Lessons From Chapter Victories

It’s a principle we often preach: Storytelling is vital to our advocacy. The advances AAFP chapters charted this year demonstrate yet again what happens when family physicians plainly communicate to lawmakers the needs of their practices and their patients. You can see the results on the AAFP’s state advocacy page, where new highlight videos outline some of these wins, a report details them, and updated resources can help chapter executives plan ahead.

Among the most noteworthy accomplishments this year were

• the Florida chapter working to ensure that the 2023-24 state budget addressed physician workface challenges,
• the Oklahoma chapter decisively holding the line against advanced practice registered nurses seeking prescriptive authority, and
• the Michigan chapter securing a boost to Medicaid payment.

Each of these wins reflects our narrative about the importance of family medicine to every community’s health. But what other tactics went into our chapters’ fight for family medicine this year? I talked with the executives from the chapters listed above to find out what they did and how they did it.

Have the Data, Use the Data

When APRNs made their push to write prescriptions — a scope-of-practice fight unfolding in numerous states — the Oklahoma Academy of Family Physicians turned out to know more about the issue’s local impacts than the other side did, chapter EVP Kari Ames Webber told me.

“They were claiming their members were paying exorbitant fees to supervising physicians and that those clinicians weren’t actually providing supervision,” she said. “They also said that the prescriptive authority they sought would solve the state’s rural health care crisis.

“We asked to see data on these: Who was charging these fees? Where were the state-level numbers and names? We asked for a number of claims filed against supervising physicians. There were none. Where were the APRNs doing primary care in underserved areas? They had national talking points but not localized data. Exposing this gap was a win by itself.”

And rural health?

“We used Colorado as a counter example about that,  because it has a similar layout in terms of a few bigger cities and more rural areas,” Webber said. “Colorado granted prescribing authority to non-physician clinicians more than a decade ago, but the map of underserved populations has not changed.”

Negotiating Is Part of the Fight

All of the above proved persuasive to legislators, but so did the OAFP’s willingness to talk with APRNs and, perhaps, find a compromise.

“Among the reasons we won is that we were more willing than anyone else to come to the table, not just with facts and data but with solutions, including possible concessions,” Webber said.

“The other side wasn’t willing to budge but also couldn’t refute our narrative, our facts and data. We just kept coming to meetings, including with the bill’s author, with solutions. We were able to say that this ultimately wasn’t about cost, lack or supervision or working in primary care — which really resonated with lawmakers.”

Play the Long Game

When I asked Karlene Ketola, CEO of the Michigan Academy of Family Physicians, to characterize the work that went into securing a boost to Medicaid primary care payment, she pointed back six years.

“First proposed in the fiscal year 2017-18 budget but not included in its final passage was a 6% increase to Medicaid reimbursement for primary care services,” she recalled. Then came COVID-19, which exacerbated the problem of low reimbursement. Eventually, the fiscal 2023 budget included $15 million to increase Medicaid payment for certain primary care services to a minimum 95% of Medicare rates.

This added up to a prelude to this session’s victory: a 7.5% increase in state Medicaid payment for primary care services for the next fiscal year, beginning Oct. 1. And it evolved from years of members putting themselves in front of lawmakers to make a sure, steady case.

“This was one of our legislative asks for our advocacy day the past two years,” she told me. That consistency paid off, she added, when “the first Democratic trifecta in 40 years” allowed swift legislative support for Gov. Gretchen Whitmer’s budget recommendations — which already reflected the chapter’s priorities. 

“There was a clear understanding from legislators that the health care workforce needed more support from the state following the COVID-19 pandemic, and a Medicaid rate increase was long overdue,” Ketola said. “It was also helpful that the primary care rate increase was tied in to increases for other providers and services, making it a larger, concerted effort across the board.”

That workforce advocacy showed up elsewhere in the state’s budget: The Michigan AFP helped ensure inclusion of $6.4 million to expand residency positions in primary care and other high-need specialties to retain physicians in underserved areas of the state.

Build and Nurture Relationships

The Florida chapter, meanwhile, notched three big budget wins: $16 million for medical loan repayment in 2023 and 2024 for primary care physicians practicing in rural areas, $30 million for enhancing GME funding for residency positions and a $76 million increase in funding for Medicaid pediatric care.

“The state had greater-than-expected tax revenue, and Senate leadership wanted to show its support for the physician workforce, which allowed us to strike while the iron was hot,” Jay Millson, the chapter’s executive vice president, told me.

“The statute for that repayment program — the Florida Reimbursement Assistance for Medical Education program  — had existed 20 years without being funded,” Millson said. “We pushed to finally get that done because we saw the opportunity. We knew addressing debt could go part and parcel with funding GME slots.”

The GME program, which Florida calls “Slots for Doctors,” provides incentives for hospitals and federally qualified health centers to increase residency positions. As funding rolls out, Millson says, the FAFP will work with the Florida Department of Health and the state medical association to ensure that money goes to family medicine residencies, particularly in rural areas.

This moment doesn’t arrive from nowhere, Millson says. As the other chapters I’ve mentioned here told me, opportunities are easier to leverage when the relationships are already there.

Build Coalitions

Successful advocacy often requires strategic unity among groups whose goals may not always be the same.

“We do work with the state medical association when our aims are aligned,” Millson told me. “That happened with a successful push we made this session on that Medicaid budget item. It means some $76 million will be allocated to ensure Medicaid-to-Medicare payment parity for pediatric care, including by family physicians.” 

“We know when we and other medical societies are fighting for similar things and how to strategize together cohesively when it makes sense,” Webber agreed. In the effort to maintain appropriate scope for APRNs, she said, her chapter worked with the Oklahoma Osteopathic Association and the state medical association.

“We’re consistent in our priorities and consistent in our willingness to have hard conversations,” she added. “Beyond the legislative session, we meet with boards and keep up the conversations.”

Keep Telling the Story

“We had incredible physicians sharing their stories,” Webber said of the members who helped rally to defeat the APRN push. “It was especially compelling that they could talk about not charging supervision fees to the APRNs in their practices while describing instead the strong relationships among their care teams.”

“Our legislature understands the physician shortage, and we have a lot to do with that,” Millson said. “We have good relationships with lawmakers, particularly among our key contacts and our PAC. The legislative session is 60 days, but at least 15 of those days we’re sending members to make connections and meet and tell their stories.”

Get Involved

You don’t have to follow politics or research policy to join your chapter’s advocacy. As a practicing family physician, you’re a uniquely valuable constituent to your elected officials, and you’re an expert in something every lawmaker needs to know about: the needs of your practice, your patients and your community. The AAFP has several ways to help get your voice heard. Learn more on the AAFP’s Grassroots Advocacy Resources webpage.

Oh, and save the date for next spring’s Family Medicine Advocacy Summit, where AAFP members align with colleagues in their chapters for face-to-face conversations with members of Congress about the Academy’s top legislative priorities. You don’t have to bring any policy expertise or advocacy experience to FMAS, but you’ll leave with both.