The AAFP will be closely tracking four issues of great importance to family physicians when legislators return after the election to finish the work of the 114th Congress: sustainability for teaching health centers (THCs), payment for chronic care management, support for direct primary care (DPC) and mental health reform.
Speaking at the 2016 AAFP State Legislative Conference in Phoenix, Robert Hall, J.D., the AAFP's director of government relations, discusses priorities for family medicine that will be taken up during the upcoming session of Congress.
Robert Hall, J.D., the Academy's director of government relations, outlined the strategy for the upcoming lame duck session of Congress during the AAFP State Legislative Conference held here Oct. 27-29.
High on the list of priorities is pressing for continued federal support of the THC Graduate Medical Education program, given its importance in expanding access to care and building the primary care pipeline by increasing primary care residency training in community and rural settings. The Medicare Access and CHIP Reauthorization Act (MACRA) allocated $60 million annually to the program in fiscal years 2016 and 2017, but the funding is set to expire on Sept. 30, 2017.
"The THC program has been wildly successful by beginning to address our historic shortage of primary care physicians and encouraging new physicians to practice in areas in dire need of family physicians' services," Hall told AAFP News.
- The AAFP will be closely tracking four important family medicine issues when Congress returns for the upcoming lame duck session: teaching health centers, chronic care management, direct primary care and mental health reform.
- The Academy supports many components of newly proposed legislation meant to improve health outcomes for Medicare beneficiaries who have chronic illnesses.
- As implementation of the Medicare Access and CHIP Reauthorization Act begins changing the way physicians are paid, the AAFP will continue to work with legislators and CMS to shape regulations and ensure a smooth transition.
The AAFP also is asking CMS to issue a final 2017 Medicare physician fee schedule that includes proposals to support payment for complex chronic care management. In addition, the Academy supports many components of a recently released legislative discussion draft(www.finance.senate.gov) meant to improve health outcomes for Medicare beneficiaries who have chronic illnesses. The proposal addresses a range of issues affecting primary care, including expansion of the Independence at Home CMS demonstration project, which has demonstrated significant cost savings for patients who are unable to visit a physician's office.
Hall said another piece of legislation, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, would expand payment for telehealth services. Such technology is a viable option for delivering some patient care, but many physicians have been slow to adopt it because insurers offer limited or no payment. If the bill passes, CMS could waive a requirement that a patient must reside in a health professional shortage area to receive telehealth services paid for by Medicare.
The AAFP also has pledged support for legislation intended to increase patient access to DPC. Although some family physicians have been moving to the DPC model, federal tax law prohibits patients from using health savings accounts (HSAs) to pay for such services. Similarly, traditional Medicare does not cover DPC practices' periodic fees for services that already are covered under Medicare. Two House lawmakers sponsored the Primary Care Enhancement Act,(www.congress.gov) which would change tax law so patients could use HSAs to pay DPC fees without incurring a tax penalty. A companion bill has been introduced in the Senate.
Another issue on the legislative agenda of importance to family physicians is the integration of primary care and mental health. The move is an essential element of improving patient care and reducing costs, yet it is not supported by payment policy. In particular, physicians are frustrated about being unable to bill for physical and mental health services provided during the same visit.
That could change if the Helping Families in Mental Health Crisis Act(www.congress.gov) passes. The AAFP supports the bill, which calls for block-grant funding that would assist primary care physicians and provide technical support for primary care practices seeking to integrate mental health care. Another provision calls for a national education campaign to reduce the stigma of mental illness.
And as implementation of MACRA begins changing the way physicians are paid by Medicare, the AAFP will continue to work with legislators and CMS to shape regulations and ensure a smooth transition. Equitable payment for physicians is a major priority, so the Academy will support CMS in its efforts to adjust the relative value units used to determine physician payment and its scheduled review to identify codes that are inappropriately valued.
"MACRA is a new world that has the potential to finally right the ship," Hall said. "Family physicians have the experience, the nimbleness and may finally have the resources under MACRA to lead the transformation of the nation's health system."
The AAFP also will ask Congress to continue funding existing programs, including
- CMS innovation programs;
- grants for continued development of state prescription drug databases;
- Health Resources and Services Administration funding for primary care training and family planning;
- tobacco prevention efforts; and
- the Agency for Healthcare Research and Quality, which supports the Choosing Wisely program and evidence-based research that assists primary care.
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