Academy Identifies Key Issues to Work On With Incoming Congress

The AAFP has laid out an aggressive legislative agenda for next year, identifying several key issues that are vital to moving the concepts of primary care and the patient-centered medical home, or PCMH, forward on the national level. That was one of the messages delivered by Kevin Burke, director of the AAFP's Division of Government Relations, during the AAFP's state legislative conference here last month.

The AAFP continues to advocate the need for fundamental payment reform, calling for changes in the Medicare physician payment system to recognize the value of primary care services. This includes implementation of a blended payment that includes fee-for-service, bonuses for quality reporting and a care management fee for physician practices that serve as a PCMH, Burke said.

According to Burke, it has been difficult to obtain adequate payments for physician services under Medicare because of the sustainable growth rate, or SGR, formula, which aligns actual spending rates with specified targets to determine Medicare payment levels. During the past seven years, spending has exceeded targeted rates under the SGR, triggering steep reductions in physician payment levels that have been averted only by last-minute congressional interventions that push the costs to future federal budgets, creating an accumulating deficit. That's why, without congressional action, the SGR will cause a 20 percent reduction in Medicare physician payment rates on Jan 1, 2010.

Burke said that during the coming year, the AAFP would continue to work with the new Congress to revise the payment formula to reflect better payments for primary care services and to eliminate what has become an annual legislative showdown.

Although the AAFP and other health care organizations have called for the outright repeal of the SGR, the elimination of the formula could cost as much as $300 billion, making its elimination politically and economically difficult, noted Burke. However, Congress may block the scheduled reductions by passing a Medicare bill that includes long-term payment reform. This would give the AAFP an opportunity to push for the inclusion of primary care and the PCMH as part of a long-term payment solution, Burke said. "We are working to make sure that the patient-centered medical home is incorporated as much as possible into any long-term payment reform."

The November elections that will bring Sen. Barack Obama, D-Ill., into the White House in January also strengthened the Democratic majorities in both houses of Congress, an outcome that is likely to boost efforts in the next Congress to revamp health care policies, according to Burke. If nothing else, the combination of a Democratic administration and a Democratic-controlled Congress will direct greater attention to health issues than there has been in the recent past, Burke said.

One of the first issues the new Congress will address is reauthorization of the State Children's Health Insurance Program, or SCHIP, which is set to expire at the end of March. SCHIP is a joint federal and state program that provides health care coverage to 6 million low income and uninsured children and 600,000 uninsured adults who are not poor enough to quality for Medicaid. In the past, President Bush has vetoed SCHIP reauthorization bills, but both the House and the Senate likely will take up reauthorization of SCHIP early in 2009, predicted Burke. "It is the first health care issue on their agenda."

In addition, the Academy will be talking to members of Congress about the need for health information technology, or HIT, that is affordable for small- and medium-sized physician practices. "One of the major barriers to this necessary technology, is the cost for small- and medium-sized practices," said Burke. "We have focused our work in Congress in making sure that any information technology legislation addresses that problem."

Burke cited a few of the HIT bills now under consideration by Congress. Rep. Pete Stark, D-Calif, chair of the House Ways and Means Subcommittee on Health, has introduced a bill that would provide more than $4,000 for each physician in a practice that adopts HIT. The legislation also would impose penalties on practices that fail to adopt HIT, a part of the bill opposed by the Academy. "But we can work with (Stark) on this," said Burke.

The House Small Business Committee is working with the AAFP on another bill that would provide direct small business loans to physician practices that adopt HIT.

Another one of the Academy's goals is to ensure that everyone in the United States has access to a PCMH. Although that goal is achievable, it requires a greater investment in the workforce pipeline that produces primary care physicians, said Burke. The Academy will continue to call for funding increases and reauthorization for Section 747 of Title VII in the Public Health Service Act, which provides the only federal grants for training family physicians. The Academy also is working with congressional members to shift the focus of the program to support the education and training of family physicians to implement the PCMH, Burke said.

At the same time, the AAFP is working with members of Congress to bolster loan forgiveness and scholarship programs for medical students, Burke added.