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The AAFP and Payment Reform — They’re Screwing It Up, Again, Part 3 – Stuff I Agree With

February 18, 2017

Sorry for the delay in posts. My day job and another side project have taken up a lot of my time recently. Onward and upward.

From the AAFP Principles to Support Patient-Centered Alternative Payment Models (APMs):

Principle #1: APMs Must Provide Longitudinal, Comprehensive Care

The principle is fine. The devil is in the details. The statement about comprehensive care reminds me of the “basket of services” listed in the Future of Family Medicine report in 2004. This basket was the most important part of that document, but it received the least attention over the next 10 years. I’m afraid comprehensive care will suffer the same fate.

Principle #2 (edited by me): APMs Must Improve Access

Improving access is an important goal. How will access improve? There are 2 important ways: 1) put more family physicians into the U.S. healthcare system and 2) pay family physicians for alternative forms of communication and care such as telephone visits, text messages, and email exchanges. Point 2 will ultimately require Medicare to change its rules. To enable point 1), the payment system for family physicians needs a disruptive change in the status quo. The PC work around pushed by the AAFP and others is to promote mid-levels and “team-based care” as the solution. They are not the solution.

Principle #4: APMs Should Promote Evidence-Based Care

I’m a huge fan of evidence-based medicine, as long as everyone recognizes its limitations. The biggest limitation is that many of the questions family physicians ask in their daily practice do not have good research to answer them. Family physicians have no large non-profit research funding organization or National Institutes of Health Institute that funds family medicine research (though there are national institutes of Social Work, Nursing, Aging, and Alternative and Complementary Medicine).

OK, that’s it. Back to the criticisms in the next post.

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