AAFP Engages Incoming Administration On Economic Stimulus Package, Health Care Issues

The AAFP has asked President-elect Barack Obama to offer an economic stimulus package that would strengthen the nation's health care system and, in turn, its economy by recognizing and rewarding the provision of primary care services.

AAFP Board Chair Jim King, M.D. of Selmer, Tenn., recently sent three letters to the president-elect to engage the incoming administration on several key health care issues essential to a sustained economic recovery. These issues, King said, should be considered essential components of any economic stimulus package put forward. They are

Congress is expected to pass an economic stimulus bill totaling $600 to $850 billion within the next few weeks.

In a Dec. 23 letter, King commended Obama for his "long-standing interest in improving everyone's access to appropriate health care." He added, however, "without an adequate supply of primary care physician practices, beneficiaries will not be able to find the health care they need."

"When Massachusetts required everyone in the state to designate a practice as their usual source of care, state officials quickly learned that they did not have enough primary care physicians to meet the increased need," King said.

He pointed out that the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment and other issues, has recommended a 10 percent bonus for all primary care services offered to beneficiaries by qualified primary care practices. The AAFP's stance surpasses the MedPAC recommendation by calling for a 25 percent payment premium to primary care physicians who provide certain primary care services.

"There is substantial evidence, consistent over 20 years, that the 200 percent payment disparity between primary care and subspecialty medicine is a predominant reason that fewer medical students are going into primary care," said King. "Since primary care is only 7 percent of the total Medicare budget, a 25 percent increase would raise total Medicare spending by only 1.75 percent."

King added that the primary care bonus could serve as a "down payment on the upcoming health reforms that should encourage physicians to remain in primary care practice and help residents and students appreciate primary care as a productive and desirable specialty."

King also pointed out that family physicians are increasingly committed to transforming their practices into patient-centered medical homes, or PCMHs.

"We believe that a patient-centered medical home is a more effective and efficient mode of health care delivery," said King. "It will mean that physician practices will have to change to become more accessible, more attentive to patients' needs, more flexible in providing care and more effective in tracking the quality of patients' outcomes."

King explained that physician practices can apply for recognition as medical homes through the National Committee on Quality Assurance, or NCQA. But this process requires a significant investment on the part of physician practices, one that is particularly difficult for small practices in rural and underserved areas, King said.

"However, these rural and medically underserved areas need the preventive health care services and the management of chronic diseases that characterize the patient-centered medical home," said King. "Consequently, the AAFP would recommend that the economic stimulus bill contain a funding program for small primary care practices serving patients in rural and underserved areas that apply for NCQA recognition as a patient-centered medical home."

In a subsequent letter to Obama, King focused on funding for education and training. He pointed out that annual appropriations for Section 747 of the Title VII Health Professions Grants Program have eroded steadily since 2003, despite the growing shortage of primary care physicians. This grant program is the only federal support aimed directly at training primary care physicians.

"Recognizing your steadfast commitment to increased funding for Title VII throughout your tenure in the Senate, the AAFP urges you to include in the economic stimulus legislation a robust investment in the Title VII, Section 747 grant program," said King.

He added that the program should be funded at a minimum level of $215 million a year. "Including that level of funding for primary care training in the stimulus bill would reinvigorate medical education and residency programs, as well as academic and faculty development in primary care, to prepare physicians to support the patient-centered medical home medical practice model," he said.

In the Dec. 24 letter, King praised Obama for "indicating that loan forgiveness for health professionals will be a part of health care reform." He urged the incoming administration to reinstate the debt-to-income ratio, known as the 20/220 pathway, of the federal economic hardship loan deferment program or provide an equivalent funding mechanism for loan deferments. This would give family medicine residents and others pursuing primary care specialties the option of postponing loan payments without facing financial penalties during a crucial time in their training, King said.

In a separate letter dated Dec. 12, King addressed the issue of HIT, which he described as an important means for improving quality and cost-effectiveness in health care.

King said six changes to HIT should be made as part of the economic stimulus package. These changes are