Bad tim­ing?

AAFP de­sire to boost pay­ment may face op­po­si­tion

Modern Healthcare - - Cover Story - An­dis Robeznieks

With a national fo­cus on chop­ping health­care spend­ing and a new study blam­ing physi­cian fees for the high cost of U.S. health­care, the Amer­i­can Academy of Fam­ily Physi­cians may have a tough time ad­vanc­ing its ef­fort to boost pay­ment for pri­mary care.

In an Aug. 29 let­ter to the CMS com­ment­ing on the pro­posed Medi­care physi­cian-fee sched­ule for 2012, the AAFP re­quested a more timely re­view of “mis­val­ued” pri­mary-care ser­vices and also pro­posed seek­ing pay­ment for tele­phone calls and online med­i­cal eval­u­a­tions.

The AAFP also re­cently launched a 22mem­ber task force to re­view and “more appropriately ap­praise” pri­mary-care ser­vices—par­tic­u­larly pa­tient eval­u­a­tion and man­age­ment. The Pri­mary Care Val­u­a­tion Task Force is seen as a coun­ter­bal­ance to the Amer­i­can Med­i­cal As­so­ci­a­tion’s Spe­cialty So­ci­ety Rel­a­tive Value Scale Up­date Com­mit­tee, also known as RUC, which gives pay­ment ad­vice to the CMS and which crit­ics say as­signs more value to pro­ce­dures per­formed by spe­cial­ists over “cog­ni­tive ser­vices” pro­vided by pri­mary-care physi­cians.

The AAFP sent a let­ter to RUC Chair­woman Dr. Bar­bara Levy rec­om­mend­ing sev­eral changes to the panel which, ac­cord­ing to the AAFP, were nec­es­sary in or­der for the RUC “to re­main a cred­i­ble en­tity” in its role as a CMS pay­ment ad­viser. These changes in­cluded elim­i­nat­ing three seats re­served for a ro­tat­ing set of sub­spe­cialty rep­re­sen­ta­tives; adding four seats for rep­re­sen­ta­tives from the AAFP, Amer­i­can Academy of Pe­di­atrics, Amer­i­can Col­lege of Physi­cians and Amer­i­can Os­teo­pathic As­so­ci­a­tion; adding three “ex­ter­nal” seats for rep­re­sen­ta­tion by con­sumers, em­ploy­ers, health sys­tems or health plans; and adding a seat for geri­atrics.

“There is an evolv­ing amount of data ap­pear­ing in the lit­er­a­ture that sug­gests the com­plex­ity of eval­u­a­tion and man­age­ment ser­vices pro­vided by pri­mary-care physi­cians to­day is dif­fer­ent and likely more ‘in­tense’ than the same ser­vices pro­vided by other spe­cial­ties,” Dr. Lori Heim, AAFP board chair­woman, wrote in the June 10 let­ter to Levy.

Chaired by Heim, the AAFP task force in­cludes rep­re­sen­ta­tives from the AAP, ACP, AOA, Cigna Health­care, the National Busi­ness Group on Health, and oth­ers. It held its first meet­ing Aug. 22.

Task force mem­bers “rec­og­nized that pri­mary care has been un­der­val­ued, that the pri­mary-care work­force de­pends on ap­pro­pri­ate pay­ment for their ser­vices, and that we’re fac­ing a cri­sis in the pri­mary-care work­force,” Heim said in a pre­pared state­ment af­ter the meet­ing. An AAFP rep­re­sen­ta­tive was not avail­able for com­ment.

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