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Tuesday Dec 20, 2016

Old Issues, New Year: A Look Back (and Ahead)

"Success is not final, failure is not fatal: it is the courage to continue that counts."
 -- Winston Churchill

As we approach the end of the year, I decided to use my final post of 2016 to reflect on the past 12 months and provide some well-deserved thank yous to a group of deserving individuals.

I'll start by recognizing a group of people that dedicate their professional careers to the AAFP -- the incomparable Academy staff. The teams at our offices in Leawood, Kan.; Washington, D.C.; Cincinnati; and Hasbrouck Heights, N.J. -- as well as individuals in Austin, Texas; and Seattle -- are an amazing collection of talented and dedicated individuals. I am impressed by the talent assembled amongst our staff and their dedication to you, our members. Each day the entire AAFP team works to advance the mission of the AAFP, by producing resources and education for family physicians, advocating for our specialty and, most importantly, dedicate themselves and their talents to making the world a better place. I am truly honored to call each of them colleagues.  

There is great risk in naming names, but there are a few people that I would like to thank for their contributions and support of this blog. David Mitchell, Min Shepherd, and Sarah Thomas are colleagues that I work with each week, and this blog would not happen without them. I am grateful for their contributions, guidance and collaboration. I am especially appreciative of David's ability to make me sound a little less "Oklahoman" and for his subtle ways of deleting controversial text!  

This was quite a year, no doubt about it. Setting aside the elections, 2016 produced significant developments and changes in health policy. As I reflected on the past year, I identified five issues/items that I think symbolize the top health policy issues and those areas where the AAFP was most engaged in 2016.

The opioid epidemic dominated health policy at the federal and state level in 2016.  According to the CDC, drug overdose is the leading cause of accidental death in the United States, with 55,403 lethal drug overdoses in 2015 alone. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. These numbers are startling and likely to increase in 2016.

The AAFP has worked closely with the Obama Administration and the surgeon general on this issue for the past two years and will continue our efforts with the Trump Administration. We have developed extensive member resources aimed at providing you the timeliest information and a set of tools you can use in your practice as you balance the treatment of pain with the challenges of addiction. This is an important issue that requires family medicine leadership, which we are committed to providing.

The past year saw the promulgation and finalization of regulations implementing Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the historic delivery system and payment reform law. In April, the AAFP launched its MACRA Ready campaign aimed at assisting family physicians in their preparation for the new Quality Payment Programs (QPP) created by the law.

During the summer, the AAFP analyzed the proposed regulations implementing MACRA and then submitted more than 100 pages of comments, which had an impact on the final rule. In September, CMS announced it would implement a Pick Your Pace program that would allow physicians to participate in one of the MACRA QPP pathways at their own pace, thus avoiding negative payment updates in 2019.

In October, CMS published the MACRA QPP final rule and launched a website aimed at assisting physicians. MACRA will continue to be a top priority for the AAFP in the coming year, and we will continue to produce tools and resources that assist you and your practice. I will be devoting future posts to this topic, so please stay tuned.

The nation once again became focused on a public health outbreak in 2016. The AAFP quickly produced information and patient education materials for our members, and we partnered with the CDC and others to inform the public on how to protect themselves from the Zika virus.

The frequency of public health emergencies is concerning to the AAFP and a central reason why we are prioritizing public health and population health in our strategic plan.  Family physicians are on the frontline of these public health outbreaks and place a critical role in educating patients and communities on how best to protect themselves against these occurrences. You can find up-to-date information on public health issues on our patient care resource page.

Direct Primary Care
The DPC practice model continues to draw interest among family physicians, and the AAFP remains at the forefront of efforts to assist interested family physicians in their transformation from a traditional, insurance-based practice model to DPC. The AAFP has developed a DPC Toolkit that provides detailed guidance on making such a change. This toolkit has been used by hundreds of physicians during the past few years and continues to be the best single source of information for those interested in DPC.  

The Academy continues to support its DPC Member Interest Group, which allows interested family physicians to share ideas and concerns with each other.

The AAFP also continues to play a prominent role in advancing policies and regulations that would make DPC practices more broadly available. In 2016, the AAFP worked closely with members of the House and Senate to introduce legislation that would allow DPC practices to be recognized under federal laws governing health savings accounts. This bill is a priority for the AAFP in the 115th Congress.

