AAFP President Urges Cooperation in Seeking Payment Increases for Primary Care PhysiciansBy James Arvantes
2/4/2009
A recent editorial by AMA Board of Trustees Chair Joseph Heyman, M.D., has led AAFP President Ted Epperly, M.D., of Boise, Idaho, to emphasize the importance of the AMA working with primary care physicians to ensure they are fairly and adequately paid for the services they provide to patients with Medicare coverage.
Heyman's editorial, which was posted Jan. 26 to American Medical News online and published in the Feb. 2 print version of the publication,
urges payment increases for primary care physicians, but he emphasizes that the
AMA would not support such increases if it means there would be corresponding reductions in subspecialists' payments.
"Payments to primary care physicians must increase," said Heyman, an OB-Gyn. However, he added, the AMA "absolutely opposes applying budget-neutrality rules that confine offsets to the physician payment pool."
"Congress should not rob Dr. Peter, the surgeon, to pay Dr. Paul, the primary care physician," said Heyman.
The AAFP and the AMA should act together to speak with a unified voice to support Medicare payment increases for primary care physicians, said Epperly. Ideally, payment increases for primary care physicians should not come via shifting payments from subspecialists, he added.
"We are disappointed that Dr. Heyman chose to use an example that pits (sub)specialists against primary care," Epperly told AAFP News Now. "It would have been more appropriate to speak of the need to think more broadly of applying budget neutrality and that the AMA would oppose solutions that pit any specialties against each other," he said.
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The AAFP is not necessarily advocating that other physicians receive less so (primary care physicians) get paid more," said Epperly. "
We don't want this to become a war amongst (physicians). We cannot 'circle the wagons' and point the guns internally and start shooting at each other. It
is much better if we circle the wagons together and collectively demand new payment modes that value the important work that family physicians and other primary care physicians perform."It is important, Epperly added, to go outside of Medicare part B when looking at this issue.
"We must go across the Medicare silos and look at other parts of Medicare -- A, B and D, as well as other sources for this payment increase," said Epperly.
In November, Senate Finance Committee Chair Max Baucus, D-Mont., unveiled a call to action that relies heavily on primary care and preventive services as a way to reform the nation's health care system. Baucus unveiled the health care blueprint during a Capitol Hill press conference in which he said increased payments for primary care physicians might require a shift in resources that results in reduced payments for subspecialists.
In the final analysis, family physicians may be faced with a situation where payment reductions to subspecialists are the only way to finance increased payments for primary care physicians. In this situation, Epperly said he would support shifts in Medicare physician payments to adequately compensate primary care physicians.
"If it comes to this being the only way (increases would) be paid for, I would say, '(Primary care physicians) need to be paid more, and (subspecialists) need to be paid less,'" Epperly said. "But I hope we can avoid going down that path.
"We need to reframe the discussion to focus on paying family physicians more for the important role they perform in integrating and coordinating health care, and all physicians need to work together with a unified voice to accomplish that goal."
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