AAFP Engages White House on Health Care Reform

In advance of a planned Feb. 25 bipartisan summit at the White House on comprehensive health care reform, the AAFP has sent a letter to President Obama urging him to work for enactment of a health care reform bill that provides Americans with access to affordable health insurance coverage and that will strengthen the nation's primary care infrastructure through payment and workforce reforms.

In the letter, AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, commends the president for convening the health care summit to try to restart stalled congressional efforts to pass health care reform. "Such action is essential to the American people," says Epperly.

"We greatly appreciate your leadership in convening this health care summit and steering the nation toward a more patient-friendly, primary care-based health system," writes Epperly.

However, he notes, health care reform also must include workforce and payment reforms to help ensure a sufficient supply of primary care physicians and to create positive incentives for innovative models to improve the delivery of primary care. This includes provisions to promote the patient-centered medical home, or PCMH.

"We strongly urge that a health reform bill recognize the value of primary care with the creation of a 10 percent bonus Medicare payment for physicians whose health care services are more than 50 percent primary care," said Epperly. "Additionally, Medicaid payment rates for primary care services should be at least equal to Medicare payment rates."

Epperly described these as "important initial steps toward signaling to medical students that the federal government is committed to investing in primary care, and they help begin to rebalance the skewed system of provider payments."

Epperly also calls for giving CMS greater authority to identify misvalued physician services and to make appropriate adjustments to the relative value of those services if appropriate and needed.

In addition, says Epperly, CMS should have specific authority for PCMH demonstration projects and should create a center for innovation to test the medical home model in Medicare. "However," he notes, "we caution against limiting PCMH demonstrations/pilots to only certain populations, such as those with multiple chronic conditions. The medical home model is particularly effective in providing the prevention and wellness health care that many of the proposed changes to the health care system attempt to promote."

The letter goes on to say that enacting health care reform would likely extend insurance coverage to millions of uninsured people, thus, creating a greater demand for primary care physicians. However, without an adequate supply of primary care physicians, health care reform would be "useless," according to Epperly.

"To that end, innovation in the training of primary care physicians is essential," he notes. Epperly recommends including a teaching health center program in any final health care reform legislation. The teaching program would train primary care residents in nonhospital settings, such as community health centers, where most primary care is delivered.

In addition, Epperly calls for increased funding for the National Health Service Corps' scholarship and loan repayment program and the reauthorization of the Section 747 Title VII training in family medicine program. Additional steps also are needed, such as establishment of competitive grants to medical schools for the development of curricula to integrate quality improvement and patient safety in clinical education, the creation of a national health care workforce commission, and an improvement in the primary care student loan program, according to Epperly.

Epperly also calls for the elimination of the current sustainable growth rate, or SGR, formula, which is used to set Medicare physician payment rates and which calls for a 21.2 percent cut in Medicare payments to physicians as of March 1.

"Legislation to reform our nation's health system is incomplete unless it brings stability and predictability to the Medicare physician reimbursement system," says Epperly.

Epperly also says that Congress should eliminate the antitrust exemptions enjoyed by health insurance plans as part of any health care reform bill. "These exemptions give the insurance companies unfair advantages in negotiating rates with physicians and in coverage decisions for patients."

At the same time, health care reform should "address the medical liability system in this country," says Epperly. "At a minimum, Congress should provide sufficient funding for states to experiment with alternative dispute resolution systems," he writes.