Finally, the AAFP is hosting a DPC Workshop in Atlanta on March 11, and the Academy will once again co-host the 2017 DPC Summit in either June or July. We are finalizing details, and an announcement will be made early next year.

Chicago Cubs?
You are probably asking yourself how the Cubs qualify as a health care issue, so I am going to tell you. For more than 100 years, our nation's third-largest city (at least the north side) has been paralyzed by an August-induced anxiety, largely associated with its beloved team's historic (and often dramatic) collapses in the fall months. By winning the World Series, the Cubs decreased the anxiety levels (at least temporarily) of nearly 10 million people in the Chicago metropolitan area and millions more around the world. And, because we know anxiety is not good for our health, I am giving the 2016 World Champion Cubs credit for positively impacting the health and wellbeing of millions of people -- a great accomplishment!

I started this blog with a quote from Churchill. This is one of my favorite statements by the former United Kingdom prime minister because it captures the fluidity of the world in which we live and reminds us to set our eyes on the horizon. In closing, thank you for your support of the AAFP, the great service you provide your patients and our country each and every day and for your support of this blog.

I hope you have a wonderful holiday season. May you always find yourself on the north side of the Red River in the New Year.



Thanks for everything that the staff and you have accomplished this year. We anticipate a busy plate for our academy in 2017.

Keith Ratcliff

Posted by Keith Ratcliff on December 20, 2016 at 11:57 AM CST #

Thank you, too, Shawn for your hard work, tenacity, instincts, insights and dry wit on our behalf! I will echo your thanks to an amazing group of AAFP staff who work for us with professionalism and creativity... not just as their mission statement but their passion!

Posted by Wanda Filer on December 20, 2016 at 01:22 PM CST #

Thank you Shawn, There also seems to be a gross error in the CPC+ decision making process for some practices that were "rejected for attribution" when it appears that is/was not a correct assessment by the CMS decision makers. As it does represent a significant missed "revenue opportunity" for FMs, you might consider determining the root cause, as those practices seemingly can not re-apply for Round 2 according to recently published info from AAFP. That certainly would gain member support for AAFP and improve transparency in decisions affecting patient care. Thank you for a response.

Posted by William Sawyer, MD on December 21, 2016 at 07:37 AM CST #

Well done, Shawn. Thanks for being a voice in our profession and continuing to wave that flag for primary care.

Thank you. Just went to the STFM Practice Management in Newport Beach last month. Had lunch at a table with 4 ladies from Kansas, all representing the AAFP. On the next day, I went to a ritzy Italian restaurant by myself but left my wallet in the car, after having swallowed a $28 dollar lunch. I saw the same ladies on the adjacent table and they spotted me $40 to pay for the meal while I went back to my car and retrieved the wallet, without having to embarrass myself with the waiter and restaurant management. I grew up in the Midwest (Iowa) but has been practicing in southern California for the past 2 decades. It warms my heart to be able to reconnect with some friendly folks from the Midwest, something I haven't done for a while. This is my Christmas story of kindness that I have been sharing at parties (I try to tell one that's most memorable with each passing year on the theme of kindness).

Went to a lecture recently, and the director of chemical dependency for the hospital basically said, "If we don't do it ourselves, someone else will do it for us." I would add, if we don't treat the patient, patients will self-medicate themselves. The opoids epidemic is a consequence of this, and perhaps this is one area where I would say it's a failure of the modern "patient-centered" healthcare model. As far as "someone else will do it for us," I still believe that the doctor-patient relationship is the last bastion of hope if we are to turn the ship around. There is no one better nor there is not another vantage point than that of the treating physician. This is not NEW.

If we let the PCP to have some control of the data, and share some of the responsibility of being in the driver seat, most will want to do or coordinate public health matters. Just look at the volunteer activities of the medical students before they became professionals. We know it's in our hearts, and we are smart enough for the job. Again, it's a public healthcare issue that needs our help. There's a lot of brain cells wasted if we don't involve or passively involve the front-liners.

Eventually technology will go mobile, apps and automation will get rid of the middleman, communications will be instant, personal with a live-face video attached. What could be more direct than that? But it has to start with technology, not the old ways of practicing medicine. I think it's inevitable.

If you believe it to be true, it will come true. It's just a matter of when.

Posted by Michael N. on December 22, 2016 at 06:22 PM CST #

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About the Author

Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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