Strengthening Primary Care With a New Professional Congress

Brian Klepper

Posted 10/01/12 on Medscape Connect’s Care & Cost Blog

Three months ago a post on this blog argued that America’s primary care associations, societies and membership groups have splintered into narrowly-focused specialties. Individually and together, they have proved unable to resist decades of assault on primary care by other health care interests. The article concluded that primary care needs a new, more inclusive organization focused on accumulating and leveraging the power required to influence policy in favor of primary care.

The intention was to strengthen rather than displace the 6 different societies – The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the Society for General Internal Medicine (SGIM), the American Academy of Pediatrics (AAP), the American Osteopathic Association (AOA), the American Geriatrics Society (AGS) – that currently divide primary care’s physician membership and dilute its influence. Instead, a new organization would convene and galvanize primary care physicians in ways that enhance their power. It would also reach out and embrace other primary care groups – e.g., mid-level clinicians and primary care practice organizations – adding heft and resources, and reflecting the fact that primary care is increasingly a team-based endeavor.

We have come to believe that a single organization cannot be serviceable. Feedback on the article suggested that several entities were necessary to achieve a workable design.

So we propose here a new set of allied entities that, by convening clinical and non-clinical primary care stakeholders, will work to re-empower primary care’s role within the larger health care enterprise. In addition to aggregating and leveraging the strengths of existing primary care organizations, this new effort would collaborate with patients and health care purchasers to gather the influence required to effect positive change.

New Organizations

We envision four new organizations – an umbrella group and three professional entities – each independent and with its own governance structure. Membership in any organization would provide membership in the umbrella Congress. The names we have applied are suggestions only.

The Congress of Primary Care Professionals. This umbrella entity would bring all groups, including existing societies, together in a representative structure. The Congress would seek to galvanize and mobilize the power required to revitalize primary care, not only for primary care’s benefit but as a key remedy for America’s health care cost crisis. The effort must be about primary care, not a specific group within it.

The Section on Primary Care Physicians. Currently there is no physician organization that unites all primary care disciplines. Many physicians are adamant that they should have their own entity, and have expressed concern that physicians’ roles might be devalued inside a structure shared with mid-level practitioners.

The Section on Allied Primary Care Professionals. The accumulation of power requires inclusiveness. It makes sense to establish a separate section embracing nurse practitioners, registered nurses, respiratory therapists, radiation technologists, physical therapists and others participating in primary care.

The Section on Primary Care Organizations. A new society structure could mobilize influence by rolling up and leveraging the power of larger primary care practices. As one physician practice leader noted, “Market traction will come from organizations that facilitate more efficient and effective primary care.”

Where to Begin?

An undertaking like this begs several questions.

Will primary care physicians, other clinicians and organizations participate? We believe that primary care can be reinvigorated, but any campaign must first convince primary’s practitioners that a new effort is worthwhile.

Who can jumpstart this? Established primary care practices – particularly those that are sizable – have some resources and offer opportunities for collaboration and the development of a larger national campaign.

What’s in it for me? Why should I bother? Primary care practitioners have been diminished under old regimes that divide primary care by sub-specialty. Their other positive attributes notwithstanding, the standing societies have been unable to drive payment policy that meaningfully appreciates primary care’s measurable value. In turn, this failure has resulted in the diminishment of primary care’s current status and future prospects. A new effort would be dedicated to restoring an appreciation of primary care’s value in policy and the marketplace.

What will this Congress do (and not do)? We should emphasize that this effort does NOT aspire to assume most roles of existing societies (e.g., standards, continuing medical education). Instead, it will create structures that can more fully and fairly represent primary care’s interests. If the new primary care organizations focus on gathering strength that can create influence, then they must do several things.

– They must actively recruit members.

– They must develop approaches for easy, rapid communication with members (e.g., email bulletins, Webinars, semi-annual meetings). Taking advantage of more modern approaches like social media could streamline operations and costs as well as differentiate the new entity.

– They must analyze policy related to primary care.

– They must develop pragmatic alliances on policy advocacy with non-health care business.

– And they must drive advocacy that speaks for all primary care, and only for primary care.

Don’t existing primary care societies already do these things? Current primary care societies may respond that they already are engaged in these approaches. That said, despite their efforts, primary care as a whole is in desperate straits, and likely to remain so. Several societies maintain they can advocate for both primary care and sub-specialty interests. Comparatively low payment and stature has driven medical students away from this discipline. Most societies continue to participate in the AMA’s Relative Value Scale Update Committee (RUC), though its opaque and biased power structure has consistently undervalued primary care services. We believe a fresh approach is necessary.

Can primary care change health care? Not by itself. But primary care is the natural ally of health care purchasers, the one group with more size and influence than the rest of health care combined. Creating a unified primary care front is the first step in building an alliance that can reshape health care to be more reflective of broad primary care values and in the public interest.

This framework was developed with the participation and support of the following advisors:

William Bestermann, MD is an Internal Medicine Physician and Medical Director of Chronic Condition Management at the Holston Medical Group in Kingsport, TN.

Tom Emerick is a health care advisor to business, and the former VP of Global Benefits for Walmart.

Paul Fischer, MD is a Family Physician and Founder of the Center for Primary Care in Augusta, GA. He is the lead plaintiff in a lawsuit against HHS and CMS over their unaccountable relationship with the AMA’s RUC, in violation of the Federal Advisory Committee Act.

Tad Fisher is the former Executive Director of the Florida Academy of Family Physicians. He is now Executive Director of the Florida Physician Therapy Association.

Richard Glock, MD is a primary care internist and lead physician in the Internal Medical Group in Jacksonville, FL.

Jerry Miller, MD is a Family Physician and Founder of the Holston Medical Group in Kingsport, TN.

Kavita Patel, MD is an internist at Johns Hopkins and a former White House health care staffer.

Patricia Salber MD, MBA is CEO of Health Tech Hatch. A former Internal Medicine physician at Kaiser Permanente, she later served as Medical Director for several large health plans.

Richard Young, MD is Associate Director of the Family Medicine Residency Program at John Peter Smith Health System. He has authored a book and blog, American Healthscare, and is in the initial class of CMS Innovation Advisors.

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