U.S. needs to recognize value of primary care – and pay for it, AAFP leader says

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Policies in Washington, D.C., are felt in family doctors’ offices around the nation.

How will the American Academy of Family Physicians influence those rules and regulations?

In September, Jen Brull, MD, FAAFP, was installed as the new president of the American Academy of Family Physicians (AAFP). She spoke to Medical Economics about a wide range of topics, and there’s much to discuss.

The 2025 Medicare Physician Fee Schedule has a 2.8% decrease in reimbursement to doctors.

Health care consolidation has gotten the attention of lawmakers in Congress, who have grilled company executives over a host of issues including the competitive business environment, technology and financial practices.

Meanwhile, the nation is less than a month away from the ballot box choice for the next national chief executive, with former President Donald Trump and Vice President Kamala Harris squaring off.

This transcript has been edited for length and clarity.

Medical Economics: It's already been publicized that through the Medicare Physician Fee Schedule in 2025 there will be another cut to physician reimbursement. What will AAFP work on to stop that?

Jen Brull, MD, FAAFP
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Jen Brull, MD, FAAFP: Family physicians have consistently taken cuts in their payment. Narrowly, family medicine and the work that we do in D.C., the advocacy work, is often focused on Medicare payment, so we will have specific advocacy points and objective that we will get that in a better place this year. I spoke that we're working on improving systems over the next three years. More broadly, it's about ensuring that the health care system writ large, recognizes the value that family medicine and primary care provide, and that we start seeing payment on that value, as opposed to payment on the visit. And that, I think, is going to be part of solving this larger problem. When Medicare is not forced to pay more money for something that doesn't bring value, instead pays more money for something that saved them money and made better care for the patient, then I think we've got a win all the way around. The challenge is, it's a zero-sum game. And so as we look at what is health care spend, primary care health care spend is about 5% to 7% of the whole health care spend. It's a drop in the bucket right now. We also have really good studies that show when you increase that to somewhere between 12% and 14% of health care spend – and there's some nice studies coming out of other countries who have better spend on primary care, and Oregon has been leading the way in terms of putting this into legislation – all of the things that we have seen in studies plays out. So when you spend more on primary care, you save more in downstream costs, and the health of the population is better. So things like fewer readmissions, fewer emergency department visits, fewer hospitalizations writ large, because people have access to a primary care doc who can head that off before it becomes a hospitalizable event. And I think that's where we need to go, is to improve those systems, make sure the value is there, and look at ways where we can demonstrate that value and make the trade-off between hospital costs, where no patient wants to be in the hospital, and primary care, which hopefully is a pretty good health home for patients.

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Medical Economics: There's been a lot of discussion about consolidation in the business of health care. What are your feelings on the rise of large and vertically integrated health systems across the United States?

Jen Brull, MD, FAAFP: I think that as we look at the trends in private equity buyout and vertical consolidation, vertical integration, as a membership organization, we need to be in all spaces. So, we need to be there for our members who are employed, whether or not they are part of a private equity buyout or a vertical consolidation, and to support them in the questions that they might want to ask through those processes, or as they're making that decision, if they are in the decision-holding seat. We also need to support family doctors who remain independent, whether they are in a tiny practice like mine in Plainville, Kansas, or in a larger health system where they are just a large primary care group, and all of those are important for us. I think that as we watch those specialties, where private equity and vertical consolidation happened sooner than primary care, and we can look specifically at – you know, dermatology is one of them that's been impacted – and we see that sometimes the results in the short term are pretty good, and in the three- to five- to eight-year term look a little bit concerning in terms of the happiness and joy of those physicians, the access that their patients have to care, the decisions that companies that are not owned by physicians make in terms of management. I think we have cause to have concern, and so we try to equip our members with knowledge and with tools so that they can make that decision about whether they will stay in an employed model or move to independent, or whether they will sell their practice or keep their practice, so that they can each make that decision at an informed level.

Medical Economics: We're less than a month out from the 2024 election. Does the Academy endorse in the presidential race, or any race?

Jen Brull, MD, FAAFP: We do not. We specifically look for ways that we can partner with whichever administration is in place. We don't want four years where no progress is made in family medicine, in health care writ large. So we look for opportunities to find alignment between both parties and all folks who are on the Hill, and to help them see the value that's there and the way that we can work together in different ways to translate that into action.