User login
PHILADELPHIA –
Practice enhancement
Hospital privileges were a hot topic for the reference committee on practice enhancement.
Adopted Resolution No. 304 calls on AAFP to oppose health insurance companies “privileging physicians based solely on their hospital privileges and hospital credentials.” The new rule also resolves that AAFP engage major national health insurance companies to develop methods to credential physicians that do not depend on hospital privileges.
The Congress also adopted Substitute Resolution No. 305, which calls on the AAFP to collaborate with the Joint Commission and other appropriate entities to create policy stating that hospitals remove undue barriers and restriction of privileges to hospitals and intensive care units for qualified family physicians who practice hospital medicine.
Delegates requested amendments to a resolution that called on AAFP to oppose nonphysician health care professionals making credentialing or privileging decisions regarding family physicians and that the AAFP oppose the use of nonphysician health care professionals in providing consultations requested of other physicians. The Congress could not agree on a final wording of the resolution.
Douglas J. Gruenbacher, MD, a Kansas delegate who works in a small hospital, said, “We actually credential in our hospital radiologists, orthopedists ... urologists. Do I know what they know? So we have to have many of our nonphysician providers, our nurse practitioners, help us. ... Should they be independent? No, of course not, but they do play an important part of our team.”
Douglas W. Curran, MD, a delegate from Texas, said, “I think we continue to give away stuff without taking care of ourselves. I have seen it for 4 years and, as result, we have seen this expansion of second-class care for people. ... Those are huge decisions, especially thinking about who’s going to do what in our hospitals. That includes small hospitals; I practice in a small hospital. I get all of that.”
After much debate, the Congress voted in favor of referring two proposed amendments to the board.
The Congress also adopted an amended version of Substitute Resolution No. 303, which calls on AAFP to support insurance coverage of acupuncture for pain control when ordered by a licensed physician or licensed collaborating advanced clinician on their practice team.
Education
Multipronged Substitute Resolution No. 606 – adopted by the Congress – aims to address racial inequities in medical education. Specifically, it calls on AAFP to do the following:
- Instruct the Liaison Committee for Medical Education to add race to its existing Cultural Competence and Health Care Disparities section 7.6 of Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree.
- Ask the Accreditation Council for Graduate Medical Education to adopt an antiracism policy that includes corresponding curricular requirements,
- Develop and implement a policy on training in racism and implicit bias for officeholders and commission members.
- Take an active stance against racism when racist events occur within the medical community.
The Congress also adopted Resolution No. 611, which calls for the AAFP to encourage the expansion of clinical behavioral health fellowships for family medicine physicians.
The resolution received mixed testimony during the reference committee meeting, with those in favor of the resolution having cited the need for more education in behavioral health due to shortages in many communities. Opponents argued that completing the fellowship would not have added value in hospital privileging and insurance payment, because it would not lead physicians to earn a certificate of added qualification.
Delegates also passed Resolution 608, over the objections of the reference committee.
As adopted, the resolution calls for AAFP to express its concern that the American Board of Family Medicine (ABFM) Family Medicine Certification Longitudinal Assessment is the only alternative to 1-day-only certification exam, and for the AAFP to urge the ABFM to offer a longitudinal self-assessment process similar to the American Board of Obstetricians and Gynecologists self-assessment process to satisfy the cognitive component of ABFM’s continued certification requirement.
The Reference Committee on Education also referred several hotly debated resolutions back to the AAFP board of directors. No. 604 called on AAFP to support forgiving 1 year of federal medical student loans for every 2 years of full-time work in a primary care position, as well as tax credits for those working in rural or underserved areas.
Advocacy
The delegates also approved most of the recommendations of the reference committee on advocacy with little discussion.
Substitute Resolution No. 515, which was ultimately adopted with an amendment by the Congress, states that AAFP support policies that provide employees with reasonable benefits, including job security, wage replacement, and continued availability of health plan coverage in the event that leave by an employee becomes necessary for documented medical conditions, with protections for small businesses. Among the policies this resolution includes are the following:
- Medical leave for the employee, including pregnancy.
- Parental leave for the employee-parent, including leave for birth, adoption or foster care leading to adoption.
- Leave if medically appropriate to care for a member of the employee’s immediate family.
The Congress adopted several other resolutions recommended by the advocacy committee:
- Resolution No. 501, calling on AAFP to advocate for state-level adoption of the Interstate Medical Licensure Compact.
