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This appeared today in the AAFP members-only section of the AAFP web site, so I'm posting it here as an FYI.
If you're a student interested in family medicine, you should already be a member. If you're not...JOIN!
If you're a student interested in family medicine, you should already be a member. If you're not...JOIN!
An Intensely Focused AAFP -- Plus You -- Can Unleash Immense Power
By Ted Epperly, M.D.
10/22/2008
What will the AAFP endeavor to accomplish in the tumultuous year ahead? I'm excited about the answer to this question and want to share it with every Academy member via this, my first president's column in AAFP News Now.
For the next 12 months, the AAFP will be laser-focused on a set of just four strategic objectives -- all of them immensely important for you and the patients who rely on you.
No more can the Academy be accused of trying to be "all things to all people"! For 2007-08, we had seven strategic objectives. For the coming year, your Board of Directors took a hard look at those seven objectives, reduced them to the most critical three, and added a fourth to maintain a connection with the soul of family medicine. Then we established metrics that will allow us to measure our progress toward achieving the objectives and to alter course quickly if we're veering off. I was honored to lead the team that honed the 2008-09 strategic objectives, and I'm certain they're effective tools for moving family medicine forward through these rapidly changing times.
I want to acquaint you with the four strategic objectives, in order of importance. You'll find they're very synergistic, in that progress on one objective -- especially the first -- often will boost progress on another. And then I'll tell you about our trump card -- our secret ingredient for success.
Strategic Objective 1: ADVOCACY -- shape health care policy through interactions with government, the public, business and the health care industry. The Academy will speak out forcefully on the patient-centered medical home, payment reform, workforce reform, medical student interest and health care for all. This high-octane advocacy effort is priority one, and it is key in our fight for progress on the other objectives.
Regarding advocating payment reform, you already know how bad it is financially for many family physicians. Indeed, you yourself might be a family doctor who's going broke in primary care. Perhaps you've had to limit the number of Medicare, Medicaid or uninsured patients you serve in the struggle to keep your office open. This simply can't continue! The catch is that advocating better payment for ourselves is difficult to do without appearing self-serving. What makes it even trickier is that there won't be "new money" available, so funds will need to be shunted away from overpaid specialists to underpaid primary care docs.
How do we handle this challenge? For one thing, we reframe "the ask" around the added value that comes with the patient-centered medical home, or PCMH. In the blended payment system we're proposing, we're asking that fee-for-service continue for face-to-face time with the patient. But we're also asking for a care-management fee for work that is not face-to-face and that, to date, hasn't been paid for, such as coordinating care; dealing with lab results; and providing referrals, telephone calls and e-mails. We're also proposing that quality incentives be built into the system. As things stand now, the system pays you to see a patient, no matter what the outcome. Quality incentives would pay you more for process measures (e.g., HbA1cs ordered, influenza vaccines given) and for outcome measures for every patient who reaches targeted goals for conditions such as hypertension and diabetes.
It also helps immensely that we're not the only ones calling for better payment for ourselves. For example, the Patient-Centered Primary Care Collaborative, or PCPCC, our powerful ally, has as its mantra the medical home and payment reform to go with it. A recent PCPCC survey brought good news when it found that Americans' support for the presidential candidates' health care plans surged when the PCMH model is included.
Strategic Objective 2: PRACTICE ENHANCEMENT -- enhance members' abilities to fulfill their practice and career goals. It's clear that the medical home concept is making headway with Americans. Now, family physicians have to deliver on the concept by transforming their practices into medical homes. Some are already there, but many have a long way to go. That's why this strategic objective comes next in our priority order. This objective means the Academy will pull out all the stops to help you make the changes necessary to earn the medical home designation and to help you achieve financial success through optimal practice management.
Regarding the synergy between strategic objectives, here's a good example. As you know, becoming a medical home requires investment in health information technology, something many practices can barely afford because of their thin margins. But as AAFP makes progress on priority one -- advocating issues, including payment reform -- family medicine practices eventually will get enough sustenance to afford the investment in health IT. Before that happens, however, you may need to make a leap of faith financially to ramp up for the future so you can be paid better for your quality work and become a PCMH. Look at this as an investment for the future for you and your patients..
Strategic Objective 3: EDUCATION -- promote high-quality, innovative education for physicians, residents and medical students that encompasses the art, science, evidence and socioeconomics of family medicine. The future requires it. If we don't have a strong family physician workforce and a pipeline filled with medical students who plan to enter the specialty, there will be no health system based on primary care.
I believe many students enter medical school wanting to serve their communities by becoming family doctors. Unfortunately, they get this desire beat out of them during medical school. They don't see family medicine get the recognition and respect it deserves. They encounter negative role models. And then their suffocating student loan debt, coupled with insufficient pay for family doctors, often extinguishes their last glimmer of interest in the specialty.
To turn this around, the Academy will pursue increased funding for the specialty in the undergraduate, graduate and continuing medical education spheres. Robust funding will give students an enriched family medicine experience in medical school and residency training, and it will ensure CME that will help FPs change their practices into evidence-based, state-of-the-art medical homes.
Strategic Objective 4: HEALTH OF THE PUBLIC -- assume a leadership role in health promotion, disease prevention and chronic disease management. We already play a prominent role in chronic disease management -- just think of how often you diagnose a chronic disease and how often you manage the care of patients struggling with more than one of these conditions. But preventing these diseases and promoting healthy lifestyles in our communities is just as important. Many of us went into family medicine because we wanted to care for the community as well as for individuals, and this specialty gives us the broad skill set we need to impact community health. Indeed, part of the magic and soul of our specialty is serving the greater good. This strategic objective is our way of staying connected to that soul.
The Academy will strive to get family doctors involved in targeted public health activities designed to help Americans reduce tobacco use and obesity and increase exercise and immunizations. We also will campaign to increase awareness and use of the Academy's consumer Web site, familydoctor.org. Just recently, I took a patient there to learn more about her health condition, but many members don't realize what a gem of a resource they have at their fingertips.
And now, here's the trump card I mentioned at the start of this message -- our secret ingredient for success. Guess what? It's you!
That's because as a family doctor, you have a unique ability to relate with people, from your patients and community leaders to your state and federal legislators. When it comes to success on our strategic objectives, especially the critical first objective on advocacy, that effort must take root locally and grow to succeed.
Last July, we had a tantalizing taste of the power of this grass-roots involvement. Then, the Academy's effort to block the 10.6 percent Medicare pay cut succeeded in large part because members inundated the Senate with their opinions, maxing out voice mailboxes and clogging e-mailboxes with more e-mails than Senate staffers could answer. The Senate was rocked back on its heels by our fervor -- and that was with the involvement of fewer than 10,000 AAFP members.
Can you imagine what it would be like if every one of the Academy's 60,800 active members took up the advocacy challenge or participated in public health activities?
We family physicians are powerful beyond our own imagining. All we have to do to unleash that power is to stand up and speak out. Will you play your part?
I look forward to working with you all during the course of this important year ahead, and you will hear more from me in the coming months. Keep the spirit. Keep the faith. I cannot possibly tell you just how important you are to your patients, your communities and our country. Let's work together to fix this broken health care system!
