Primary Care Collaborative Succeeds in Pushing Legislative Agenda

One of the nation's largest collaboratives to support primary care has launched a campaign to make primary care and the patient-centered medical home key components in federally funded health care programs and legislation.

The Patient-Centered Primary Care Collaborative, or PCPCC, a coalition that comprises the AAFP, other health groups, major employers and a consumer group, has sent legislative proposals to Capitol Hill, asking lawmakers to provide financial support for states wanting to make patient-centered medical homes a part of their Medicaid and State Children's Health Insurance Programs, or SCHIPs.

The key to reforming the health care system is a patient-centered medical home for all patients, said AAFP President Rick Kellerman, M.D. of Wichita, Kan., during a collaborative roundtable meeting here on June 11.

"We know the current system is unsustainable, and we are just happy that so many employers, insurers, policy makers and legislators are starting to get this," Kellerman said about the medical home.

He pointed out, however, that "it has probably never been harder in the current health care system to provide that medical home because of payment and paperwork issues."

The PCPCC's legislative proposal, "will essentially provide a funding source for states that wish to pay a care management fee to physicians who support a patient-centered medical home," said Robert Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, during the roundtable.

The legislative proposals would base the patient-centered medical home on a model put forth by the National Committee for Quality Assurance and endorsed by the PCPCC. Doherty said the patient-centered medical home has wide backing, generating support from physicians, employers and consumers both inside and outside of the Beltway.

So far, the PCPCC has been able to get language promoting the medical home into at least four bills on Capitol Hill, including the National Health Information Incentives Act, H.R. 1952, (at the THOMAS Web site, type "HR 1952" in the search box after selecting Bill Number) legislation introduced by Reps. Charles Gonzalez, D-Texas, and Phil Gingrey, R-Ga. The bill would provide incentives, such as grants, loans, expanded tax deductibility and Medicare payments, to support health information technology and care coordination in a patient-centered medical home. It also would give the HHS secretary the ability to provide care management fees to cover the costs involved in acquiring electronic systems to provide coordinated and patient-centered care to beneficiaries, especially those with multiple chronic illnesses.

In the meantime, Reps. Michael Burgess, R-Texas, and Henry Cuellar, D-Texas, have introduced H.R. 2854, the High-Need Physician Work Force Incentives Act of 2007, (at the THOMAS Web site, type "HR 2854" in the search box after selecting "Bill Number") to provide state grants for management fees to physicians in medically underserved communities. The fees would support the provision of "targeted, accessible, continuous, coordinated and patient-centered care through a qualified medical home" that adopts the care management model, according to a bill summary.

A third bill pending in the House and Senate, H.R. 2244 and S.B. 1340, respectively, (at the THOMAS Web site, type HR 2244, SB 1340 after selecting "Bill Number") would create a new Medicare benefit to provide comprehensive reviews of patients' medical conditions, their functional and cognitive capacities, and their environmental and psychosocial needs.

Patients qualifying for care coordination services under that bill would have the option of choosing a physician or a chronic care manager who enters into an agreement with HHS to provide care coordination services, according to the legislation, which was introduced by Sen. Blanche Lincoln, D-Ark., and Rep. Gene Green, D-Texas. The government would pay the physician a monthly, prospective, bundled care coordination fee for managing high-cost Medicare beneficiaries and beneficiaries with either multiple or chronic conditions or dementia.

Finally, Sens. Mike Enzi, R-Wyo., and Edward Kennedy, D-Mass., will re-introduce a health information technology bill later this month that awards competitive grants to physicians who adopt health information technologies. The legislation, which was first introduced last year, will give preference to "entities that organize their practices as a patient-centered medical home," according to a legislative summary.

Doherty, like other primary care proponents at the roundtable, decried the declining number of primary care physicians, telling the audience that "primary care in the United State is in dire straits."

"The number of medical students choosing to go into primary care programs has declined precipitously as the current cohort of primary care physicians begin to retire," he said. "There are a large percentage of physicians over the age of 55 who will be retiring. There will not be primary care physicians coming in to replace them until something is done."

Robert Berenson, M.D., a senior fellow at the Urban Institute, pointed out that some subspecialists earn two to three times more than family physicians under public and private payer systems, creating disincentives for careers in the primary care field.

"The primary care world is saying, 'These kinds of variations are so great they distort decisions that medical students make as to what specialty to go into,'" said Berenson.

Kellerman agreed, saying simply that "our medical students are good at math," and they are adding things up.

Kellerman added that public and private payers should adopt a blended payment system that incorporates a basic care coordination fee, a fee-for-service payment and a pay-for-performance structure.