- Substitute Resolution No. 505, asking AAFP to request a National Coverage Determination for Cardiac Rehabilitation Programs to allow such programs to operate without physician supervision when an AED is immediately available, and the patient is attended by nursing staff currently trained in basic life support.
- Substitute Resolutions No. 506 and 507 to support and encourage the ability of parents to breastfeed in the workplace through its advocacy efforts, as well as promote the enforcements of current law.
- Resolution No. 508, to petition CMS, national health insurance companies, and pharmacy benefits managers to include all generic medications in a class within a health plan’s formulary and implement a system that informs the prescriber of all formulary alternatives to a medication when denying the same medication immediately upon denial, while also providing a mechanism to rapidly appeal the denial.
- Substitute Resolution No. 512, to petition the CMS to reevaluate its current policy on the time requirements for discharge summaries from hospitals and post-acute care facilities and specifically require such facilities to provide primary care physicians with discharge summaries within 7 days.
- Substitute Resolution No. 517, to unequivocally support the right of physicians to organize and bargain collectively.
- Substitute Resolution No. 519, to support legislation that decriminalizes people who are solicited for sex or sexual activities in exchange for money or goods, without supporting the legalization of the selling of sex, and advocate against legislation that decriminalizes sex-buying and third-parties who promote and/or profit from sex buying.
Some of the resolutions that incited many passionate responses during the reference committee on advocacy were not discussed during the Congress of Delegates meeting.
One of these asked the AAFP to oppose legislation of physician-patient decision making in child and adolescent gender-affirming care. Some in support of this resolution referred to this type of care as evidence-based medicine and said that legislators should be kept out of the exam room. Those opposed disagreed with classifying this type of care that way, noting that the long-term effects of some of the treatments are unknown.
During the reference committee, one opponent of the resolution, Lisa Gilbert, MD, claimed that gender-affirming care refers to blocking puberty, followed by cross-sex hormones,which would permanently sterilize the children. Dr. Gilbert, who identified herself as a member from Kansas speaking independently, added that if children have gone through puberty naturally, this would be a different discussion.
Kevin Wang, MD, an alternate delegate from Washington, who supported the resolution, noted that the rate of suicide in the transgender population is nine times that of the general population.
“I do want to emphasize that doing nothing does cause significant harm,” Dr. Wang said, The committee referred resolution No. 509 to the board for further clarification and study.
The merits of two other resolutions (No. 510 and No. 511), which called for the AAFP to no longer reject the use of “physician-assisted suicide” and “assisted suicide” and avoid the use of vague and euphemistic terms when referring to lethal medications prescribed with the intention of ending a patient’s life in statements and documents, also were heavily debated during the advocacy reference committee meeting. The committee recommended such resolutions be referred to the board for discussion.
The delegates approved the advocacy committee’s recommendations for Resolutions 509, 510, and 511.
PHILADELPHIA –
Practice enhancement
Hospital privileges were a hot topic for the reference committee on practice enhancement.
Adopted Resolution No. 304 calls on AAFP to oppose health insurance companies “privileging physicians based solely on their hospital privileges and hospital credentials.” The new rule also resolves that AAFP engage major national health insurance companies to develop methods to credential physicians that do not depend on hospital privileges.
The Congress also adopted Substitute Resolution No. 305, which calls on the AAFP to collaborate with the Joint Commission and other appropriate entities to create policy stating that hospitals remove undue barriers and restriction of privileges to hospitals and intensive care units for qualified family physicians who practice hospital medicine.
Delegates requested amendments to a resolution that called on AAFP to oppose nonphysician health care professionals making credentialing or privileging decisions regarding family physicians and that the AAFP oppose the use of nonphysician health care professionals in providing consultations requested of other physicians. The Congress could not agree on a final wording of the resolution.
Douglas J. Gruenbacher, MD, a Kansas delegate who works in a small hospital, said, “We actually credential in our hospital radiologists, orthopedists ... urologists. Do I know what they know? So we have to have many of our nonphysician providers, our nurse practitioners, help us. ... Should they be independent? No, of course not, but they do play an important part of our team.”
Douglas W. Curran, MD, a delegate from Texas, said, “I think we continue to give away stuff without taking care of ourselves. I have seen it for 4 years and, as result, we have seen this expansion of second-class care for people. ... Those are huge decisions, especially thinking about who’s going to do what in our hospitals. That includes small hospitals; I practice in a small hospital. I get all of that.”
