AAFP Leaders Make Case for Family Medicine During Capitol Hill Visits

As Congress moves closer to passing a comprehensive health care reform bill, the AAFP continues to make a strong case for primary care and family medicine on Capitol Hill, telling lawmakers that health care reform will not succeed without a robust primary care system.

In a series of Capitol Hill meetings on Oct. 21, AAFP President Lori Heim, M.D., of Vass, N.C.; President-elect Richard Goertz, M.D., M.B.A., of Waco, Texas; Board Chair Ted Epperly, M.D., of Boise, Idaho; and AAFP member Danny Proffitt, M.D., of Fayetteville, Ark., met with Sen. Blanche Lincoln, D-Ark., who is a member of the Senate Finance Committee Subcommittee on Health. The group also met with the health care staff of Sen. Mark Pryor, D-Ark., and Heim and Goertz met separately with Rep. Dennis Cardoza, D-Calif., who is on the House Rules Committee.

The AAFP leaders, along with AAFP Director Kenneth Bertka, M.D., of Holland, Ohio, also met with the health care staffs of Sens. Sherrod Brown, D-Ohio, and George Voinovich, R-Ohio.

In each meeting, the AAFP leaders delved into some of the details of health care reform, emphasizing the importance of the patient-centered medical home; adequate funding for graduate medical education, or GME; and support for a proposed CMS rule that would increase Medicare payments for family physicians by 8 percent, on average, in 2010.

"The members of Congress and their staffs were incredibly supportive of family medicine in particular and primary care in general," said Heim in an interview with AAFP News Now after the event. "They understand that there have to be fundamental changes in how we support family medicine if we are going to have successful health care reform. That came across loud and clear in our discussions."

During the meeting with Lincoln, for example, Proffitt furnished a local perspective on health care reform, discussing issues such as physician workforce and payment reform from the point of view of physicians in Arkansas. Heim, Goertz and Epperly then provided a national perspective on health care reform, explaining how it would affect family physicians and their patients on a national level.

In this way, the AAFP was able to provide a "one-two combination that started with local Arkansas issues and lead, in turn, to national issues," said Epperly.

Proffitt told Lincoln about the difficulties of finding physicians to take new Medicare patients in Arkansas because of low Medicare payment rates and the overall lack of primary care physicians in the state, messages that resonated with the senator.

"Sen. Lincoln knows what physicians are up against," said Proffitt. "She understands how difficult it is to attract physicians into primary care."

During the meetings, the AAFP leaders also stressed the importance of supporting a CMS proposed rule that would increase Medicare payments for family physicians by 8 percent in 2010.

"We brought that up with every single staffer we met and with Lincoln and Cardoza," said Heim. "There was generally good support for the proposed rule."

The income disparity between primary care physicians and subspecialists "is not lost on lawmakers or their staffs," and all agreed that the payment formula used in the proposed rule is valid, said Heim.

During their meeting with Cardoza, Heim and Goertz thanked him for his interest in a pilot project that would modernize GME training by providing funds to nonhospital entities that train primary care physicians.

"We have to applaud his foresight and his support of family medicine," said Heim. "Cardoza is someone who clearly understands that if we are going to have health care reform, we are going to need the workforce to provide access. And that means we have to start changing how GME funds primary care residencies."

In addition, AAFP leaders discussed the elimination of the sustainable growth rate, or SGR, formula during the Capitol Hill meetings. The SGR, which is used to determine physician payment rates under Medicare, would require a 21 percent cut in Medicare payments to physicians in January if Congress does not intervene.

"Every legislator I have talked with during the past several years has agreed that the SGR has to be fixed," said Heim. "That is not disputed or debated." But there are questions about how to pay for a permanent SGR fix and what should replace the current formula. Last week, Senate leaders were unable to bring a bill to the floor that would have eliminated the $245 billion debt accumulated to date by Congress, which has blocked multiple yearly SGR adjustments.

"It is very disappointing that we are once again back in the same boat we have been in every year because of the flawed formula," said Heim about the SGR.

However, she added, there is cause for optimism. She believes that Congress will provide a temporary fix to the SGR by the end of the year, thus blocking the 21 percent Jan. 1 payment cut.

"Congress understands the SGR has to be fixed," said Heim. "(Family physicians) cannot be left with a guillotine over our heads every time we turn around. The SGR stops practices from being able to plan for the long term and to innovate."

There still is a long way to go in terms of health care reform, noted Heim, but she added, the AAFP, for its part, will continue to advocate on behalf of family medicine on Capitol Hill and elsewhere.