GAFP’s Congress of Delegates Additional 2015 Resolutions & Information

The Georgia Academy of Family Physicians would like you to participate in the 47th Annual Congress of Delegates.  There will be a call on October 20 at 6 pm where all members are invited to listen in and discuss the policy deliberations.  Time and call in information will be announced in the next newsletter.  We would like for all members to participate.

Please plan to be on this call as we would like for you to voice your opinion on the resolutions being presented.

The request for resolutions deadline has passed and therefore these are the final resolutions.

1.     Universal Vaccination

Submitted by: Willard A. Snyder, Jr., MD

Whereas, Vaccination is an important Public Health issue;

Whereas, Improving vaccination rates is a universal goal of the CDC, CMS, AAFP, GAFP and most (if not all) health insurers;

Whereas, The provision of vaccinations at the doctors’ offices is becoming less and less common and more and more difficult due to costs, rules and regulations of storage by various organizations and numbers and sources of vaccine;

Whereas, Rhode Island has had a successful Universal Vaccine program for nearly 20 years saving the state millions of dollars;

Therefore be it Resolved that, the GAFP Board of Directors be tasked with advocating, promoting and requesting legislative changes required to make possible Universal Vaccinations for Children and Adults whereas physicians get vaccines for free from a single source (paid for by others) and be paid for provision of the vaccines,

And, be it Further Resolved that, the rules and regulations for storage be based on hard science, not recommendations of the ideal storage solution (minimum recommendations not maximum) and documentation be easy.

2.     Redistribution of Congress of Delegates District Delegates

Submitted by:  Drs. Loy “Chip” Cowart, Speaker, Congress of Delegates and Michelle Cooke, Vice Speaker Congress of Delegates 

Whereas, the Congress of Delegates has not had a full delegation of active members of 90 delegates since 1999 but rather a range of 50 to 75 has been the average attendance;

Whereas, the Family Medicine Residency Programs have not sent more than 5 resident delegates since 2010;

Whereas, the Family Medicine Interest Groups have not sent more than 5 students from each school in as many years;

Whereas, GAFP staff and COD leaders average 100-200 business hours annually to secure district quorums;

And whereas, the GAFP Bylaws in Chapter 8, Section 7 states: The Congress of Delegates having at least one member from each district shall constitute a quorum at any meetings of the Congress.

Let it be Resolved that, the Congress of Delegates move to a full delegation of up to 70 active members such that the new Bylaws language will state in Chapter 8, Section 2: The total number of delegates in the Congress of Delegates shall be up to 70;

And, let it be resolved that, the Family Medicine Residency Programs consider a full delegation to be up to 2 resident members and 2 alternate resident members collectively from the Georgia residency programs with elections by resident members if needed;

And let it be Resolved that, the Family Medicine Interest Groups move to a full delegation of 2 student members and 2 alternate student members from the total of the medical schools in the state at their various locations with elections by student members if needed;

And, let it be further Resolved that, this new COD composition be effective beginning the 2016 Congress of Delegates.

3.     AAFP should immediately stop trying to deny law abiding citizens of their Second Amendment Rights

Submitted by: Phillip Kennedy, MD

Whereas, the AAFP claims to be an evidence-based medical society;

Whereas, according to FBI crime statistics, rifles, much less “assault rifles”, are NOT commonly used as murder weapons;

Whereas, our membership has many differing opinions on this issue and this issue is not part of the AAFP’s core mission;

Whereas, the second amendment of the US Constitution guarantees the right to bear arms;

Resolve that, the AAFP should immediately stop its involvement in any program that attempts to deny the legal ownership of guns to law-abiding citizens;

Resolve that, the AAFP should show real leadership in our nation’s dialogue about violence and murder by changing the conversation to our culture’s lack of respect for life and away from the focus on inanimate objects such as guns;

Be it further resolved, that the AAFP would always avoid getting into emotional debates that are void of real evidence.

