DENVER – The federal Affordable Care Act was a win for family physicians, but there’s room for improvement.
That was the main message from officers at the annual Congress of Delegates of the American Academy of Family Physicians. They also pledged to continue advocating for family physicians as regulations to enact the law are drafted.
“We are into the regulatory phase, folks. The devil is in the details. We have restructured our D.C. office to focus on this phase,” Dr. Lori Heim, chair of the AAFP board of directors, told delegates.
Dr. Glen Stream, who was chosen as the academy’s president-elect at the meeting, said although the AAFP and other medical groups succeeded in getting provisions favorable to family physicians included in the law, he was “not na?ve enough to think the future is assured. We must continue our legislative advocacy.”
The law recognizes a central role for primary care in the nation’s health, and includes, among other measures, the following:
– A 10% Medicare bonus payment starting in 2011 for certain primary care services, enacted to attract medical students to the field;
– A 2-year experiment starting in 2013 that guarantees that Medicaid pays at least as much as Medicare for primary care services, including immunizations;
– Continuation of federal funding for family medicine residency programs; and
– Recognition and advancement of the patient-centered medical home (PCMH) concept.
Overall, the law “advances our agenda by leaps and bounds,” said academy president, Dr. Roland Goertz, but “it’s not perfect.”
The 10% bonus, for instance, doesn’t apply to enough family physicians, the officers said. At least 60% of Medicare billings must be for primary care services to qualify. The academy “will continue to ask legislators” to lower the threshold to 50% and expand qualifying services, according to a report released at the meeting.
In addition, the Affordable Care Act did not amend or replace the problematic sustainable growth rate formula that is used by the federal government to calculate Medicare reimbursements, and which has been a longstanding legislative priority for the AAFP and other physician groups.
It’s too early to tell how other, potentially problematic measures in the law will be resolved, including the provision for accountable care organizations (ACOs). Those regional organizations will be given lump sum payments to coordinate and streamline care of enrolled patients, with providers sharing in savings to the Medicare program.
The law allows providers to form such organizations and specifies adequate participation by primary care physicians. However, there is concern that antitrust laws may block family physician practices from organizing into ACOs.
Academy officers told delegates it is also possible that the hospital industry could dominate ACOs, which would exclude family physicians from positions of leadership and control.
Are ACOs “going to be based on primary care practitioners, or large hospitals and large hospital systems?” asked Dr. Heim. It’s “a debate at the state and national level. Larger systems are already poised to move into this arena and take it over.”
The academy said in the report that it will work to prevent that. However, as the Centers for Medicare and Medicaid Services work out the regulatory definitions of ACOs, it is difficult for the academy to give members guidance on how to proceed, AAFP officials noted.
The federal health reform act also encourages CMS to test patient-centered medical homes for “high-need” beneficiaries and allows pilot projects to expand if they improve care, save money, or both. The objective is to have one medical practice coordinate a patient’s care and offer health counseling, and other services that go beyond traditional problem-oriented visits.
Given the legislative encouragement, positive results from PCMH demonstration projects, and other factors, PCMHs are “an unavoidable future” for family physicians, Dr. Stream told delegates.
Even with federal money available to make the switch to electronic medical records, ramping up to offer PCMH services is prohibitively expensive for small or solo practices, some delegates cautioned – especially at a time when most payers aren’t covering the extra costs.
Several AAFP officers said they understood the concerns. With continued advocacy, however, they expect those costs eventually will be covered to some extent – and even before that happens, a move toward the PCMH model promises better patient care.
“Sometimes, you have to [act on] faith,” Dr. David Ellington, a board member, told concerned delegates.