New HampshireAcademy of Family Physicians

Report of AAFP Congress of Delegates 2012

The 65thAmericanAcademy of Family Physicians Congress of Delegates met in Philadelphia, Pennsylvania from October 14 to 17, 2012. The New Hampshire delegation included delegates Paula Leonard-Schwartz and Lou Kazal, Jr as well as alternate delegates Rob Kiefner and Molly Rossignol. Over the four day meeting, the Congress considered 43 resolutions from state chapters and constituencies, 12 board reports, 9 committee and commission reports, as well as a complete revision of the bylaws. This report summarizes the actions of the Congress of Delegates on the resolutions, many of which were discussed at the September meetingof the NHAFP Board of Directors. Highlights of the new bylaws are included in this report as well. Detailed discussion of all resolutions and reports, as well as copies of all officer speeches, can be found in the Congress of Delegates section on theAAFP website.

Resolutions Adopted:

  • AAFP Policy on Candidate Campaign Activities and Rules (to allow candidates for office to discuss issues within their respective caucus meetings during the COD)
  • Increasing Prominence of the Working Group on Rural Health (to educate AAFP members about the WGRH and to increase collaboration between the WGRH and AAFP commissions)
  • Social Media Guidelines (to develop guidelines for FP’s professional use of social media)
  • New Physician Board of Directors Support (to provide all chapters with funding to send a new physician delegate to NCSC every year)
  • Physician Awareness and Education about Pharmaceutical and Biological Risk Evaluation and Mitigation Programs (to increase FP’s awareness of REM’s and to encourage inclusion of REM’s in e-prescribing and point of care resource products)
  • Improve Medicare Coverage of Mental Health Counseling (to educate FP’s about proper ways to bill “incident to” charges for counseling services provided by marriage and family therapists and licensed professional counselors, particularly in the PCMH)
  • Economic Impact of PCMH on Small and Solo Practices (directing the AAFP to study the economic impact of PCMH on the future viability of practices, particularly small and solo practices)
  • Relief from Rules Governing Diabetic Supplies and Treatment (to seek relief from burdensome and non-value added payer requirements in the prescribing of diabetic supplies)
  • Healthy Foods (to increase availability of healthy foods to recipients of supplemental nutrition programs)
  • Tar Wars 25th Anniversary in 2012 (to formally acknowledge and commemorate the national Tar Wars program on its anniversary)
  • End Age Restrictions on Emergency Contraception (to advocate for EC to be available without prescription to all women of reproductive age)
  • Patient Centered Medical Home (to investigate developing an AAFP PCMH certifying process and to advocate for multiple pathways to achieve recognition as a PCMH)
  • Critical Access Hospitals (to advocate for the preservation of the core concept of CAH’s: improved payments to maintain quality access to care and prevent hospital closures)
  • Increase the Ability of CMS to Change Payment Guidelines for Immunizations without New Congressional Legislation (to allow CMS to pay for immunizations recommended by CDC and ACIP, and to cover under Medicare Part B where applicable)
  • Survival of Independent Primary Care Practices (to develop model legislation to support PCP’s right to collectively bargain with immunity from anti-trust statutes)
  • Declaration of Support for Civil Marriage for Same-Gender Couples (to contribute to overall health and longevity, improved family stability, and to benefit children of GLBT families)
  • ABFM Self-Assessment Module on Advance Care Planning (to urge ABFM to incorporate content regarding Advanced Care Planning into applicable SAM’s)

Resolutions Referred to BOD:

  • Life Members of AAFP (to identify issues of importance to life members)
  • Patient Access to Therapeutics (to investigate a variety of issues about use of DEA numbers)
  • Telemedicine (to study the complex and changing nature of telemedicine)
  • Electronic Medical Records (to consider studying the effects of implementation of EHR on issues such as productivity, practice solvency, and patient safety)
  • Endorse the U.S. Medical Eligibility Criteria (USMEC) for Contraceptive Use (to consider endorsing a clinical practice guideline already endorsed by ACOG;probably will be referred to Commission on the Health of the Public and Science)
  • Antibiotic Resistance, Food Production and Human Health (to consider studying antibiotic use in food production)
  • Ensure Contraceptive and Confidential Health Care for Minors and Adults Insured as Dependants (Reference Committee on Health of the Public and Science actually disagreed with BOD suggestion to “support policies that do promote confidentiality in billing and insurance information” and instead referred the issue to the BOD)
  • Cap on Suboxone Patients (to study issues, such as lack of qualified prescribers especially in rural areas, drug diversion, etc)
  • Veterans’ Access to Healthcare (to encourage VA to cover prescriptions by community physicians for formulary medications; it was felt to be “complicated and requires further study”, particularly as it might further fragment care)
  • Rural/Underserved Physician Tax Credit (to be addressed as part of a comprehensive plan for solving rural physician work force issues)
  • Medical Facility Regulations for Students Shadowing Physicians (to investigate multiple rules impacting students who seek clinical shadowing experiences)

Resolutions Not Adopted:

  • Change of AAFP Membership Fee Structure (to reduce membership dues for physicians in part-time practice)
  • Family Medicine Specific Billing Codes for CMS (to have AAFP develop new CPT codes to be used only by FP’s and to have AAFP be recognized as “the official and exclusive body for establishment of billing codes for preventative and primary care services for Medicare”)
  • Certified Nurse Midwives (to encourage FP’s to develop cooperative and collaborative relationships with CNM’s while removing the wording in current policy requiring physician). New AAFP advocacy paper “Primary Care for the 21st Century” describes physician led teams. Reference Committee felt “the more general approach of defining relationships with all non-physician providers in a similar way and calling for team-based care would better serve patients with safe, reliable and high quality care”.
  • Retention and Availability of CME Participation Records (to require CME providers to report physician attendance directly to a central data repository)
  • Fairness of Transition of the MOC Process (to allow FP’s near the end of their careers to maintain certification for 7 yrs after successful completion of recertification exam, without full participation in the MOC process)

Bylaws

The AAFP Task Force on Bylaws Revision was formed in 2009 to provide a comprehensive review of the bylaws, the first such undertaking since the organization was founded. After several meetings and input from AAFP members, the task force proposed a complete revision of the bylaws, which was approved by the BOD and referred to the COD for its approval. There were several changes approved by the COD:

  • Dues and Assessments. Old bylaws gave authority to BOD to establish dues for all categories of membership, with a cap on active member dues ($450). Proposed bylaws eliminated the cap but still authorized the BOD to set dues amounts. A proposed resolution from Michigan sought to require that the BOD gain the approval of AAFP COD for any dues increase in all membership categories. The Reference Committee on Bylaws recommended a compromise: that dues amounts be established by the BOD but “active member dues shall not exceed any maximum amount that may be established, from time to time, by majority vote of the Congress of Delegates”. This language was accepted.
  • Voting by the Speaker of the COD. The old bylaws permitted the Speaker to vote only in the event of a tie on the floor of the COD. The proposed bylaws removed this option. The Reference Committee, however, recommended that the option to break a tie vote be restored. The COD concurred.
  • Late resolutions. Old and proposed bylaws were not clear on who (delegates or chapters or members) could submit late resolutions and when (at the opening session of COD or before each business session). The Reference Committee recommended clarifications: any member or chapter may submit a late resolution up to one hour before the opening session of the COD but any delegate may submit a late resolution up to one hour before each day’s business session of the COD. These changes were accepted, as were the remainder of the proposed bylaws with a few minor changes.