Our Positions

HPV Vaccine Mandate


Family physicians cite unanswered questions

The Wisconsin Academy of Family Physicians (WAFP) said today that while it supports use of the HPV vaccine Gardasil, critical questions about the new vaccine’s safety, supply and cost must be answered before the group will support mandated vaccinations. The organization suggested a state health rule be considered in lieu of a legislative mandate. The vaccine was approved last year to protect girls and young women from a sexually transmitted virus called HPV, or human papillomavirus, which can cause cervical cancer and genital warts.

“While studies suggest that Gardasil may be a major step forward in cancer prevention,” said John Brill, MD, president of WAFP, “we don’t believe it should be required until the long-term safety of the vaccination is clearly evident.” Brill said family physicians support the use of the vaccine as an effective tool in reducing the risk of cervical cancer and genital warts, but believe the choice of whether to use an immunization drug that has been approved for less than a year should be a decision made by doctor and patient.

“Wisconsin has traditionally taken a long-term, thoughtful approach to mandating vaccines,” Brill said. “We believe that should be the case with Gardasil, and suggest that it go through the rule-making process at Wisconsin’s Department of Health and Family Services, rather than legislatively, to provide more time for input and development. This is a very significant vaccine that could save many lives and improve the quality of others, and it's important that the process be done right.”

Family physicians are also concerned about supply and cost, according to Brill.

“If the vaccine is mandated, we need to make sure public health departments and physician offices across Wisconsin have enough supply to meet demand for the three shot series required for proper vaccination,” said Brill. “With many states considering a vaccine mandate, there is no guarantee of enough vaccine to go around. Some communities around the country have already reported shortages, without a mandate.”

Brill said the vaccine is expensive and that the costs associated with mandating its use could exceed currently available funding. “We support coverage of the vaccine by the state and private insurers, and we encourage our members to discuss it with their patients.”

Gardasil was approved last June for girls and women aged 9 to 26. It reduces the risk of two HPV strains believed responsible for about 70 percent of cervical cancer cases, and two other strains that cause 90 percent of genital wart cases.

Patient Compensation Fund


Family physicians urge legislators to protect Patient Compensation FundAs the Wisconsin Academy of Family Physicians, our 1,700 members caution state legislators to closely guard the integrity of Wisconsin’s Injured Patients and Families Compensation Fund. Tampering with the Fund will take money from patients while jeopardizing access to health care, by the inevitable creation of a shortage of physicians.

Wisconsin law clearly states the Injured Patient and Families Compensation Fund is to be “…held in irrevocable trust for the sole benefit of health care providers…and proper claimants.” The Fund contains patient money - not tax money. It is money contributed by doctors to pay liability claims from injured patients. By keeping the proper reserve available, patients are assured money is available to pay liability claims not covered by insurance. When the Governor proposes taking $175 million dollars from the Fund, he is taking money from the pockets of the sick, the injured, their families and dependents.

This is the third effort by the governor to divert patient compensation money for state spending, a move that may be illegal, because state law stipulates the money be held “…in irrevocable trust for the sole benefit of health care providers…and proper claimants.”

Despite that wording in the statutes, the governor attempted to divert $200 million from the Fund in 2003 and $180 million in 2005. Both efforts were soundly defeated by lawmakers, who agreed with the statute: the Fund should be untouched. State legislators should react the same way today. The Fund must not be used to balance the state budget.

The fact is the fund is not tax money. It is money contributed by doctors to pay liability claims from injured patients. By keeping the proper reserve available, patients are assured money is available to pay liability claims not covered by insurance.

The Legislative Audit Bureau, in its report of March 22nd, confirmed the Fund is at the optimum level required to provide critical protection for patients. The audit bureau was realistic when it stated “Both the uncertainty and long-term nature of medical malpractice claims make it difficult to predict the size and timing of claims that will be settled and paid from the Fund.” There is no crystal ball. Because no one can accurately predict future liability claims, the level of money held in the Fund must be estimated. In its report, the Legislative Audit Bureau repeated a 2005 actuarial audit conclusion: “…the Fund’s loss liability estimates were reasonable, although conservative.” In short, there is no additional money in the Fund. Taking money out of the Fund would endanger patient protection.

A secondary issue of reducing the Injured Patients and Families Compensation Fund is the potential impact on the quality and cost of Wisconsin health care.

