Senate Finance Committee Considers Expanding Medical Home Demonstration

The Senate Finance Committee likely will include a provision to expand a Medicare medical home demonstration program as part of a Medicare bill that will be introduced on Capitol Hill in October or November, giving added impetus to the medical home as Congress heads into the final three months of 2007.

Senate Finance Committee members plan to introduce a bill to address Medicare physician payment after the Columbus Day break and will include an expansion of the Medicare Medical Home Demonstration Grant program passed by Congress as part of the Tax Relief and Health Care Act of 2006, AAFP News Now has learned. The Medicare Medical Home Demonstration program, which is scheduled to take effect in 2009, will fund demonstration projects in eight states.

In early August, the House passed a measure to greatly expand the demonstration project, passing a provision to fund a nationwide medical home demonstration project for as many as 500 practices as part of a larger bill to reauthorize the State Children's Health Insurance Program, or SCHIP. The House SCHIP bill also included a provision to prevent steep reductions in Medicare physician payment rates scheduled to take place in 2008 and 2009 under the Medicare Physician Fee Schedule. House and Senate conferees dropped both the medical home and the physician payment provisions from the final SCHIP bill passed by Congress.

As a result, the Senate Finance Committee plans to introduce a bill to provide a two-year Medicare physician payment update and will, at the behest of the AAFP and other organizations, likely include a nationwide patient-centered medical home measure in that bill similar to the one passed by the House.

"Senate leaders are very aware of the value of primary care, and because family physicians have become so much more active in communicating with their legislators in Congress, those leaders contact the AAFP to discuss how to help their family doctors," said Kevin Burke, director of government relations for the AAFP.

Staff from the AAFP and two other physician groups, the American College of Physicians and the American Osteopathic Association, met with Democratic and Republican staff from the Senate Finance Committee on September 26 to discuss how the committee's legislation should address the expansion of the medical home demonstration grants authorized in 2006. Committee staff members requested the meeting to gather input on the bill and the patient-centered medical home, and the AAFP made several suggestions, including recommendations on how to structure payments to physician practices that serve as medical homes.

The AAFP also asked that the Senate Finance Committee base the medical home provision on a list of nine standards that the National Committee for Quality Assurance, or NCQA, plans to use to recognize physician practices as medical homes. The NCQA expects to introduce the nine standards for the patient-centered medical home in November.

"Committee staff did not tell us what they were going to do -- they asked us what we wanted," said Burke. "This is a consultative process."

The meeting serves as a testimony to the importance of member advocacy, Burke said. Democratic and Republican staff members made a point of telling the AAFP and the other groups that they "are aware" of the difficulty primary care physicians face because of "conversations they had with their constituent physicians," Burke said.

"The staff reached out to us because they wanted to know how they could help primary care physicians," Burke explained. "They are sensitive to that because of the conversations they've had with physicians back in their states."

Senate Assistant Majority Leader Richard Durbin, D-Ill., and Sen. Richard Burr, R-N.C., meanwhile, are expected to introduce a bipartisan bill within the next few weeks that would give states money to establish patient-centered medical home demonstration projects for Medicaid and SCHIPs. The legislation, known as the Medical Homes Act of 2007, will be referred to the Health, Education, Labor and Pensions Committee.