AAFP Letter to House Speaker Expresses Support for Reform Legislation
But Changes Are Called For, Says Board Chair
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.
"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.
Payment Rule Legislation
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.
"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.
AAFP Guidelines on Health System Reform
During an October meeting, the AAFP Board of Directors voted to adopt Academy advocacy guidelines for health system reform (15-page PDF; About PDFs) to help guide the AAFP's advocacy efforts during the federal push to achieve health system reform in 2009.
The guidelines cover conditions for reform that the AAFP would like to see in any approved legislation, including conditions for reform of the private insurance market, principles for support of any public plan option, creation of independent commissions to oversee payment and reform of the medical liability system. The Board does note, however, that the guidelines are subject to change and compromise during negotiations with the Obama administration and Congress on health system reform.
In particular, the section on reform of the medical liability system, which was amended to the original Board report, includes provisions stipulating that any reform should
The guidelines cover conditions for reform that the AAFP would like to see in any approved legislation, including conditions for reform of the private insurance market, principles for support of any public plan option, creation of independent commissions to oversee payment and reform of the medical liability system. The Board does note, however, that the guidelines are subject to change and compromise during negotiations with the Obama administration and Congress on health system reform.
In particular, the section on reform of the medical liability system, which was amended to the original Board report, includes provisions stipulating that any reform should
- impose a hard cap on noneconomic damages;
- limit attorneys' contingency fees;
- inform juries of prior insurance payments to patients and reduce awards by the amount of compensation from collateral sources;
- replace joint and several liability with proportionate liability, so each party would pay a share of a malpractice award based on the proportion for which he (or she) is liable;
- allow periodic payment of future damages at a defined award limit;
- provide for alternative dispute resolution systems; and
- require that expert witnesses possess knowledge and expertise pertinent to the case being considered and practice in the same medical specialty as the defendant.
Health Care Reform Legislation
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.
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."
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."
