After several years of effort, the AAFP and other primary care specialty groups scored a huge win at the 2008 interim meeting of the AMA House of Delegates when the delegates agreed to support the Academy’s vision of the patient-centered medical home, or PCMH.
During the meeting, AMA delegates adopted, intact, the “Joint Principles of the Patient-Centered Medical Home,” a document that was developed by the AAFP, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.
The 7 joint principles describe characteristics of the PCMH, including the following:
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Coordination of care to enhance the patient-physician relationship
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A focus on quality and safety
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Enhanced access to care
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A payment structure that recognizes the value of and pays physicians appropriately for coordinated services and care management
According to AAFP President Ted Epperly, MD, of Boise, Idaho, the adoption of the principles is “historic” for the Academy because it “brings on board the AMA’s support of the joint principles as a health care delivery system that’s rooted deeply in primary care for the people of America.”
During testimony at a reference committee hearing, Epperly said that the principles exemplify “comprehensive patient-centered health care with deep trusting relationships with a patient’s personal physician and his or her practice in which care is integrated, coordinated and focused on the whole person.”
“Multiple state, national and international studies have demonstrated that this care will increase the value of health care by increasing quality and lowering cost,” Epperly noted.
Dale Moquist, MD, of Houston, Texas, chair of the Academy’s delegation to the AMA, said that the delegates’ action indicates “where the house of medicine is going to be” on this issue. “When we’re testifying about health system reform and the benefits of the PCMH, the AMA can be right beside us,” he said.
In all, the delegates acted on several resolutions related to the medical home. One amendment the delegates added was referred to the Board of Trustees for further study. That amendment calls on the AMA, working with all interested specialty societies, to continue to study the PCMH concept, with particular emphasis on ensuring the following:
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The value-added services of the medical home are fully funded by financing mechanisms outside the Medicare Part B physician payment pool, including from private insurance, Medicare Parts A and D, and Medicaid
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Patient access to necessary quality specialty care without a gatekeeper is preserved
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Patients can select any qualified physician practice as their medical home
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The house of medicine is unified on this issue
PRIMARY CARE TRAINING
The AMA House of Delegates also voted to support several measures designed to encourage physicians and physicians-in-training to choose careers in primary care. The measures included calls to enhance payment for primary care physician services and decrease debt loads.
The AMA agreed to advocate creation of various programs to encourage physicians to practice in underserved areas, including the permanent reauthorization and expansion of the Conrad State 30 J-1 visa waiver program.
“We feel we won a trifecta,” said Moquist. “We got the adoption of the patient-centered medical home. We got the adoption of the (AMA Council on Medical Education report recommendations on) primary care as a medical career choice. And we got the actions to promote physicians to practice in underserved areas,” he said, referring to another CME council report.
BARRIERS TO PRIMARY CARE
Noting that patients’ access to care is “negatively impacted” by a shortage and maldistribution of primary care physicians, the medical education council report on barriers to primary care directs the AMA, in collaboration with primary care specialty organizations, to advocate the adoption of recommendations from the AMA/Specialty Society Relative Value Scale Update Committee that address payment for evaluation and management, or E/M, services and coverage of services related to care coordination. The report also directs the AMA to work to ensure that private payers recognize the value of E/M services.
The delegates directed the AMA to study matters related to new models of providing primary care services, such as the medical home. Topics for study include the following:
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The impact of these models on primary care physicians’ work-life balance and satisfaction
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The growth and expansion of new models in the public and private sectors
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The availability of expanded public- and private-sector funding at national and local levels to support implementation of new models
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The impact of these models on primary care physician compensation
Furthermore, said the delegates, the AMA should support existing programs and advocate the establishment of new programs that decrease the debt load of physicians who choose primary care.
- © 2009 Annals of Family Medicine, Inc.
