JUNE HAPPENINGS: SIGNIFICANT FOR SPECIALTY?

Paula Binder

doi:10.1370/afm.636

June 2006 could prove to have been a watershed month for family medicine because of a convergence of events that bode well for the specialty’s future. Many of the events were brought about by the AAFP’s hard work over time, said AAFP President Larry Fields, MD, of Ashland, Ky. The events:

CMS proposed changes that should significantly increase family physicians’ Medicare payments for evaluation and management services beginning in 2007. For example, said Fields, if a family physician sees 86 patients a week, codes two thirds of the visits 99213 and codes the other one third 99214, his or her income could rise about $30,000 a year. These proposed changes reflect recommendations made by the Relative Value Update Committee. The AAFP has a representative and an alternate representative on RUC, as well as an adviser to RUC. The committee’s recommendations speak volumes about the Academy’s influence through these individuals, Fields said.
The AMA House of Delegates called for an increase in the number of primary care physicians and a change in payment systems to “incentivize” such an increase. “Having AMA policy on our side may not sound all that sexy, but it’s hard to overemphasize how important it is,” said Fields. The Academy has intensified its efforts to influence the AMA through the AAFP delegation and other family physicians active in the AMA house—and it’s paying off, he said. As of now, there are family physicians on every major AMA council and on several other groups within the AMA, and that includes the new chair-elect of the AMA board.
The AMA house also decided that comprehensive health system reform should “be of the highest priority.” Because of policies it now has in place, the AMA should be working in concert with AAFP for reform that has a primary care base, payment incentives to attract medical students to primary care, and liability system changes to preserve access and drive down the cost of defensive medicine. “Changes in these 3 areas are imperative no matter what kind of system we end up with—multiple-payer, single-payer or something in between,” said Fields.
The Massachusetts Medical Society’s annual physician workforce study shows that primary care physicians are in short supply in that state, including a “severe” shortage of family physicians. “This acknowledges the strange paradox that the specialty most desired by people is in the shortest supply because academic health centers receive incentives to train and recruit subspecialists to get research dollars,” said Fields.
The Institute of Medicine reported that emergency departments are overwhelmed, in part because of patients’ lack of access to primary care services. Fields noted, “We can hope that this will prompt the American College of Emergency Physicians to join the Massachusetts Medical Society, AAFP and AMA in calling for the training of more FPs, and to support FPs continuing to do a broad scope of practice, including working in the emergency room.”
Annals of Family Medicine published a study showing that liability reforms other than caps didn’t make a dent in the cost of malpractice awards or premiums. Fields said it was gratifying to have an independent study confirm the conclusions reached last year by the AAFP Strike Force on Liability Reform, which he chaired. “It’s high time policy makers stopped trying to blow smoke in the eyes of the American people with voodoo about solving the liability crisis,” he said. “Instead, Congress should focus on legislating effective changes, such as caps on noneconomic damages and alternative dispute resolution, not on maintaining the earnings of trial lawyers.” There currently is a Senate bill that would establish pilot projects for just such tort changes, he noted.

“I believe these happenings in June raised the collective consciousness about the value of primary care, bolstered the prospects for family medicine and set the stage for real health care reform,” Fields said. “Everyone should keep the faith. We are not going to lie down, but rather we are going to keep the pressure on and continue the momentum toward a better health care system for us all.”