AAFP, ACP, AOA Call for Systemwide Health Care Reform

Congress needs to provide a total 30 percent payment increase for primary care physicians under Medicare during the next five years to revitalize the nation's primary care infrastructure and, thus, achieve true reform of the U.S. health care system. That's according to AAFP President Ted Epperly, M.D., of Boise, Idaho, who spoke during a Capitol Hill press briefing on June 18.

Epperly paired that message with calls to bolster the primary care workforce through graduate medical education policies that support medical students' choice of careers in primary care and revamp the health insurance system so that Americans are able to access needed health care services.

"This isn't about trying to get dollars in our pocket as much as it is trying to get primary care practices across the nation sustainable for the future so they are there for people," Epperly said during the press briefing.

Epperly participated in the event with Joseph Stubbs, M.D., president of the American College of Physicians, and Larry Wickless, D.O., president-elect of the American Osteopathic Association. Together, the three organizations represent more than 300,000 U.S. primary care physicians and care for the majority of the nation's Medicare patients.

All three organizations have called for an immediate 10 percent increase in Medicare physician payment rates in fiscal year 2010 and an additional 5 percent increase in each of the following four years. According to Epperly, there is enough money currently in the Medicare system to pay for the increases, as long as those funds are spent wisely.

"We believe there are (opportunities) across Medicare to have more integrated, coordinated care," he said. "It is in these savings that primary care can be made whole, as opposed to finding new money outside the system."

In his remarks, Epperly identified three key elements needed for health care reform:

Epperly pointed out that medical students often are saddled with enormous debt when they graduate, making primary care a less attractive career path than many more lucrative subspecialties. He called on Congress to enact reform that "encourages more medical school graduates to enter primary care because they see it as a viable career that provides both professional and economic opportunity."

"Health system reform must begin at the beginning," said Epperly. "For years, funds to train primary care doctors have been sorely lacking. We have told our lawmakers that support for primary care education must be increased."

Describing the sustainable growth rate, or SGR, formula used to determine physician payment rates as "an anchor that is dragging the whole system down," Epperly decried the current physician payment system, warning that "until the SGR is done away with, innovation and creative models are going to be hard to come by."

"For decades, primary care physicians have struggled with a payment system that has sent them downriver, as payment for health care deteriorated, while payment for sick care and interventions skyrocketed," he said. "We have told lawmakers that implementing and paying for the patient-centered medical home is crucial to preventive care, early diagnosis and treatment. It is the key to coordinated care, reduced fragmentation and duplication and, most important, better patient outcomes at better cost to patients and the system."

Stubbs agreed, saying that failure to eliminate the SGR as a part of an overall health care reform plan could be disastrous for primary care. Stubbs said he was encouraged by a draft health care proposal put forth by three relevant House committees that calls for eliminating the SGR.

"We feel the right steps are being taken to try to transform our health care delivery system to one in which it incentivizes and aligns itself with providing value instead of volume," said Stubbs.

Meanwhile, Wickless described health care in terms of the relationships patients have with their physicians -- most often, their primary care physicians.

"In our opinion, this country has lost the perspective on how valuable and how essential the patient/physician interaction is to the health of the patient and the success of the health care system," he said.

Epperly, Stubbs and Wickless also spent much of the day meeting with federal legislators and their staff, reinforcing the message that primary care and the patient-centered medical home are keys to achieving the simultaneous goals of greater health care access, improved quality and cost-containment.

"We have told lawmakers that this nation needs health insurance options for everyone under a system that preserves employer-based coverage, expands access through premium assistance and offers an array of predictable, understandable plans that families -- regardless of their health history, pre-existing conditions and economic status -- can afford," Epperly said in a subsequent interview with AAFP News Now.