walk away, we walk away alone,” he said.

In the end, the Reference Committee on Practice Enhancement rejected the resolution and instead opted to continue with a plan already set in motion to work directly with the Centers for Medicare and Medicaid Services to achieve higher reimbursement for primary care services. Given the political pressures to keep Medicare Part B spending budget neutral, “there are better uses of AAFP financial and political capital,” according to the committee's report.

Several clearly frustrated members protested the leadership's decision to enter into a consumer alliance with the Coca-Cola Co. During the town hall meeting, Dr. Heim explained that the AAFP needed to develop alternative revenue streams given a recent mandate to phase out pharmaceutical support.

Under a 1-year contract, the beverage company will pay AAFP a “strong six figure sum” to provide on its Web site (www.familydoctor.org) consumer-oriented, evidence-based education materials on sweetened, unsweetened, and artificially sweetened beverages, she explained. No specific brand names are supposed to appear on the site, and the AAFP will maintain 100% editorial control, Dr. Heim emphasized.

“I have had patients that got better when they quit drinking Dr. Pepper. … The evidence on this is clear and consistent. The single biggest contributor to the obesity epidemic is sugar-sweetened beverages,” said Dr. Robert Rauner, president of the Nebraska Academy of Family Physicians. The AAFP's “guilt by association could be a problem here,” he said. He and others expressed concern that the alliance could tarnish the academy's image at a time when the stakes of that image are at an all-time high given its pivotal role in pushing for an acceptable health care reform bill.

Dr. Heim urged members to take a wait-and-see approach and reserve judgment until the materials are up on the site.