Wisconsin initiated the Fund in 1975 to offset rising costs of medical liability insurance premiums. The Fund works. Wisconsin is now one of only 7 states not facing a medical malpractice crisis.

Experts predict that with no Injured Patients and Families Compensation Fund, Wisconsin medical liability premiums could jump from an annual average of $15,000 to more than $80,000, causing physicians to reduce services, close clinics, retire or move to other states.

States with higher medical liability premiums and higher medical malpractice awards have a more difficult time recruiting physicians, especially those in high-risk specialties such as surgery and obstetrics.

States with higher liability premiums are less likely to attract new doctors. About half of the country’s medical students list the cost of liability insurance as a key factor in determining medical specialty. Wisconsin does not want to be a place where new doctors refuse to practice.

States with higher premiums inevitably have higher health care costs.

And states with higher medical liability have exacerbated shortages of medical care in underserved communities, particularly those with lower income populations.

A primary mission of the Wisconsin Academy of Family Physicians is to improve everyone’s access to affordable healthcare. Clearly, a reduction in the Injured Patients and Families Compensation Fund would cause a decrease of physician services, a sharp reduction in the quality of health care and further increases in health care cost to everyone in Wisconsin.

Such a situation is preventable.

Legalization of Concealed Weapons

WAFP Position Paper on Legalization of Concealed Weapons

The WAFP opposes the legalization of the use of concealed weapons by the citizens of the State of Wisconsin.

According to testimony before the Judiciary Committee, Wisconsin is one of six states that does not have legalization for the carrying of concealed weapons. It is also one of the safest states in the nation with the 5th lowest incidence of violent crime in the U.S. If the state legislature is to pass legislation that promotes use of concealed weapons for personal protection, it should be done with clear and inarguable evidence that such laws would decrease the incidence of violent crime, while not putting the citizenry at additional risk. To make a change in law that has stood for 130 years in this state should be a decision based in fact, rather than emotion and opinion.

To this point, no such clear and irrefutable evidence exists. Advocates for this change who testified at Judiciary Committee hearings quoted the publications of John Lott, a University of Chicago law professor. Other scholars on this subject have criticized this research for both its content and methodology. (New England Journal of Medicine 339:2029-2030, Book Review of D. Hemenway, PhD. More Guns, Less Crime: Understanding crime and gun-control laws. Making a Killing: the business of guns in America.) The Judiciary Committee also heard from others who gave emotional testimony of their own victimization and their opinion that these tragedies would not have been perpetrated were they to have been armed with a gun. Testimonials of the benefit can be matched with examples of harm. The legislature instead must rely on evidence in this decision.

The evidence noted in several articles in recent medical literature is worthy of the legislature’s attention.

The Wisconsin Research Network Firearm Safety Survey was published in the July 2003 Wisconsin Medical Journal. This survey was done in eleven widely disbursed clinics in large and small Wisconsin communities. Responses were received from nearly 1,000 individuals who were asked about the types of firearms kept in their homes, for what purpose these firearms are kept and specifically, how these firearms are stored in their homes. We learned that firearms are commonly kept in the homes of our patients, with 60% of respondents reporting firearms ownership. This compares to 25% of adults reporting gun ownership in national telephone surveys. We learned that individuals reported keeping guns for personal protection more commonly if they lived in larger cities. Handguns were more likely to be owned, if firearms were kept for protection. And lastly, we learned that firearms are far more likely to be kept in an unlocked and/or loaded condition, when kept for protection. Typically firearms that are kept for hunting, target shooting, or other recreational activities are maintained in a safe condition in the homes of their owners.

Legislation intended to promote use of guns for personal protection would appear to raise the risk for increasing the numbers of households with guns kept in unsafe storage. Is the education and training requirement for licensure to carry concealed weapons a guarantee for safe storage? The research of this question shows discouraging results from such education. A telephone survey was done in Massachusetts gun owners who had extensive safety instruction as part of their firearm purchase. 21% of these recently educated consumers kept their firearms loaded and unlocked. These same authors reported that guns kept for protection correlated with handgun ownership and unsafe storage, similar to the observed pattern in the Wisconsin Reserch Network Firearm Safety Survey. ( Sanguino MS, Dowd MD, McEnaney SA, Knapp J, Tanz RR. Handgun safety: what do consumers learn from gun dealers? Arch Pediatr Adolesc Med. 2002; 156:777-780) Also, the current bill does not restrict individuals licensed in other states to carry concealed weapons, even if that state has no similar education or training requirement.

