Healio exclusive: As AAFP turns 70, CEO looks at future priorities, challenges

Douglas E. Henley

Founded in 1947 as the American Academy of General Practice, the AAFP changed its name in 1971 to reflect that family medicine was officially recognized as a specialty, allowing for the creation of residency programs in family medicine.

With 129,000 members, it is currently one of the largest medical organizations in the United States.

In this Q & A, Academy executive vice president and CEO Douglas E. Henley, MD, FAAFP, discusses the progress AAFP has made throughout the organization’s history, some of the challenges that lie ahead, and the role family physicians can play in helping the Academy address some of those challenges. – by Janel Miller

Question: What are some of the most significant initiatives AAFP has spearheaded?

Answer: We were the first medical association to require CME for membership, and to require a certain number of credit hours per 3-year membership cycle to maintain membership. We were also supportive of not only initial certification in family medicine, but also we were the first specialty to require recertification every 7 years.

In the mid-1980s, the Academy took the federal government to court, because at that time, the Medicare reimbursement system was discriminating against family physicians for how it paid for certain services such as a routine office visit. Family physicians were getting paid far less than other specialties and we successfully challenged that, which led to a new payment model in Medicare that paid the same for each Current Procedural Terminology code regardless of specialty.

In 1989, we were the first medical association to call for health care coverage for all and began working toward that goal. Obviously, that is not a goal this country has accomplished to date. We’ve had some success in that regard, but we still have work to do.

Q: Did you think it would take this long to achieve that goal?

A: Is it frustrating that health care coverage for all hasn’t happened by now? Yes.

The health care debate represents the democracy that we have. It represents the beliefs of different parts of the country in terms of the importance of health care coverage vs. access to health care coverage through ED. We’ve established that health care access is a right, because all you have to do is show up in an ED and the medical professionals will take care of you, regardless of your status and whether you can pay nor not. But we haven’t established that coverage is something that everyone should have, even though we know that it does matter, in terms of outcomes. Universal health care coverage is a goal the Academy still has. The recent challenges to the Affordable Care Act showed that the American people better understand that need as well. When the possibility of 23 million people — many of whom never had health insurance before — were under the threat of having that coverage taken away, you saw a dramatic shift in the public’s support of the Affordable Care Act.

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Q: What are some of the other things that AAFP has encouraged its members to do in the past, that you are seeing pay off today?

A: We were one of the first groups to inform, educate and encourage our members to move toward electronic health records. Today, more than 85% of our members have electronic health records that they use daily; that’s a higher percentage than any other specialty in the country and we’re proud of that. However, the software involved in electronic health records remains rather clunky. Systems don’t communicate with one another and aren’t integrated into the workflow of everyday practice. Electronic health records have added a lot to the administrative burden, and have not delivered on the promise of improving the workflow.

Q: What is AAFP is doing to alleviate that burden?

A: We think the vendors need to be held more accountable for their products. We used to hear the phrase, ‘death by a thousand cuts.’ Now we’re hearing ‘death by a thousand clicks of the mouse’ on the electronic health record. It’s getting to the point where it is interfering with the patient-physician relationship in the clinic. Something needs to be done, and we’re putting more pressure on these vendors.

Q: What is one of the top priorities that the Academy has, moving forward?

A: We see the need within primary care to continue to transform our practices to the medical home model, to practices that are more team-based, and patient-centered in the delivery of care. We can no longer primarily focus on one patient, we need to use community resources to focus on the entire population that the practice is responsible for and hopefully at the same time compare costs as well.

Q: What are some other Academy priorities?

Payment reform is another Academy priority. The United States spends $3.6 trillion on health care, and yet, only 5% or 6% of that goes to primary care. Most other developed nations have better health outcomes than ours, spend far less money, and their investment in primary care is about 12% or 16% of total health care spending. We think this country needs to make a significant redirection of current resources to invest more in primary care. We don’t think we need to spend more to do that, we just need to redirect our spending towards primary care and prevention. Some people estimate that $800 billion of that $3.6 trillion represents duplicative or unnecessary care or care that doesn’t lead to better outcomes, so we need to have discussions on how we can spend that money more wisely.

In addition, we need to move away from fee-for-service to alternative payment models, which is a significant area of focus moving forward.

There’s also the administrative and regulatory burden in the multipayer system that we have. The average family doctor has to work with six or seven or more health plans, and they all have their own rules and regulations or documentation guidelines and performance measurement programs. It’s just chaotic and it’s a mess. Frankly, it’s beginning to impede quality of care rather than improve it and is leading to a lot of physician burnout. You can’t have healthy patients if you don’t have healthy physicians and other clinicians.

Q: Can you please elaborate on AAFP’s population health initiative?

A: We need to pay more attention to this issue. That $3.6 trillion in health care that I mentioned earlier only accounts for the health of about 30% percent of the population. Part of the other 70% relates to genetics which we can’t do a lot with now but can in the future. The other part relates to the social determinants of health in terms of the education level of a community, access to safe transportation, good schools, access to fresh fruit and vegetables and more. As a nation, we need to have a conversation about investing more in social service support, healthy communities and better education, because all these issues affect the overall health of the population. When you’re talking about high school graduation rates, or how much of a crop a farmer yields, you’re talking about health implications, not just education and agriculture ones.

Q: What can family medicine doctors do to help in this initiative?

A: Family medicine has always been about that bridge between primary care and public health. Within a given community, family physicians have always linked their patients to the resources that they need. These efforts by medical professionals must continue.

At the federal and state level, we need to have conversations with education experts, food experts, transportation experts and others to find out how we can invest more in that so that the social support services are always there when the patient needs them.