AAFP President Continues to Press Congress on Health Care Reform Issues

AAFP President Lori Heim, M.D., of Vass, N.C., returned to Capitol Hill on Nov. 5, meeting with lawmakers and their staff members for the second time in less than two weeks to re-emphasize the importance of primary care and family medicine in any health care reform bill passed by Congress.

Heim met with Sen. Tom Harkin, D-Iowa, chair of the Health, Education, Labor and Pensions, or HELP, Committee; Rep. Dennis Moore, D-Kan.; Rep. Mario Diaz-Balart, R-Fla.; and staff members from the offices of several other lawmakers, including Sens. Charles Grassley, R-Iowa; John Kerry, D-Mass.; Christopher Dodd, D-Conn.; Joe Lieberman, I-Conn.; and Rep. Allyson Schwartz, D-Pa. In nearly all of the meetings, Heim focused on a few key issues, such as applying the patient-centered medical home, or PCMH, to all population groups; the need for graduate medical education, or GME, funding reform; and support for a recent CMS rule that would phase in a 5 percent to 8 percent increase in Medicare payments to primary care physicians during the next four years.

The AAFP messages were well received in the meetings, according to Heim. She noted that she particularly stressed the importance of having the PCMH apply to all patient population groups, not just patients with special needs or chronic conditions. The first iteration of the House health care reform bill called for the creation of a community-based PCMH pilot project that would have pertained only to special needs populations. But that language has been expanded to include all population groups in the recent health care reform bill passed by the House, a change championed by the AAFP.

"Limiting the patient-centered medical home to a specific group of patients with chronic diseases does not work when practices have re-engineered their practices around the medical home," Heim told the lawmakers and their staff members. "The pilots need to include all patients within the practice."

The revised House language demonstrates that the AAFP's messages are being heeded, she said.

Heim also noted that every lawmaker and staff member she spoke with was knowledgeable about the PCMH and understood both its purpose and value, something that was not the case only a few years ago, she said.

"The patient-centered medical home is not just disease or condition management," said Heim. "The medical home is a change in how primary care physicians deliver care. Conveying that is still an educational process, but we are now talking to an audience that is receptive and much more well-versed on the subject."

When meeting with staff from Kerry's office, Heim was accompanied by a representative from IBM who talked about the importance of the PCMH from a business perspective.

"It changes the discussion when you are sitting side-by-side with an employer like IBM who is also saying, 'This is what I need as an employer,'" said Heim. "That is very powerful."

Heim said she also called for fundamental changes in GME funding. In particular, she explained that GME programs should pilot-test a process in which funding goes directly to residency programs -- including family medicine residencies -- rather than to sponsoring hospitals, which then make the funds available to residencies.

FP David Carlyle, M.D., of Ames, Iowa, who accompanied Heim on her visits with Harkin and Grassley's staff, explained that the system for GME funding was created in 1965 when people typically received their care through hospitals. However, the practice of medicine has changed profoundly in the past 45 years, said Carlyle. "It would be best to change the payment system based on how we take care of patients in 2009," he said. "Residents are trained in offices, not hospitals. We would like to have the money go directly to the programs instead of filtering through the hospitals."

Heim, meanwhile, reiterated the importance of keeping a 2010 CMS rule that would phase in a 5 percent to 8 percent increase in Medicare payments for primary care physician services during the next four years. Various subspecialty organizations have been meeting with members of Congress to urge them to override these provisions of the CMS rule. But Heim explained that the CMS rule is based on a valid, scientifically rigorous survey, making it an accurate way to determine physician expenses and payment rates.