The consequences of unsafe firearm storage go beyond the examples of accidental shootings. An article from the March 7, 2003 Morbidity and Mortality Weekly Report which is published weekly by the Center for Disease Control looked at the source of firearms used by students in school associated violent deaths between the years 1992 and 1999. The predominant source (over 60%) of firearms associated with these homicide and suicide deaths were firearms kept in the homes of the perpetrator’s parents or in the homes of friends and family members. Specifically, these were firearms stored in unsafe unlocked or loaded conditions. This article documents that students generally do not go to the street to buy firearms when contemplating these very disheartening, impulsive acts of violence.

The CDC has provided considerable insight into the impact of violence on the lives of students. Nationwide, 6.6% of students report missing one or more days of school during the previous month for fear of violence. In Wisconsin 13.3% of high school boys reported carrying a weapon at some time during the previous month; 4.8% reported those weapons to be guns. (Youth Risk Behavior Surveillance – United States, 2001. Supplement to MMWR June 28, 2002; 51/No. SS-4) Does the Wisconsin State Legislature really want to pass laws that might increase the risk of giving access by adolescents to unsafely kept firearms?

The proposed legislation gives very few restrictions to where concealed weapons might be carried. The right of property owners or businesses to restrict guns from their premises is apparently overridden by the gun owners right to carry the concealed weapon. It would also appear that employees have a right to carry concealed guns to their workplace over the objection of their employer. Can this be appropriate safe public policy?

The cost of education and training for licensure is a matter of fiscal impact that is not considered in the bill. The mechanism to accomplish background checks is not addressed satisfactorily, nor who will pay for these checks. Should this law not allow for retrieval of licensure from individuals who develop findings of mental instability or who may become involved in domestic incidents of threat or violence? Who would be responsible for reporting such changes in the status of the licensed individual? Do the people of the State of Wisconsin want to absorb the cost of still another government bureaucracy to administer this change of law?

The current legislation also does not address the issue of civil liability of gun owners if a bystander is injured by use of a concealed weapon or if an accident occurs. The liability of the gun owner if an unsafely stored firearm is taken and used in an act of violence must be reinforced. The concept of mandatory liability insurance for civil actions brought against gun owners is a necessary corollary to this legislation if it is to be passed, similar to the concept of mandatory automobile insurance coverage in this state.

Policies to regulate for safety of firearms were subject of national surveys. The authors of this work report broad public support even among gun owners for these safety strategies. (New England Journal of Medicine 339:813-818) Clearly the legislature owes the electorate a responsible review of this material before jumping to this personal protection legislation with its uncertain public heath consequences.

On July 8, 2011, Wisconsin Governor Scott Walker signed Senate Bill 93 – known as the Concealed Carry bill – into law as 2011 WI Act 35. The new law took effect on November 1, 2011. WAFP has prepared a Q&A to help you answer what does Conceal Carry mean for Wisconsin Physicians?

Recognition of Family Physicians Under Current Mental Health Law

Recognition of Family Physicians under Current Mental Health Law

Family physicians support the goal of improving coverage for mental and addictive disorders. We appreciate your involvement as part of the special study committee reviewing the issue of mental health parity.Previous legislative efforts in this policy area have focused on mandating insurance coverage for mental health services of only a small core group of mental health providers whose services are to be covered by insurers: psychiatrists, psychologists, hospitals and state-certified outpatient clinics. Family physicians are mental health professionals who are not recognized under current law.

Instruction in the prevention, diagnosis and management of mental health disorders, in the individual and family context, is an integral part of family medicine residency training and continuing medical education, as well it should be, considering that approximately 60% of patients with mental disorders seek treatment from primary care physicians. According to a report by the U.S. Preventative Services Task Force released last May, five to nine percent of adult patients in primary care settings suffer from depression and up to half go untreated.

Family physicians use their mental health care skills and knowledge as well as their ability to effectively relate to patients and influence patient adherence to mental health treatment recommendations. The continuity of care inherent in family practice places them in a unique position to promote the mental health of individuals and families. They have the responsibility for early detection of mental illness, treatment of metal illness and consultation or referral for those patients who require more specialized care.

