LEONARD FROMER, MD is a CAFP past president and, as senior delegate to AAFP's Congress of Delegates, continues to serve on CAFP's board of directors. He practiced family medicine at the Prairie Medical Group in Santa Monica for 21 years before becoming a private consultant in 2004. CFP recently caught up with Dr. Fromer to discuss issues of importance to all family physicians.

How do you define the "medical home?"  What are your thoughts for making this a reality?

The medical home is truly what family medicine means. It is where patients and their families can find comprehensive care for all of their health care needs. It is the intersection of clinical medicine with the psycho-social, work and school issues surrounding the health and well-being of our patients. It includes patient self-management combined with cutting edge technology and our traditional values of "high touch" to bring evidence-based care to each and every one of our patients.

We not only need to advocate tirelessly for the medical home to be included as a feature of every health plan, and for family physicians to be paid appropriately to provide medical home services, but also to ensure that on the family medicine side, we're fully equipped and prepared to provide those services, thanks to practice re-design.

What needs to happen to improve the payment disparities between family docs and sub-specialists?

There are two approaches to improving the current inequities by specialty. First, we must advocate for changes within the existing RBRVS (resource-based) payment system to reward and value evaluation and management CPT codes. Second, the time has come for family medicine to undertake direct contracting with buyers of health care coverage (employers, federal and state government and patients) to receive payment for quality and patient satisfaction. This takes the form of pay-for-outcomes. Metrics that appropriately reward the delivery of value and quality defined by patients and physicians, not insurance companies, are long overdue.

How can small physician practices adopt practice improvement recommendations without shouldering too much of the financial burden?

Every family physician can make substantive changes in his or her practice and achieve re-design around the new delivery model of patient-centered, evidence-based care. It is as possible in a solo practice as in a large, vertically integrated group practice. The key is scalability. We must re-invent what works and makes sense for the work flow needs of our practices and the clinical needs of our patients.

Investing modest resources can achieve substantial results. The key to affordability lies in the payment-for-services paradigm. In the current, broken RBRVS system, any successful re-design that works will lead to substantial savings in the medical loss ratio, especially for patients with high-cost chronic diseases. Without a new payment system that rewards performance improvement, those savings will add to the already rich bottom lines of the health insurers. Contracts that reward quality and patient satisfaction not only make practice re-design affordable, but give FPs a tremendous opportunity for financial success by distinguishing themselves as the most comprehensive sources of care.

The number of medical students choosing careers in family medicine has seriously declined. How can we change this?

The solution lies in improved compensation and quality of life for those who choose our specialty. As I have outlined above, if we fix the payment problem, create a true medical home and re-invent the workflow processes in our practices, the world will beat a path to our door. In that environment, medical students will flock to family medicine because of the rewards it can offer.

By the same token, we need to work proactively to ensure that tomorrow's family physicians - today's students - accurately reflect the face of America. That means we must actively recruit ethnic and racial minority students who speak the languages and reflect the cultures of the diverse patient populations in our state.

It's been my honor for the past six years to co-chair The California Endowment's Medical Leadership Council on Cultural Proficiency (MLC), which is convened by CAFP. I'm very excited about the work we've done, especially now that we're turning our attention to looking at best practices for recruiting students interested in medical careers at the high school and undergraduate levels. I recently authored an article on the work of the MLC in Southern California Physician.

For information on Dr. Fromer's campaign, visit www.fromer-aafp2007.org.