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Wednesday Nov 26, 2014

A Day On the Hill: Meaningful Use, Medicaid, Medicare and More

There is a long list of time-sensitive issues facing primary care -- meaningful use, impending Medicaid cuts, the Medicare sustainable growth rate (SGR) formula, and funding for graduate medical education, just to name a few -- and on Nov. 20, AAFP officers had a chance to discuss all of these concerns (and more) with legislators, congressional staff and representatives from federal agencies.

Here's an overview of the whirlwind day I spent on Capitol Hill with AAFP President Robert Wergin, M.D.; Board Chair Reid Blackwelder, M.D.; and Academy staff.

ONC

In a meeting with Karen DeSalvo, M.D., M.P.H., the National Coordinator for Health Information Technology, and other senior leaders at the Office of the National Coordinator (ONC), we addressed the fact that the cost of complying with the meaningful use program presents a huge challenge for many family physicians. Specifically, we laid out three of the biggest obstacles family physicians face: 

  • complying with meaningful use stage two and the almost impossible task presented by stage three;
  • the anticompetitive behavior of certain electronic health records vendors, who have established so-called "vendor lock" in many communities around the nation; and
  • the overall lack of accountability among vendors marketing these products.  

The last point is a particularly critical element of our advocacy efforts. Barring a hardship exception, physicians who have not yet attested to meaningful use will see a 1 percent Medicare payment reduction beginning Jan. 1. Those penalties can climb to as much as 5 percent over time.

© 2014 Michael Laff/AAFP
AAFP President Robert Wergin, M.D., (far left), Board Chair Reid Blackwelder, M.D., (second from right) and I meet with Sen. Lamar Alexander (R-Tenn.). AAFP officers and staff met with congressional staff, legislators and representatives from federal agencies Nov. 20 in Washington.

It's a problem the AMA House of Delegates tackled during its interim meeting earlier this month, when the AAFP delegation backed a resolution directing the AMA to urge CMS to halt penalties related to meaningful use. This same point was emphasized during our meeting with ONC representatives. Why do physicians face penalties for noncompliance, but vendors are not held financially accountable for the performance of their products or their service?

SGR
During our time on the Hill, AAFP officers and staff met with legislators and congressional staff from both chambers and both parties. In these meetings, we discussed a variety of topics, including the importance of repealing the SGR and replacing it with value-based payment, preventing cuts in Medicaid, and renewing funding for teaching health centers.

Physicians face a 21 percent cut in Medicare payment beginning April 1 unless Congress intervenes. Legislators have patched the SGR issue 17 times during the past 12 years at a cost of more than $169 billion. Bicameral, bipartisan legislation introduced earlier this year would repeal the SGR and replace it with new methods of value-based payment, but to date, Congress has not passed the bill, in part because legislators have not agreed on how to offset the cost of the fix.

Overall, the mood among lawmakers and staff was that enacting a permanent SGR fix would be challenging during the lame-duck session but that Congress could summon the will to enact the repeal-and-replace legislation by the end of March 2015. You can help by telling your legislators to support the bipartisan legislation.

Medicaid Cuts
For primary care physicians, cuts to Medicaid payments are even more imminent. Section 1202 of the Patient Protection and Affordable Care Act (ACA) required state Medicaid programs to raise payments for certain primary care services to Medicare levels in 2013 and 2014, but barring an extension, states will be free to drop Medicaid payments back to 2012 levels on Jan. 1.

We emphasized that these cuts -- which vary by state but average more than 40 percent -- represent a severe disruption to the business of practicing medicine and pose a threat to patients' access to care. In fact, total health care spending for Medicaid patients could increase if they can't access their family physician and instead turn to emergency departments.

The Academy supports a bill that would require Medicaid programs to extend the parity payments for primary care for two years. This would not only bolster primary care practices and ensure access to care, it would give us more time to show how important it is for patients to have a regular source of comprehensive care. There is long-term value in providing preventive care, and health care costs can be reduced when chronic conditions are controlled.

Here's another opportunity for you to help. Voice your support for preventing cuts to Medicaid by contacting your legislators through the Academy's Speak Out tool.

Teaching Health Centers
Teaching health centers face two obstacles. First, federal funding for the Teaching Health Center Graduate Medical Education program(bhpr.hrsa.gov) established by the ACA will end after the 2015 fiscal year absent congressional intervention. The AAFP is one of more than 100 organizations that recently sent a letter to congressional leaders about extending support for teaching health centers.

Additionally, the Health Resources and Services Administration (HRSA) announced this month that awards for teaching health centers will be reduced from $150,000 to $70,000 per resident for the 2015-2016 academic year. The Academy wrote to HRSA officials about this issue last week, and we drove the point home again in our meetings with congressional staff and legislators.

Residents who train in these programs are more likely to practice in underserved or rural areas when they complete their training. Not only does the funding need to be continued beyond its scheduled expiration on Sept. 30, it should be expanded.

Other Agency Meetings
We also met with family physician and AAFP member Joe Selby, M.D., executive director of the Patient Centered Outcomes Research Institute (PCORI). PCORI requested the meeting, during which we discussed our practice-based research networks and the work of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

Finally, in a meeting with Rajiv Jain, M.D., assistant deputy undersecretary of health for patient care services at the Department of Veterans Affairs (VA), Wergin discussed our members' ability and willingness to help care for veterans and the need to break down barriers to doing so. Wergin also expressed concern that some family physician practices may struggle to serve veterans if the VA does not pay at least Medicare-level rates.

Wanda Filer, M.D., M.B.A., is president-elect of the AAFP.

Posted at 03:14PM Nov 26, 2014 by Wanda Filer, M.D.

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