After much debate, the Congress voted in favor of referring two proposed amendments to the board.
The Congress also adopted an amended version of Substitute Resolution No. 303, which calls on AAFP to support insurance coverage of acupuncture for pain control when ordered by a licensed physician or licensed collaborating advanced clinician on their practice team.
Education
Multipronged Substitute Resolution No. 606 – adopted by the Congress – aims to address racial inequities in medical education. Specifically, it calls on AAFP to do the following:
- Instruct the Liaison Committee for Medical Education to add race to its existing Cultural Competence and Health Care Disparities section 7.6 of Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree.
- Ask the Accreditation Council for Graduate Medical Education to adopt an antiracism policy that includes corresponding curricular requirements,
- Develop and implement a policy on training in racism and implicit bias for officeholders and commission members.
- Take an active stance against racism when racist events occur within the medical community.
The Congress also adopted Resolution No. 611, which calls for the AAFP to encourage the expansion of clinical behavioral health fellowships for family medicine physicians.
The resolution received mixed testimony during the reference committee meeting, with those in favor of the resolution having cited the need for more education in behavioral health due to shortages in many communities. Opponents argued that completing the fellowship would not have added value in hospital privileging and insurance payment, because it would not lead physicians to earn a certificate of added qualification.
Delegates also passed Resolution 608, over the objections of the reference committee.
As adopted, the resolution calls for AAFP to express its concern that the American Board of Family Medicine (ABFM) Family Medicine Certification Longitudinal Assessment is the only alternative to 1-day-only certification exam, and for the AAFP to urge the ABFM to offer a longitudinal self-assessment process similar to the American Board of Obstetricians and Gynecologists self-assessment process to satisfy the cognitive component of ABFM’s continued certification requirement.
The Reference Committee on Education also referred several hotly debated resolutions back to the AAFP board of directors. No. 604 called on AAFP to support forgiving 1 year of federal medical student loans for every 2 years of full-time work in a primary care position, as well as tax credits for those working in rural or underserved areas.
Advocacy
The delegates also approved most of the recommendations of the reference committee on advocacy with little discussion.
Substitute Resolution No. 515, which was ultimately adopted with an amendment by the Congress, states that AAFP support policies that provide employees with reasonable benefits, including job security, wage replacement, and continued availability of health plan coverage in the event that leave by an employee becomes necessary for documented medical conditions, with protections for small businesses. Among the policies this resolution includes are the following:
- Medical leave for the employee, including pregnancy.
- Parental leave for the employee-parent, including leave for birth, adoption or foster care leading to adoption.
- Leave if medically appropriate to care for a member of the employee’s immediate family.
The Congress adopted several other resolutions recommended by the advocacy committee:
- Resolution No. 501, calling on AAFP to advocate for state-level adoption of the Interstate Medical Licensure Compact.
- Substitute Resolution No. 505, asking AAFP to request a National Coverage Determination for Cardiac Rehabilitation Programs to allow such programs to operate without physician supervision when an AED is immediately available, and the patient is attended by nursing staff currently trained in basic life support.
- Substitute Resolutions No. 506 and 507 to support and encourage the ability of parents to breastfeed in the workplace through its advocacy efforts, as well as promote the enforcements of current law.
- Resolution No. 508, to petition CMS, national health insurance companies, and pharmacy benefits managers to include all generic medications in a class within a health plan’s formulary and implement a system that informs the prescriber of all formulary alternatives to a medication when denying the same medication immediately upon denial, while also providing a mechanism to rapidly appeal the denial.
- Substitute Resolution No. 512, to petition the CMS to reevaluate its current policy on the time requirements for discharge summaries from hospitals and post-acute care facilities and specifically require such facilities to provide primary care physicians with discharge summaries within 7 days.
- Substitute Resolution No. 517, to unequivocally support the right of physicians to organize and bargain collectively.
- Substitute Resolution No. 519, to support legislation that decriminalizes people who are solicited for sex or sexual activities in exchange for money or goods, without supporting the legalization of the selling of sex, and advocate against legislation that decriminalizes sex-buying and third-parties who promote and/or profit from sex buying.
Some of the resolutions that incited many passionate responses during the reference committee on advocacy were not discussed during the Congress of Delegates meeting.
