House Letter Targets Medicare Pay Reform; AAFP Reinforces Importance of Primary Care

The AAFP is reinforcing its message on Capitol Hill that a primary care-based health care system could generate significant cost reductions for the nation's Medicare program. The heightened emphasis comes in response to a letter two House members are circulating that asks Congress to not provide increases in payment for primary care physicians by cutting payments to subspecialists.

"Recently, some have proposed financing increased Medicare payments for some physicians and services by cutting payments to other physician specialties," says a letter being circulated by Reps. Shelley Berkley, D-Nev., and Mark Kirk, R-Ill. The letter asks members of Congress to sign on to a letter addressed to House Speaker Nancy Pelosi, D-Calif., and House Minority Leader John Boehner, R-Ohio.

"Many ideas have been offered about how to reform Medicare's physician payment system," says the sign-on letter. "One idea we cannot support is a proposal to finance increased reimbursement for one physician specialty or one set of physician services by simply cutting reimbursement for all others. While we must find ways to help Americans better manage their care, we do not support proposals that would establish a reimbursement structure that would threaten patients' access to the life-saving care that other physician specialties are trained to provide."

"The health care system needs primary care, and primary care physicians need improved payment," says Kevin Burke, director of the AAFP Division of Government Relations. He adds that the AAFP is not proposing that those increased payments come from other specialties' Medicare payments.

In fact, in correspondence and meetings with congressional members, the AAFP continues to stress that basing health care reform on primary care would create systemwide savings by reducing and, in some cases, preventing more expensive types of care, such as emergency room visits, hospitalizations, and excess costs from duplicative laboratory and imaging services. To achieve those savings, however, lawmakers must strengthen the primary care infrastructure by paying primary care physicians adequately, says Burke.

"A primary care system would create savings throughout the entire Medicare program," he says. "So … increased Medicare payments for primary care should come from the entire Medicare program."

The Berkley-Kirk letter is "premature," adds Burke, because it attempts to take one possible solution for increased primary care payment off the table. "In an environment that so strongly stresses cost control, it is wrong to take anything off the table that could help pay for primary care increases."