4.     Estimated Radiation Dose

Submitted by Marc S. Berger, MD

Whereas,patients are now often subject to numerous radiographic studies involving ionizing radiation, often at more than one facility;

And whereas, there is legitimate concern of delayed adverse effects of cumulative radiation exposure;

And whereas; it is technically and practically feasible to estimate the radiation dose for any given radiologic study, and this calculation may not create a new, excessive burden on radiologists to include an estimated dose in their official reports;

And whereas, family physicians, and other primary care providers, particularly in the setting of the Medical Home are able to compile and maintain data on each patient’s estimated radiation dose;

And whereas, it has been seen that this data has been included by other organizations in their reports;

Be it Resolved that, the GAFP, (with a recommendation to the AAFP-perhaps by resolution to the COD), the AMA, and the American College of Radiology) formally requests that each radiographic study (x-ray) that involves ionizing radiation have the estimated dose of radiation absorbed (Rads or cGrays) published in the body of the radiologist’s report.

5.      Opposition to The ABFM Maintenance of Certification Diploma

Submitted by Marc S. Berger, MD

Whereas, the ABFM now gives a Diploma to Board Certified Family Physicians, which does not have a defined period of board certification; the ABFP now believes that physicians should go through stages every 3 years;

And whereas, the previous Certificate, whether it be the old 7-year or the new 10-year certificate was accepted as proof of Board Certification (subject to secondary verification if desired by credentialing agencies); but without an expiration date, the Diploma is no longer useful for credentialing;

And whereas, the stages of MC-FP in reality require you to be re-Board Certified (but without necessarily taking the formal computer examination) every 3 years;

And whereas, the ABFM has planned a yearly process (checking with their Website on February 15 yearly) for Diplomates and credentialing institutions to re-verify their credentials (this is not standard operating procedure for the various credentialing authorities), effectively leading to a one year Board Certification period;

And whereas, the ABFM may withdraw a Diplomate’s status due to incompletion of all the prerequisites of a stage of Maintenance of Certification, leading to a large number of unanticipated problems (see exhibit 2, letter from ABFM explaining the new Certificate);

Be it resolved that, the Georgia Academy of Family Physicians strongly opposes this Diploma certificate without the defined term of being Board Recertified, and requests that the ABFM rethink this aspect of their new Maintenance of Certification policy.

And be it further resolved that, the GAFP convey this request to the AAFP by COD resolution.

6.      Resolution to GAFP: Presumptive/Preliminary Diagnosis Modifier

Submitted by Marc Berger, MD

Whereas in the upcoming ICD-10 system for coding medical diagnoses, if a diagnosis is not definitive, finalized, certain or proven, the coder is nevertheless instructed to code the presumptive, or differential, or working diagnosis as if it is a final diagnosis. This creates permanent linkages to that patient and that diagnosis, even if it is later found to be incorrect. There may be significant consequences to being linked to a specific diagnosis (think “diabetes”) that may be unintended by the diagnosis coder. Once a patient is linked with a diagnoses, there is no way in the future to retract that diagnosis from their medical record or database. A preliminary diagnosis may have unintended, inadvertent consequences, particularly when it is in a searchable electronic database, such as an Electronic Health Record. For example, when an order for a laboratory test is requested, a diagnosis must be included, and often this preliminary diagnosis is used to order a test that will rule out that diagnosis, but the electronic database has no way to know that, and the association of that patient with that diagnosis cannot be withdrawn. Although EHR programs may be able to cancel diagnoses, billing, laboratory and governmental databases cannot have historic diagnosis entries modified after the fact. Future electronic queries and searches will forever associate that patient with that diagnosis on that date;

And whereas electronic databases record all diagnoses as final, even if it is only a preliminary diagnosis, yet there may often be significant stigmata and potential health concerns to attaching a preliminary diagnoses to a part of an electronic record/database, and there is no way yet to retract a misdiagnosis from a database;

Insurers usually insist on an ICD9 or ICD10 diagnosis as justification for performing services that are coded by procedure codes, such as HCPS or CPT.  These other coding mechanisms do have ways to employ modifiers.  It may be important to the patient and physician to electronically flag a diagnosis as “preliminary” if it is attached to a procedure code.

Be it resolved that the GAFP request, by similar resolutions and correspondence, that the AAFP, AMA and CMS (through their HCPS coding system), develop policy and create a new modifier code to flag that the procedure code associated with that diagnosis is preliminary.

