AAFP Weighs In on Economic Stimulus Package

In separate letters to key House and Senate committees, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., has expressed support for provisions in the House and Senate versions of the economic stimulus package that would provide additional funding and support for primary care training; health information technology, or HIT; Medicaid funding for states; and comparative effectiveness research.

Although the House recently passed a version of the stimulus package (at the THOMAS Web site, type "H.R. 629" or "S. 1" in the search box after selecting "Bill Number"), the Senate still is considering its version of the bill. The stimulus package is known as the American Recovery and Reinvestment Act, or ARRA, in both the House and Senate.

If enacted, the House version of the recovery and reinvestment act would bolster the National Health Service Corps and essentially double the annual appropriation for Title VII, Section 747, of the Public Health Service Act, the only federal grants used for training family physicians. The House stimulus package would take an important step toward ensuring that everyone has access to health care, said King in a letter to members of the House Committee on Appropriations, the Committee on Energy and Commerce, and the Committee on Ways and Means.

In a letter to the Senate Committee on Finance and the Committee on Appropriations, King said he was disappointed the Appropriations Committee had not followed the House's example by doubling the appropriation for Title VII.

"We urge you to include in the stimulus legislation provisions that represent sound investments in the country's health care system; specifically, funding for the training of primary care physicians," King said. "Coverage for all and providing better care in a cost-efficient manner requires a health care system that is primary care-based. Consequently, we must train more family physicians to meet this goal."

In both letters, King said that the AAFP, which has been a long-time supporter of HIT, was gratified to see the large allocations to HIT in the two versions of the stimulus package -- $20 billion in the House bill and $23 billion in the Senate bill.

"Physicians should have effective incentives to purchase a wide variety of technology that is appropriate for their particular setting," said King. He added, "We agree that the Department of Health and Human Services should be allowed latitude to determine what products should be certified. Any funds to support the purchase of certified products should be followed by incentives that align payment with quality and efficiency. This is critical to drive the utilization of the adopted systems."

King said the Academy strongly supports targeting HIT dollars in the ARRA to physicians who are "meaningfully using HIT." But he also asked whether physicians who have already purchased HIT systems would be eligible for funding to buy additional software to enhance their practices.

"We believe (these physicians) should be eligible to receive funding to upgrade their systems," King said.

He also commented on a provision in the ARRA to impose reduced payments on physicians not using HIT after 2016.

"We understand your strong desire to encourage physicians to purchase HIT," King said. But with Medicare payment levels already at low levels, "we strongly urge you not to include this provision unless the physician payment issue is addressed, especially for family medicine and primary care," he said.

"We would also ask that you consider the capacity of the HIT market to support the deployment of HIT solutions to all physicians by 2016," King said. "We do not believe the market has this capacity."

More than $95 billion in the ARRA is slated for Medicaid programs. One provision would increase the federal government's contributions to states for Medicaid through the Federal Medical Assistance Percentage, or FMAP, thus allowing states to maintain current levels of Medicaid coverage.

"An increase in the FMAP not only will help those most in need, but will have the additional benefit of stimulating the economy through targeted, specific relief in a large and critical sector of the economy," King said.

The ARRA contains other Medicaid measures, as well, including a provision that would allow states to temporarily offer Medicaid coverage to a limited number of workers who have lost their jobs in the current economic downturn and who might not otherwise qualify for the program. Under this temporary arrangement, the federal government would cover the costs of administration and benefits for states that implement the option.

King also addressed the issue of comparative effectiveness research funds, which were included in the House version of the stimulus package. Comparative effectiveness research has "great potential to improve health care quality and patient outcomes while assuring patients receive the best care at the best value," said King.

"We would like to express our support for the $1.1 billion (for comparative effectiveness research) included in the stimulus package," he added. "We need to spur the development of data in which drugs, devices and therapies used to treat the same conditions are evaluated for their relative safety, effectiveness and cost."