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Tuesday Jan 06, 2015

A New Year, a New Congress and New Opportunities for Family Medicine

Happy New Year! Today marks the start of the 114th Congress. For the first time since 2006, Republicans control both the House of Representatives and the Senate. It also marks the final two years of President Obama’s administration.

If history is any indication, the combination of a divided government and a lame duck president may lead to more productivity than many are predicting as Republicans focus on demonstrating the ability to govern, and the President strives to solidify his legacy.  

A lingering question for the AAFP is how will health care policy fit in these two distinct agendas?  

It is important to remind ourselves that all activities in Washington during the next two years will be conducted with an eye on Nov. 8, 2016 -- the date of the next presidential election. As we prepare for the upcoming legislative session, I want to outline the Academy's advocacy priorities as a means to inform you about where the AAFP plans to focus its attention during the next two years and as an invitation for you to comment on other areas where you would recommend the AAFP focus resources.

To get us started I have created a top 15 list of priority issues:

  • Physician payment (specifically primary care);
  • Primary care workforce and graduate medical education reform;
  • Delivery system reform and innovation;
  • Electronic medical records and meaningful use;
  • Health system financing, coverage and insurance reform;
  • Medicaid expansion;
  • Children’s Health Insurance Program reauthorization;
  • Telemedicine, digital health and medical apps;
  • ICD-10 implementation;
  • National Health Service Corps reauthorization and funding;
  • Administrative simplification;
  • Network adequacy (Medicare, Medicaid, health insurance marketplaces); 
  • Social determinants of health and health disparities;
  • Health care consolidation and antitrust issues; and
  • Professional liability insurance reforms.

In addition to the list of issues, I wanted to expand on three important areas where the AAFP will be focusing significant resources on your behalf. These three items are routinely identified by our members and state chapters as the top advocacy priorities for family physicians. Although the information below is not exhaustive, it is a fair depiction of the top policy issues we have identified for the 114th Congress.  

Physician Payment
There are four priorities for the AAFP in this area: sustainable growth rate (SGR) formula reform, the Medicare Primary Care Incentive Payment program, improved Medicaid payment policies for primary care, and the establishment of a new payment formula for primary care.

Under current law, the Medicare physician payment rate will be reduced by 20.1 percent on April 1 unless Congress takes action to prevent this cut. It is highly anticipated that Congress will take the necessary steps to prevent this draconian cut, but it is unclear if legislators will attempt to enact long-term payment reforms prior to the 2016 election. The early line is that Congress will enact a 20- to 24-month extension of current payment rates in March and then make a run at permanent repeal of the SGR in November/December 2016.

The Primary Care Incentive Payment (PCIP) program was established by the Patient Protection and Affordable Care Act and provides a 10 percent add-on to eligible Medicare payments for qualifying physicians. The program is set to expire Dec. 31, 2015. This important policy has benefited thousands of family physicians and increased access to primary care for beneficiaries, and we are making its extension a top priority.

Medicaid parity payments ended Dec. 31, 2014.  More than a dozen states have made a commitment to continuing the payment policy in 2015 at their own expense. We are pleased to see these states take such action, but we continue to believe that the establishment of an equitable primary care payment rate for the Medicaid program should be part of the federal mandate for states receiving federal matching funds.  

Workforce and Graduate Medical Education
The AAFP has placed a priority on increasing the primary care physician workforce by expanding both the type and number of graduate medical education programs for family physicians. During the 114th Congress, we will actively seek to further establish the AAFP as the leading voice on primary care workforce and graduate medical education.

During a Capitol Hill briefing in September, the AAFP unveiled its GME reform policy proposal  “Aligning Resources, Increasing Accountability, and Delivering a Primary Care Physician Workforce for America.” The proposal has garnered much attention and, along with the Institute of Medicine’s GME proposal(www.iom.edu), “Graduate Medical Education That Meets the Nation's Health Needs,” has challenged conventional wisdom on the issue of GME structure and financing. Since the release of our GME proposal, we have conducted numerous meetings with congressional legislators and staff and thought-leaders inside the administration and academia.  

The AAFP will continue to advance policies that challenge the hospital-based GME system and place a greater emphasis on ambulatory training opportunities that are appropriately funded. A critical component of these efforts will be the reauthorization of the Teaching Health Center program, which expires in 2015. In addition to reauthorizing the program, the AAFP will be advancing policies that aim to establish a more predictable and robust funding mechanism for the program in contrast to the current funding formula which has proven inadequate to support it.

Electronic Health Records
The next two years will be critical to our national efforts to create and implement an interoperable electronic health records system. As the meaningful use program enters the penalty phase, more than 250,000 physicians can expect reductions in their Medicare payments due to their non-participation in the program. For those who are participating, the program is not proving to be a walk in the park. The program is fraught with problems and the “one-size-fits-all, check box, pass/fail and then get audited” style of MU phase 2 has most physicians anxious, if not angry. We are having ongoing discussions with the Office of the National Coordinator of HIT and the Congress on these issues. Although a solution isn’t yet available, we are hopeful that the MU program will be improved during the next 12 months.

A national, interoperable health records system should not be unobtainable, yet it remains so.  Maybe 2015 will be the year that an industry that has benefited from $29 billion in government-backed purchasing power will reverse its epic failures and assist those who are trying to actually use their products for the betterment of patient care.

One of the unique aspects of our governing structure is that every two years we get to start over.  Similar to an Etch A Sketch, we simply shake off the old and create a clean canvass for the next two years. As a new Congress begins, I hope each of you will continue to engage with the AAFP in our advocacy efforts. Share your thoughts and help us better meet your needs and expectations. In the meantime, I wish you a healthy and prosperous 2015.

Posted at 08:00AM Jan 06, 2015 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.