The majority of people with mental illness or substance abuse problems can return to productive lives if their illnesses are treated. Unfortunately, many patients who need treatment for mental illness do not seek it, either out of ignorance or the fear of being stigmatized as mentally ill. A patient may often be willing to accept care from a known and trusted primary care provider but be unwilling or unable to seek out care from the limited number of available mental health specialists. Such specialty-only care can result in delays of treatment and increased medical expenditures. It is more cost effective and better overall for the health care system to have family physicians providing the first level of care for mental health problems. Moreover, even for those with more serious disorders, the family physician can play a key role in coordinating patients' care and working with their families.

Studies suggest that providing mental health services to medical patients can either reduce or offset subsequent medical utilization and their associated costs. The utilization of specialty only mental health care not only requires a patient to seek out such care (which many are unwilling to do due to the previously mentioned stigma), but results in increased medical expenditures through referrals by family physicians to a psychiatrist or other provider covered by insurance. It is more cost effective and better overall for the health care system to have family physicians providing the first level of care for mental health problems. Moreover, even for those with more serious disorders, family functioning and coordination of these patient’s overall care with other specialists is a key role played by the family physician.

If mental illness is truly to achieve parity and be regarded as any other medically treatable illness, the time has come to correct the oversight in our current health law and treat family physicians the same way we treat other mental health professionals. Thousands of patients could benefit from being able to receive covered mental health services from their family physician. Equally important, the health care system and insurers could benefit from the cost savings.

The assignment of the Legislative Council Special Committee on Mental Health Parity provides an opportunity to improve access to mental health services. Failure to make this investment now could result in far higher costs to our health care system in the future, but more importantly, many mental disorders that could have been handled by a family physician will go untreated. If this occurs, the human toll, as well as the financial toll, will steadily increase.

Please consider including family physician care of mental and substance abuse problems among those providers’ services to be covered by health insurance plans in any legislation subsequently recommended by the Committee.

WAFP’s Principles for Reform of the U.S. Health Care System

The Principles for Reform of the U.S. Health Care System call for the following actions:

  1. Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.

  2. The health care system in the U.S. must provide appropriate health care to all people within the U.S. borders, without unreasonable financial barriers to care.

  3. Individuals and families must have catastrophic health coverage to provide protection from financial ruin.

  4. Improvement of health care quality and safety must be the goal of all health interventions, so that we can assure optimal outcomes for the resources expended.

  5. In reforming the health care system, we as a society must respect the ethical imperative of providing health care to individuals, responsible stewardship of community resources, and the importance of personal health responsibility.

  6. Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.

  7. Cost management by all stakeholders, consistent with achieving quality health care, is critical to attaining a workable, affordable and sustainable health care system.

  8. Less complicated administrative systems are essential to reduce costs, create a more efficient health care system, and maximize funding for health care services.

  9. Sufficient funds must be available for research (basic, clinical, translational and health services), medical education, and comprehensive health information technology infrastructure and implementation.

  10. Sufficient funds must be available for public health and other essential medical services to include, but not be limited to, preventive services, trauma care and mental health services.

  11. Comprehensive medical liability reform is essential to ensure access to quality health care.

    The above Principles are endorsed by:
    • American Academy of Family Physicians
    • American Academy of Orthopedic Surgeons
    • American College of Cardiology
    • American College of Emergency Physicians
    • American College of Obstetricians and Gynecologists
    • American College of Osteopathic Family Physicians
    • American College of Physicians
    • American College of Surgeons
    • American Medical Association
    • American Osteopathic Association

Additional Principles adopted by Wisconsin Academy of Family Physicians:

  1. Reimbursement reform should recognize changes in providing health care services consistent with the Medical Home concepts

    • Any comprehensive health care reform needs to emphasize the patient-centered medical home. The patient-centered medical home delivers the safest and highest quality care of any currently studied model. The resulting coordination of care minimizes waste and maximizes value through a relationship based on trust and enhanced by use of technology. To function, this system requires payment reform that will attract new physicians into primary care and retain those already practicing in Wisconsin.

  2. Incentives for obtaining and providing coverage such as tax advantaged premiums for individuals and businesses as well as Health Savings Accounts, Medical Savings Accounts, Health Reimbursement Accounts, Flexible Spending Accounts, etc. should be considered.

  3. Health Care Reform packages should include incentives for wellness, preventive care, and appropriate management of chronic conditions.

  4. Primary Care Physicians should be partners in assuring that Quality Initiatives, Health Promotion, and Health Prevention are encouraged for the entire population.

  5. Health Care Reform should retain a pluralistic health care system that promotes competition based on quality and cost.

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