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Tuesday Aug 29, 2017

Congress Faces Tight Deadlines on Critical Issues

"I love sleeping in on Saturdays, and I love college football games. I love not acting my age and good barbeque."
-- Eric Church

Summer is drawing to a close, and the daylight hours are slowly waning. Labor Day weekend is largely recognized as the end of summer and a time when we all turn our attention toward fall.

Fall is a special time of year. The temperatures start to drop (which is a big deal in Washington, D.C.), kids are back in school and a new football season begins. This season will feature a fresh face on the sideline in Norman, Okla., but Sooners fans are optimistic that this is our season of destiny. For those of you who are fans, may your team enjoy a successful season.

Now on to more important issues.

Next week, Congress will conclude its summer recess and return to Washington for the fall legislative period. Legislators return to a complicated to-do list, an unpredictable political environment that grew more precarious during the past month and a short runway to pass critical legislation.

At the top of that to-do list are two must-pass bills: a bill to fund the federal government in the 2018 fiscal year (Oct. 1, 2017, through Sept. 30, 2018) and a bill that would raise the government's borrowing limit (better known as the debt ceiling). Both bills face complicated paths to passage, and the consequences of failing to pass both are significant for the country. Should Congress fail to pass a funding bill by Sept. 30, the federal government would shut down until such time as a spending bill was enacted into law.

The AAFP communicated its health program funding priorities in a May 31 letter(4 page PDF) to the House Appropriations Committee. We anticipate Congress will get this done, but I don't expect there to be much time remaining on the clock when lawmakers finally get this bill to the president.

These aren't the only two issues facing a Sept. 30 deadline. Congress also must pass legislation to reauthorize the Children's Health Insurance Program (CHIP) and pass a set of reauthorizations that are commonly referred to as the "MACRA-extenders," including AAFP priorities such as reauthorization of the Teaching Health Center Graduate Medical Education (THCGME) program and the National Health Service Corps. These programs are set to terminate unless Congress acts to reauthorize and fund them for additional years.

Oh, and don't forget that other little issue -- the Patient Protection and Affordable Care Act (ACA). The Senate Health, Education, Labor and Pensions (HELP) Committee is scheduled to kick off hearings regarding the ACA(www.help.senate.gov) in September, and there are growing calls for bipartisan fixes to the law.

Reauthorization of the THCGME program is at the top of the AAFP's priority list for the fall. Few policies enacted in the past decade have performed as well as this program. I have historically referred to this program as a "diamond in the rough." Few programs have met the intent of its authorizing law and done so in such an efficient manner.

The THCGME program was established as part of the ACA in 2010 to increase the number of primary care physicians in the United States. In 2015, Congress reauthorized and extended funding for the program as part of the Medicare Access and CHIP Reauthorization Act (MACRA) for fiscal years 2016 and 2017. Unfortunately, the program faces termination if it is not reauthorized and funded by Congress before Sept. 30.

Failure to reauthorize this program would be a travesty. Since its implementation, the program has produced hundreds of primary care physicians -- most of whom are family physicians -- and several dozen dentists. Currently, there are approximately 740 residents being trained in 59 THC residencies in 27 states and the District of Columbia. Based on an analysis of the THCGME program, we know that family physicians graduating from a THC residency program are more likely to practice in underserved communities and are more likely to see vulnerable populations in their practices compared with residents trained in hospital-based programs.

In July, the AAFP, in collaboration with other organizations, secured the introduction of legislation reauthorizing the THCGME program in both the House and Senate. The Training the Next Generation of Primary Care Doctors Act of 2017 (H.R. 3394/S. 1754), was introduced in the House by Reps. Cathy McMorris Rodgers (R-Wash.) and Niki Tsongas (D-Mass.) and in the Senate by Sens. Susan Collins (R-Maine) and John Tester (D-Mont.).

This legislation would reauthorize the program for three years, provide sustained funding for current residency programs and positions, and provide funding for new programs in rural and underserved communities. The AAFP is working to secure co-sponsors for these two bills, and we invite you to join us in this effort. Using our Speak Out program, you can send a letter to your representative and senators urging them to co-sponsor this important legislation.

Thank you for joining us in this important work.

Wonk Hard

On Aug. 18, the AAFP submitted its official comments(95 page PDF) on the Medicare Quality Payment Program (QPP) 2018 Proposed Rule. CMS made improvements to the QPP, and we thanked them for those changes. However, the AAFP continued to press CMS on the administrative complexity of the QPP and leveled our harshest comments on those areas that require physicians to perform unnecessary activities.

The following is a quick summary of five key comments included in our 95-page letter to CMS:

  • The AAFP is concerned that CMS is prematurely requiring a full year of quality reporting for the 2018 performance year. We encourage CMS to continue to allow 90-day reporting periods for the quality, advancing care information and improvement activities performance categories in the Merit-based Incentive Payment System (MIPS) 2018 performance period.
  • The AAFP thinks it is appropriate for primary care physicians in medical home models to accept performance risk, but not financial risk. We believe this is supported by the original MACRA statute, which reflects congressional intent regarding the qualification of medical home models as advanced alternative payment models (AAPMs).
  • The AAFP recommends that physicians should automatically be held harmless by CMS if their certified electronic health record technology becomes decertified.
  • The AAFP believes that all physicians of all specialties and subspecialties should be required to meet the same program expectations as other MIPS participants.
  • The AAFP reiterates its steadfast opposition to the entire MIPS APM category. This entire category was created outside of the statutory requirements and introduces an unnecessary level of complexity to an already complex program.

Posted at 07:00AM Aug 29, 2017 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.