SupportingtheReal BusinessofFamilyMedicine

R. Shawn Martin AAFP Chief Executive Officer

Supporting the Real Business of Family Medicine

The business of family medicine, at its While we work to strengthen FFS payments in the core, is helping patients prevent disease, short run, we recognize FFS is incapable of supporting maintain their health and live fulfilling the primary care system that our health care system lives. To accomplish this, family physicians needs and that patients deserve in the long run. engage in a variety of activities that range from Primary care is comprehensive, continuous, holistic, caring for and treating patients when they are portable, and patient-centered. FFS is, by design, the sick, partnering with patients to achieve their complete opposite. It is focused on units of care, units health goals and working closely with families and of time, and sites of service. Family medicine has caregivers to ensure that everyone is supporting the politely whispered for years that FFS was an illogical health outcomes of the patient. The value of family paymentconstructforprimarycare, and the COVID-19 medicine has been articulated by researchers, but pandemic has put a giant spotlight on this issue. true first contact, comprehensive, continuous and Prospective payment changes that. Individuals coordinated primary care is without peer when it within the commercial health insurance sector comes to driving health outcomes and the efficient have told us that capitated primary care practices use of resources. have coped better and more effectively with the

Family physicians must rely on a payment system pandemic. Imagine if every family physician had had that supports their pursuit of these core functions. an attributed panel of patients and an associated “No margin, no mission,” as we say in the non-profit prospective payment for each when the crisis sector, also applies to the practice offamilymedicine. hit. Transformation from office-based to virtual Without appropriate payment structures, the health workflows would have been easier and quicker. care mission of family physicians becomes more When units of care and units of time no longer get difficult to achieve. measured, providing care to patients becomes the

The American Academy of Family Physicians focal point. And, when providing care to patients is (AAFP) understands how important payment is to the the focal point, family medicine wins. business of family medicine. In fact, one of our strategic The concept of prospective payments is not objectives is to support and sustain comprehensive new. The AAFP has advocated adopting this type familymedicine practices byadvocatingformodels of of payment model for years and, in 2018, we payment reform that result in greater investment in developed the Advanced Primary Care Alternative family medicine. We do that by achieving enhanced Payment Model. Our model is the foundation of the payment of primary care services in today’s fee-forPrimary Care First model that CMS will implement service (FFS) world while laying the groundwork for in 2021. We also have advocated for other global/ better models ofprimary care payment in the future. prospective value-based payment models, such as

For most family physicians, payment remains an FFS direct contracting, physician-led accountable care proposition, with office visits being the service they organizations, and direct primary care arrangements. provide most often. Medicare’s payment allowances And, we’re not stopping there. The AAFP is working and the relative value units underlyingthem drive the on a payment strategy, “Vision 2025,” to support fees paid for family physicians’ services. Recognizing continuous, comprehensive, and coordinated that, in 2019, the AAFP participated in a survey of primary care into the future. the physician work and practice expenses typically To achieve the vision of sustainable, associated with office visits. As a result of that effort, comprehensive family medicine practices, we must the Centers for Medicare & Medicaid Services (CMS) fundamentally change the way in which our health plans to increase the relative value of office visits care system pays for primary care. While increased in 2021. Consequently, CMS estimates that family FFS resources help ensure family medicine’s survival physicians will experience a 12% increase in their in the short term, financing must shift away from Medicare allowed charges in 2021. To the extent the FFS system designed for last century’s care to a commercial health insurers and other public payers flexible, prospective, value-based model for the 21st use the Medicare rates and relative values to set century. When that happens, the AAFP will be a long their own fees, we expect family physicians will see way toward achieving one of its strategic objectives, an increase in payment for office visits from multiple and family medicine practices will be in a better payers in 2021, which will support and sustain family position to do the real business offamily medicine. medicine practices.