AAFP Board Chair Robert Wergin, M.D., (right) and President Wanda Filer, M.D., M.B.A., talk to Rep. Kurt Schrader, D-Ore., about the importance of teaching health centers as a pipeline for training primary care physicians.
AAFP leaders visited Capitol Hill last week to consult with legislators about new payment models, payment for chronic care, and other issues of major importance to family medicine.
In a meeting with senior HHS officials, AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., and President-elect John Meigs Jr., M.D., of Brent, Ala. pressed for changes to benefit family physicians in the pending implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), which introduces new payment models. AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., and CEO and EVP Douglas Henley, M.D., also attended the meetings on Capitol Hill.
CMS is expected to make public proposed rules for alternative payment models under MACRA this summer, and to announce the final rules later in 2016. Physicians will first be measured in 2017 to determine their payments in 2019 using these new models. AAFP leaders explained to officials why the initial measurement year should be delayed until 2018.
- AAFP leaders met with federal officials, lawmakers and legislative staff last week to explain issues of key importance for family medicine.
- Some of the discussion made the case that performance measurements for new Medicare payment models should be delayed until 2018.
- AAFP leaders talked to Congressional staff about the importance of continuing funding for the Agency for Healthcare Research and Quality.
"Physician practices will have to make a lot of changes and they won't have enough time," Filer said. "They need another year."
Board officers also discussed the CDC's draft 2016 Guideline for Prescribing Opioids for Chronic Pain and cautioned officials about allowing the guidelines to become a default standard of care.
"They should be called best practices because the quality of evidence is not there to support calling them guidelines," Meigs said.
HHS officials welcomed the feedback and praised the AAFP for taking a leadership stand and offering to be part of the solution.
Meigs said legislators and their staff members also showed keen interest in the issue of opioid prescriptions, asking AAFP leaders detailed questions and looking for ways to solve the problem. And legislators said they recognized the need to ensure that primary care physicians are paid for the mental health services they provide, in order to support better integration of mental health and primary care.
In a meeting with the staff of Sen. Roy Blunt, R-Mo., who chairs the appropriations subcommittee with jurisdiction over health programs, AAFP leaders discussed continued funding for the Agency for Healthcare Research and Quality. Filer said the agency's research helps primary care practices make the necessary transformations to handle new patient needs. One of the agency's projects saved an estimated 17,000 lives, she said, a fact that is not widely known among legislators.
Discussing family medicine issues on Capitol Hill recently are (from left) AAFP CEO and EVP Douglas Henley, M.D.; Rep. Kurt Schrader, D-Ore.; AAFP President Wanda Filer, M.D., M.B.A.; Board Chair Robert Wergin, M.D.; and President-elect John Meigs Jr., M.D.
Rep. Kurt Schrader, D-Ore., told Academy leaders that he supports primary care, and particularly teaching health centers. He does not have a teaching health center in his district but he expressed interest in research showing that residents who train in one tend to continue working in areas where primary care is most needed.
In a meeting with Senate Finance Committee staff, Filer and Meigs shared their own experiences of caring for patients with multiple chronic conditions. They explained how primary care physicians help chronic care patients qualify for food programs, obtain transportation to appointments and manage personal finance issues such as utility bills. Some Senate staff members were unaware of the reach of primary care physicians regarding such social determinants that affect physical health.
"They were very impressed with all that we handle," Filer said.
Filer told the committee staff that the chronic care management fee is important, but the volume of documentation that physicians are required to complete for payment is onerous.
"We said, 'If you can't give us a per-patient, per-month fee, then at least simplify the documentation process,'" she recalled.
AAFP officials also explained why the $8 patient copayment for chronic care should be waived. Because it is a copayment for a non-face-to-face visit, patients are confused when they are billed for it. In addition, the copayment might discourage them from using an important service.