AAFP Leaders Take Family Medicine's Message to Capitol Hill

To be heard on Capitol Hill, it helps to be seen -- especially when it comes to health policy. So AAFP leaders came here this week to make the case for support of family physicians directly to legislators and their staffs.

Members of the AAFP Board of Directors met with several lawmakers to discuss frustration with the meaningful use program, proposed changes in Medicare payment, the integration of mental health in primary care and other issues important to family physicians. The meetings came as Congress prepares to allocate federal funds for the next budget cycle.

In a meeting with House Minority Whip Steny Hoyer, D-Md., Academy leaders emphasized the importance of delaying implementation of meaningful use stage three. They expanded on earlier arguments from the AAFP and other medical associations that the program should be reworked to align with the final rules of the Medicare Access and CHIP Reauthorization Act. Implementation of stage three should pause to allow time for essential improvements of electronic health record (EHR) systems, the Academy has said.

"We gave him concrete examples of how EHRs are not beneficial for patient care," said AAFP President Wanda Filer, M.D., M.B.A., of York, Pa. "We explained how it can be difficult to get pertinent information from the records. Just checking boxes for meaningful use requirements is not advancing patient care. He seemed receptive to our concerns."

AAFP Board Chair Robert Wergin, M.D., of Milford, Neb.; President-elect John Meigs Jr., M.D., of Brent, Ala.; and EVP and CEO Douglas Henley, M.D., also carried the Academy's message to Washington.

Earlier this year, Wergin spoke at a Senate in a hearing in which he also told legislators about problems with EHRs, as well as his own troubles with meaningful use requirements.

"They understand the burdens involved with EHRs and how disruptive they are to workflow," he said of legislators.

Wergin explained to Hoyer the burden of "work after clinic" -- the administrative work that physicians must complete after they have cared for their last patient of the day. It might help insurers, he said, but it has little or no connection with patient care.

Wergin also told Hoyer that the movement toward value-based Medicare payments must remain focused on physicians who actually provide primary care. He warned that many subspecialists will seek increased payment for providing "primary care services" even if that constitutes only a small percentage of their practice. He explained the difference between those subspecialists and physicians who are trained in primary care.

"Just because you do some primary care doesn't mean you are a primary care physician," Wergin said. "I do some neurology, but I'm not a neurologist."

Academy leaders also made the case for reimbursement for mental health services. Filer pointed out that although primary care physicians care for a significant number of patients with behavioral health needs, they cannot bill for primary care and behavioral health services on the same day.

"He and other officials we talked to were surprised by that," she said. "We need to get that fixed."

AAFP leaders also pressed for continued funding for the Agency for Healthcare Research and Quality (AHRQ), as well as teaching health centers and other programs supported by the Health Resources and Services Administration. The House did not include funding for AHRQ in its budget proposal for the upcoming year.

Primary Care Caucus Grows

Also on Capitol Hill, Board members met with two House members who last month inaugurated the Primary Care Caucus. Academy leaders thanked Reps. David Rouzer, R-N.C., and Joe Courtney, D-Conn., for their efforts and discussed next steps for the caucus.

The caucus now has 14 members, and Courtney sent a letter to his colleagues in Congress this week asking them to join. He explained that the caucus will educate legislators and the public about the importance of primary care to the health system.

"Our hope is that the Primary Care Caucus will transcend politics to focus on a positive path forward for patients, providers and our health care system that will finally achieve the triple aim of higher quality, lower cost and better outcomes," Courtney wrote.

He told AAFP leaders that he plans to help organize several events each year to explain the value of primary care. AAFP members can help, he said, by contacting their representatives in Congress and encouraging them to join the caucus. The Academy has created a tool to help members do just that.

Courtney also thanked AAFP leaders for engaging students and residents in advocacy efforts, saying they have an important role to play in shaping the future of public health policy.

"He told us that there are a lot of caucuses that are just 'window dressing,' so he wants this one to have a real impact," Filer said.