One of these asked the AAFP to oppose legislation of physician-patient decision making in child and adolescent gender-affirming care. Some in support of this resolution referred to this type of care as evidence-based medicine and said that legislators should be kept out of the exam room. Those opposed disagreed with classifying this type of care that way, noting that the long-term effects of some of the treatments are unknown.
During the reference committee, one opponent of the resolution, Lisa Gilbert, MD, claimed that gender-affirming care refers to blocking puberty, followed by cross-sex hormones,which would permanently sterilize the children. Dr. Gilbert, who identified herself as a member from Kansas speaking independently, added that if children have gone through puberty naturally, this would be a different discussion.
Kevin Wang, MD, an alternate delegate from Washington, who supported the resolution, noted that the rate of suicide in the transgender population is nine times that of the general population.
“I do want to emphasize that doing nothing does cause significant harm,” Dr. Wang said, The committee referred resolution No. 509 to the board for further clarification and study.
The merits of two other resolutions (No. 510 and No. 511), which called for the AAFP to no longer reject the use of “physician-assisted suicide” and “assisted suicide” and avoid the use of vague and euphemistic terms when referring to lethal medications prescribed with the intention of ending a patient’s life in statements and documents, also were heavily debated during the advocacy reference committee meeting. The committee recommended such resolutions be referred to the board for discussion.
The delegates approved the advocacy committee’s recommendations for Resolutions 509, 510, and 511.
PHILADELPHIA –
Practice enhancement
Hospital privileges were a hot topic for the reference committee on practice enhancement.
Adopted Resolution No. 304 calls on AAFP to oppose health insurance companies “privileging physicians based solely on their hospital privileges and hospital credentials.” The new rule also resolves that AAFP engage major national health insurance companies to develop methods to credential physicians that do not depend on hospital privileges.
The Congress also adopted Substitute Resolution No. 305, which calls on the AAFP to collaborate with the Joint Commission and other appropriate entities to create policy stating that hospitals remove undue barriers and restriction of privileges to hospitals and intensive care units for qualified family physicians who practice hospital medicine.
Delegates requested amendments to a resolution that called on AAFP to oppose nonphysician health care professionals making credentialing or privileging decisions regarding family physicians and that the AAFP oppose the use of nonphysician health care professionals in providing consultations requested of other physicians. The Congress could not agree on a final wording of the resolution.
Douglas J. Gruenbacher, MD, a Kansas delegate who works in a small hospital, said, “We actually credential in our hospital radiologists, orthopedists ... urologists. Do I know what they know? So we have to have many of our nonphysician providers, our nurse practitioners, help us. ... Should they be independent? No, of course not, but they do play an important part of our team.”
Douglas W. Curran, MD, a delegate from Texas, said, “I think we continue to give away stuff without taking care of ourselves. I have seen it for 4 years and, as result, we have seen this expansion of second-class care for people. ... Those are huge decisions, especially thinking about who’s going to do what in our hospitals. That includes small hospitals; I practice in a small hospital. I get all of that.”
After much debate, the Congress voted in favor of referring two proposed amendments to the board.
The Congress also adopted an amended version of Substitute Resolution No. 303, which calls on AAFP to support insurance coverage of acupuncture for pain control when ordered by a licensed physician or licensed collaborating advanced clinician on their practice team.
Education
Multipronged Substitute Resolution No. 606 – adopted by the Congress – aims to address racial inequities in medical education. Specifically, it calls on AAFP to do the following:
- Instruct the Liaison Committee for Medical Education to add race to its existing Cultural Competence and Health Care Disparities section 7.6 of Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree.
- Ask the Accreditation Council for Graduate Medical Education to adopt an antiracism policy that includes corresponding curricular requirements,
- Develop and implement a policy on training in racism and implicit bias for officeholders and commission members.
- Take an active stance against racism when racist events occur within the medical community.
The Congress also adopted Resolution No. 611, which calls for the AAFP to encourage the expansion of clinical behavioral health fellowships for family medicine physicians.
The resolution received mixed testimony during the reference committee meeting, with those in favor of the resolution having cited the need for more education in behavioral health due to shortages in many communities. Opponents argued that completing the fellowship would not have added value in hospital privileging and insurance payment, because it would not lead physicians to earn a certificate of added qualification.
Delegates also passed Resolution 608, over the objections of the reference committee.
