AAFP Letter to House Speaker Expresses Support for Reform Legislation

In a letter to House Speaker Nancy Pelosi (3-page PDF; About PDFs), D-Calif., the AAFP has expressed its support for two health care reform bills pending in the House, but the Academy also noted that there are improvements that could be made in the bills to support tort reform and improve payment for primary care physicians.

The Affordable Health Care for America Act, H.R. 3962 (at the THOMAS Web site, type "H.R. 3962" in the search box after selecting "Bill Number"), would provide health insurance coverage for about 96 percent of Americans and reduce the federal deficit by $30 billion. The Medicare Physician Payment Reform Act, H.R. 3961 (at the THOMAS Web site, type "H.R. 3961" in the search box after selecting "Bill Number"), would replace the sustainable growth rate, or SGR, formula with physician updates that are tied to inflation, not specified targets.

"While there are several areas where we think these bills can be modified to improve care to our patients, they are consistent with the principles of health care reform that the AAFP believes are necessary to achieve," said AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, in the letter.

The letter urges Congress to pass H.R. 3961, which would block a pending 21.5 percent cut in Medicare physician payments scheduled to take effect in January. But the Academy also is urging Congress to not make changes to a final 2010 Medicare physician payment rule issued by CMS that would phase in a 5 percent to 8 percent increase in Medicare payment rates for primary care physicians during the next four years.

"The physician expense provisions of the (CMS) final rule are based on valid, scientifically rigorous survey, and CMS should be allowed to use that accurate and more current survey to determine physician expenses and, ultimately, payment rates," Epperly said.

In addition, Epperly noted that H.R. 3962, the health care reform bill, contains improvements from the first version of the bill, including wider eligibility for patients in community-based Medicare medical home demonstration projects. The broadening of the medical home demonstration projects "will show the best results if they are available to all patients, and physician practices can transform their delivery of health care without regard to segments of their patient populations," Epperly said.

Epperly also noted that the new legislation retains a provision to bring Medicaid payments for primary care services to a level that is at least as high as Medicare payment rates, while prohibiting the imposition of cost sharing for recommended preventive services.

However, the Academy is calling for improvements in the bill based on concerns expressed by its members. For example, wrote Epperly, although the AAFP appreciates that H.R. 3962 now includes a voluntary program to encourage states to implement alternatives to traditional medical malpractice litigation, the AAFP recommends that Congress consider other reforms as well, including caps on noneconomic damages that have proven effective in several states.

In addition, although the AAFP applauds the legislation's commitment to improving payment for primary care services, "given a decade-long declining trend in students choosing primary care, we will continue to request additional investments in this area," said Epperly. "This is crucial for growing the number of medical students who choose primary care as their medical career." And an increase in the number of primary care physicians, he added in the letter, is "fundamental to building a health care delivery system that improves quality and cost efficiency based on the strength of the trusted relationship with a personal physician."