NEW ORLEANS -- Equity, advocacy, and payment reform were key themes at the 2018 American Academy of Family Physicians (AAFP) Congress of Delegates meeting here on Monday.
"The belief that we are all worthy, we are all equal, we all count in the eyes of our laws, our leaders, our God, and our government," said AAFP Executive Vice President and CEO Douglas Henley, MD, pausing to stop his voice from breaking after quoting these remarks from the of Rep. Joe Kennedy III (D-Mass.).
"Our mission calls for us to speak out on these matters," Henley said.
He zeroed in specifically on the challenges faced by immigrant families: America is a nation "founded and nourished by immigrants," he said, but right now immigrants and their families are being left behind.
Henley may have been referring to the administration's "zero tolerance" policy on immigration, which led to thousands of children being separated from their parents. Or, he may have been thinking of a more recently proposed federal regulation that would deny green cards to some legal immigrants if they are judged to be overly dependent on public programs such as Medicaid and food stamps.
While our government "seems to be trying to back away" from decades-old civil rights protections, Henley urged family physicians not to forget their duty to serve all patients.
He called for "a new agenda," neither Democratic nor Republican, but one based on "decency and humanity."
Continuing in the vein of caring for all people, AAFP president Michael Munger, MD, a family physician in Overland Park, Kansas, stressed the academy's support for women and specifically for maintaining funding for Title X programs. Such programs remain a target of the Trump administration.
He also stressed the importance of preserving access to essential health benefits including maternity care, and contraception. (In May, the Department of Health and Human Services (HHS) to the Title X program, stating that recipients "may not perform, promote, refer for, or support, abortion as a method of family planning.")
"We must always fight to continue our ethical obligation to help our patients make choices consistent with good, sound medical practice," Munger said stressing that family physicians must also "always reject restrictions on information our patients receive from us."
Several healthcare groups have expressed concern over the possible return of a domestic "gag rule," which forbids providers who receive Title X funding from even talking about abortion or from making referrals.
In addition to advocating for these patient protections, Munger also seemed skeptical of the Trump administration's plans to overhaul evaluation and management (E/M) codes, calling the new approach "directionally appropriate but technically flawed."
Such a move has the potential to incentivize lower-acuity care and more frequent visits, Munger said.
"That is not patient-centric, that is not the work of 'comprehensivists,' and that is not moving us toward valued payments" he said.
While uncertain about coding changes, Munger appeared more hopeful about the prospects for alternative primary care models (APMs) for family physicians.
The AAFP submitted its own APM model to the Physician-focused Payment Model Technical Advisory Committee (P-TAC) last year, which was recommended to HHS in December 2017. The model has yet to be approved by HHS Secretary Alex Azar; however, he did show his support for transforming payments in the direction of primary care.
While Munger highlighted the importance of maintaining primary care-oriented principles, "we must be prepared to be flexible in the construct of that payment reform," he said.
While the final APM may not "resemble" the APM the AAFP introduced, its important that it have the same focus on care management and improved coordination, and that it endorse a "comprehensives" approach, he said.
Finally, almost all of the morning speeches before the Congress of Delegates highlighted the discrepancy in spending between primary care and other specialties -- currently, about six to eight cents of every healthcare dollar are spent in primary care.
The AAFP hopes to see that number double to 12% to 16%, Munger said.
Finally, John Cullen, MD, president-elect of the AAFP and a family physician in Valdez, Alaska, called on family physicians to help carry AAFP's message to Washington.
"Family medicine needs a louder voice," he said.
A research firm AAFP hired revealed that the Academy ranks second in terms of influence on Capitol Hill; Munger said he wants the academy to rank first.
To that end, the academy also recently engaged a public relations firm specifically to "control our message."
"All too often the solutions that are created for us are created without our input," Cullen said, citing electronic health records as one example where a lack of input to HHS led to negative consequences.
"The only answer is to be a part of the design team," he said.