As adopted, the resolution calls for AAFP to express its concern that the American Board of Family Medicine (ABFM) Family Medicine Certification Longitudinal Assessment is the only alternative to 1-day-only certification exam, and for the AAFP to urge the ABFM to offer a longitudinal self-assessment process similar to the American Board of Obstetricians and Gynecologists self-assessment process to satisfy the cognitive component of ABFM’s continued certification requirement.
The Reference Committee on Education also referred several hotly debated resolutions back to the AAFP board of directors. No. 604 called on AAFP to support forgiving 1 year of federal medical student loans for every 2 years of full-time work in a primary care position, as well as tax credits for those working in rural or underserved areas.
Advocacy
The delegates also approved most of the recommendations of the reference committee on advocacy with little discussion.
Substitute Resolution No. 515, which was ultimately adopted with an amendment by the Congress, states that AAFP support policies that provide employees with reasonable benefits, including job security, wage replacement, and continued availability of health plan coverage in the event that leave by an employee becomes necessary for documented medical conditions, with protections for small businesses. Among the policies this resolution includes are the following:
- Medical leave for the employee, including pregnancy.
- Parental leave for the employee-parent, including leave for birth, adoption or foster care leading to adoption.
- Leave if medically appropriate to care for a member of the employee’s immediate family.
The Congress adopted several other resolutions recommended by the advocacy committee:
- Resolution No. 501, calling on AAFP to advocate for state-level adoption of the Interstate Medical Licensure Compact.
- Substitute Resolution No. 505, asking AAFP to request a National Coverage Determination for Cardiac Rehabilitation Programs to allow such programs to operate without physician supervision when an AED is immediately available, and the patient is attended by nursing staff currently trained in basic life support.
- Substitute Resolutions No. 506 and 507 to support and encourage the ability of parents to breastfeed in the workplace through its advocacy efforts, as well as promote the enforcements of current law.
- Resolution No. 508, to petition CMS, national health insurance companies, and pharmacy benefits managers to include all generic medications in a class within a health plan’s formulary and implement a system that informs the prescriber of all formulary alternatives to a medication when denying the same medication immediately upon denial, while also providing a mechanism to rapidly appeal the denial.
- Substitute Resolution No. 512, to petition the CMS to reevaluate its current policy on the time requirements for discharge summaries from hospitals and post-acute care facilities and specifically require such facilities to provide primary care physicians with discharge summaries within 7 days.
- Substitute Resolution No. 517, to unequivocally support the right of physicians to organize and bargain collectively.
- Substitute Resolution No. 519, to support legislation that decriminalizes people who are solicited for sex or sexual activities in exchange for money or goods, without supporting the legalization of the selling of sex, and advocate against legislation that decriminalizes sex-buying and third-parties who promote and/or profit from sex buying.
Some of the resolutions that incited many passionate responses during the reference committee on advocacy were not discussed during the Congress of Delegates meeting.
One of these asked the AAFP to oppose legislation of physician-patient decision making in child and adolescent gender-affirming care. Some in support of this resolution referred to this type of care as evidence-based medicine and said that legislators should be kept out of the exam room. Those opposed disagreed with classifying this type of care that way, noting that the long-term effects of some of the treatments are unknown.
During the reference committee, one opponent of the resolution, Lisa Gilbert, MD, claimed that gender-affirming care refers to blocking puberty, followed by cross-sex hormones,which would permanently sterilize the children. Dr. Gilbert, who identified herself as a member from Kansas speaking independently, added that if children have gone through puberty naturally, this would be a different discussion.
Kevin Wang, MD, an alternate delegate from Washington, who supported the resolution, noted that the rate of suicide in the transgender population is nine times that of the general population.
“I do want to emphasize that doing nothing does cause significant harm,” Dr. Wang said, The committee referred resolution No. 509 to the board for further clarification and study.
The merits of two other resolutions (No. 510 and No. 511), which called for the AAFP to no longer reject the use of “physician-assisted suicide” and “assisted suicide” and avoid the use of vague and euphemistic terms when referring to lethal medications prescribed with the intention of ending a patient’s life in statements and documents, also were heavily debated during the advocacy reference committee meeting. The committee recommended such resolutions be referred to the board for discussion.
The delegates approved the advocacy committee’s recommendations for Resolutions 509, 510, and 511.
REPORTING FROM AAFP Congress