Supporting the Real Business of Family Medicine
T
R. Shawn Martin AAFP Chief Executive Officer
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he business of family medicine, at its core, is helping patients prevent disease, maintain their health and live fulfilling lives. To accomplish this, family physicians engage in a variety of activities that range from caring for and treating patients when they are sick, partnering with patients to achieve their health goals and working closely with families and caregivers to ensure that everyone is supporting the health outcomes of the patient. The value of family medicine has been articulated by researchers, but true first contact, comprehensive, continuous and coordinated primary care is without peer when it comes to driving health outcomes and the efficient use of resources. Family physicians must rely on a payment system that supports their pursuit of these core functions. “No margin, no mission,” as we say in the non-profit sector, also applies to the practice of family medicine. Without appropriate payment structures, the health care mission of family physicians becomes more difficult to achieve. The American Academy of Family Physicians (AAFP) understands how important payment is to the business of family medicine. In fact, one of our strategic objectives is to support and sustain comprehensive family medicine practices by advocating for models of payment reform that result in greater investment in family medicine. We do that by achieving enhanced payment of primary care services in today’s fee-forservice (FFS) world while laying the groundwork for better models of primary care payment in the future. For most family physicians, payment remains an FFS proposition, with office visits being the service they provide most often. Medicare’s payment allowances and the relative value units underlying them drive the fees paid for family physicians’ services. Recognizing that, in 2019, the AAFP participated in a survey of the physician work and practice expenses typically associated with office visits. As a result of that effort, the Centers for Medicare & Medicaid Services (CMS) plans to increase the relative value of office visits in 2021. Consequently, CMS estimates that family physicians will experience a 12% increase in their Medicare allowed charges in 2021. To the extent commercial health insurers and other public payers use the Medicare rates and relative values to set their own fees, we expect family physicians will see an increase in payment for office visits from multiple payers in 2021, which will support and sustain family medicine practices.
MISSOURI FAMILY PHYSICIAN July - September 2020
While we work to strengthen FFS payments in the short run, we recognize FFS is incapable of supporting the primary care system that our health care system needs and that patients deserve in the long run. Primary care is comprehensive, continuous, holistic, portable, and patient-centered. FFS is, by design, the complete opposite. It is focused on units of care, units of time, and sites of service. Family medicine has politely whispered for years that FFS was an illogical payment construct for primary care, and the COVID-19 pandemic has put a giant spotlight on this issue. Prospective payment changes that. Individuals within the commercial health insurance sector have told us that capitated primary care practices have coped better and more effectively with the pandemic. Imagine if every family physician had had an attributed panel of patients and an associated prospective payment for each when the crisis hit. Transformation from office-based to virtual workflows would have been easier and quicker. When units of care and units of time no longer get measured, providing care to patients becomes the focal point. And, when providing care to patients is the focal point, family medicine wins. The concept of prospective payments is not new. The AAFP has advocated adopting this type of payment model for years and, in 2018, we developed the Advanced Primary Care Alternative Payment Model. Our model is the foundation of the Primary Care First model that CMS will implement in 2021. We also have advocated for other global/ prospective value-based payment models, such as direct contracting, physician-led accountable care organizations, and direct primary care arrangements. And, we’re not stopping there. The AAFP is working on a payment strategy, “Vision 2025,” to support continuous, comprehensive, and coordinated primary care into the future. To achieve the vision of sustainable, comprehensive family medicine practices, we must fundamentally change the way in which our health care system pays for primary care. While increased FFS resources help ensure family medicine’s survival in the short term, financing must shift away from the FFS system designed for last century’s care to a flexible, prospective, value-based model for the 21st century. When that happens, the AAFP will be a long way toward achieving one of its strategic objectives, and family medicine practices will be in a better position to do the real business of family medicine.