 And, be it resolved that a new Modifier,  “-PD”,  or a similar code or number, be incorporated in the 2017 CPT and HCPS coding schemes to flag that the diagnosis associated with that code is “Preliminary” or “Presumptive.”

And, be it further resolved that the WHO be requested (through our medical representatives) to allow a “Presumptive Diagnosis” modifier to be incorporated into ICD11, to likewise record in the database that the diagnosis is not a final, definitive diagnosis.

7.      Telemedicine Standard of Care

Submitted by Marc S. Berger, MD

Whereas, many aspects of medical services require a multitude of medical components to make up the proper Evaluation and Management of a patient with a particular complaint or diagnosis;

And whereas, the Physical Examination is often an essential part of the assessment;

And whereas, telemedicine and physician telepresence services do not yet have the necessary capability of replacing a physician for many aspects of physical examination or appropriate real-time laboratory investigation;

Be it Resolved that

1.)    It shall be the Policy of the AAFP that:

For a medical service, where customarily specific components of the Evaluation and Management services require the physical presence of the physician (such as for physical examination), telemedicine or telepresence does not meet the standard of care.

2.)    Likewise, the AAFP should present this policy to the AMA and other specialty societies for consideration as their own policy.

8.      Resolution for New CPT Code: Detailed Medical Data Review

Submitted by Marc S. Berger, MD

Whereas, much of medical analysis and management now occurs outside the presence of the patient, such as extensive review of other physicians’ electronic records, home monitoring data/blood pressure/symptom diaries/diabetic blood sugar logs, etc., that take a significant amount of providers’ clinical time, and are not adequately compensated, because they are not “face-to-face,”

And whereas, for management of homebound patients by the supervision of home health agencies now is compensated on a time basis, (HCPCS G0181), at least by Medicare, without the requirement for “face-to-face visits”,

And whereas, electronic, as well as paper, lab, radiology, other providers’ medical records, and other electronic data exchange information (such as the CCD) requires extensive time for effective medical review, that cannot be performed by anyone other than the treating clinician who is directly managing the patient’s care, especially with a goal toward coordinating care and administering a “Medical Home”,

And whereas, other learned professions, specifically the attorneys of the legal profession, do bill for review of legal matters,

And whereas, there is presently no CPT code for review (without the Evaluation and Management components) of electronic/paper data, and yet physician review of outside data is essential to excellent medical care of that patient;

Be it Resolved that the GAFP will recommend, by a resolution to the AAFP and the AAFP Board of Directors, that the AAFP create a policy of recommending compensation, on a time basis, for the detailed Physician review of patient medical information that does not require a “face-to-face visit”;

Be it Further Resolved that the AAFP delegation to the AMA (and the AAFP leadership) will formally request the creation of a new CPT code: Detailed Review of Medical Record Data.

9.     A resolution from the Bylaws Committee with 2015 updates was already posted.

Click here to review: https://www.gafp.org/proposed-bylaws-changes-2015-gafp-congress-delegates/.

10.  Resolution: Georgia Medical Licensing (External)

Submitted by Chetan Patel, MD

Whereas physicians from Medical Schools Recognized by the Medical Board of California (MSRMBC) can apply for a Georgia medical license through the Georgia Composite Medical Board after one year of post-graduate medical education and,

Whereas physicians from all other graduate medical education programs must complete three years of post-graduate medical training prior to submitting a licensure application and,

Whereas post-graduate medical training is wholly different in form and function from graduate medical education and,

Whereas differences in medical education quickly become superseded by similarities in post-graduate medical training and,

Whereas family medicine residency training last only three years and,

Whereas the ability to moonlight in the third year of residency is a critically important tool to the ongoing development and maturation of family physicians in training and,

Whereas expanded experiences and opportunities for third year family medicine residents will allow more rural Georgians to receive the care they desperately need closer to their homes and therefore increasing access to care and satisfaction with the care provided,

Be it resolved that the Georgia Academy of Family Physicians will advocate for a rule change which grants physicians from graduate medical program apart from the Medical Schools recognized by the Medical Board of California (MSRMBC) to apply for a medical license from the Georgia Composite Medical Board after completing two years of post-graduate medical education.