ALBANY, N.Y. — The New York State Academy of Family Physicians' Congress of Delegates last month staked out positions on managed care reform and a range of controversial topics in medicine, including abortion and access to emergency contraception.
The Congress of Delegates also voiced frustration over the numerous administrative requirements from managed care companies and the lack of reimbursement for those tasks.
“We feel that we're kind of drowning here,” said Raymond Ebarb, M.D., of West Sayville.
The delegates voted that the state academy should partner with other state medical societies to lobby the government to encourage health insurance carriers to compensate family physicians for all work they perform for patients.
The delegates cited referrals to specialists, processing appeals for patients who have been declined coverage, preauthorization for pharmaceuticals, and diagnostic tests as examples.
They also voted to ask the American Academy of Family Physicians to advocate for the same relief at the federal level.
Paul Salizberg, M.D., who practices in Callicoon, said that he spends 1–2 hours a day on paperwork and he even had to hire more staff to keep up with the requirements from insurers. “We're not getting reimbursed for this,” he said.
Lawmakers need to at least be made aware of the problem, Dr. Ebarb said, so that they can put pressure on payers to make changes.
The delegates also called for the creation of a confidential national clearinghouse for collection of information regarding undesirable practices by health care insurers in an effort to identify trends and support the development of effective policy.
And the delegates voted to support the establishment of a formal advocacy process to support any family physician who is threatened with the restriction of his or her practice, reduction in compensation, termination, or exclusion from a health care organization. The state academy will present these ideas to the AAFP's national Congress of Delegates this fall in San Francisco.
“We desperately need some intervention and some support,” said Linda Prine, M.D., of New York City.
The state academy also went on record opposing measures that interfere with the prompt dispensing of emergency contraception. The delegates voted to recommend that the state academy collaborate with pharmacists to eliminate barriers to prompt access to all types of contraceptives.
And the delegates voted to refer the issue to the AAFP congress for national action.
Emefre Udo, M.D., of Brooklyn, said she introduced the resolution because of news reports that pharmacists across the country had refused to dispense both emergency contraception and birth control.
The delegates also debated scope of practice and residency training issues related to abortion.
There was widespread agreement among the delegates to recommend that New York family medicine residencies provide residents with annual up-to-date lectures in evidence-based contraception and pregnancy options counseling.
However, there was extensive debate prior to the vote to approve a resolution recommending that family medicine residencies make available, when possible, abortion training for those residents desiring it.
“The residents want this education,” said Dr. Prine.
However, she said, most residency programs don't have an existing arrangement with another program that allows residents to get abortion training off site. In fact, residents often go through a lot of barriers to get abortion training, Dr. Udo said.
Supporters also pointed out the resolution was a recommendation only, not a requirement that programs include abortion training. But opponents said the recommendation would not be received well within the state's many Catholic teaching hospitals.
Philip Kaplan, M.D., of Manlius, said the resolution would only serve to make enemies out of institutions opposed to abortion. “It will change nothing in a tangible way. We will simply raise a flag of divisiveness.”
The delegates also staked a claim that reproductive health care, including abortions, is part of the scope of practice in family medicine.
The group voted to ask the AAFP to encourage state chapters to work with local professional liability insurers and regulators for fair rates for family physicians who provide contraceptive care, maternity care, medical and early aspiration termination of pregnancy care, and other services.
They also urged the AAFP to encourage state chapters to work with local payers to ensure fair and equitable reimbursement for these services.
The resolutions are needed, according to Dr. Prine, because some liability insurers are charging prohibitively high premiums for family physicians who perform abortions or refusing to provide coverage for those procedures. “This continues to plague us,” she said.