AAFP to White House: Hold the Line on Supporting FPs, Primary Care in 2012 Budget

Even as the AAFP and other family medicine organizations recently applauded the Obama administration's efforts to "provide appropriate payment for primary care services and support primary care workforce programs," the groups specifically called for a "multiyear Medicare schedule (that) narrows the payment differential between primary care and other physicians."

In a March 7 letter (3-page PDF; About PDFs), AAFP President Roland Goertz, M.D., M.B.A, of Waco, Texas, and the presidents of four other family medicine organizations praised the administration's 2012 fiscal year, or FY 2012, budget request, which would pay for a two-year extension of the sustainable growth rate, or SGR, formula. That, in turn, would prevent mandatory reductions to Medicare payment rates through the end of 2013.

CMS now estimates that physicians will face a 29.5 percent reduction under the SGR on Jan. 1, 2012, unless Congress acts to block the cut.

According to the letter, which, in addition to Goertz, was signed by the presidents of the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Association of Departments of Family Medicine, the FY 2012 budget request, if enacted, would provide "two years of relief for physicians from devastating reductions in payments resulting from the SGR." However, the groups noted that "a multiyear Medicare schedule (that) narrows the payment differential between primary care and other physicians is needed."

"The House of Representatives approved an example of differential payment when it passed the Medicare Physician Payment Reform Act in 2009," the groups said. "The bill would have created a conversion factor of GDP (gross domestic product) plus 2 percent for primary care services, while specifying a conversion factor of GDP plus 1 percent for all other physician services."

In addition, the groups pointed out that the Council on Graduate Medical Education, or COGME, has called specifically for improving payment for practicing primary care physicians to achieve the desired ratio of primary care to subspecialty care. In its December 2010 report, COGME said the average incomes of primary care physicians "must achieve at least 70 percent of median incomes of all other physicians." Modification of current payment policies would ensure qualified medical students could afford to choose to train as primary care physicians, said the report.

The groups also acknowledged that the White House budget proposal would provide increases for health professions training programs.

"We commend your request for $140 million to fund Title VII Section 747 of the Public Health Service Act, which supports family medicine training," the organizations said. "Data show that medical schools and primary care residency programs funded by Title VII, Section 747, disproportionately serve as the medical education pipeline for physicians who go on to work in community health centers and participate in the National Health Service Corps, or NHSC, to treat underserved populations."

Furthermore, the organizations said, "Since there is evidence that debt is a barrier to students from low- and middle-income families who are more likely to go into primary care, we support your FY 2012 request to increase the NHSC program by $277 million from the FY 2010 level. With those funds, the NHSC will be able to provide for new scholarship as well as continuations and new and continuing loan repayment awards."

Acknowledging the budgetary pressures facing the nation, the organizations nevertheless expressed regret that the president did not request funding for the new National Health Care Workforce Commission or the Primary Care Extension Program, which aims to provide support and assistance to FPs and other physicians on evidence-based therapies and techniques. In their letter, they vowed to "continue to advocate for an effective National Health Care Workforce Commission and a robust Primary Care Extension Program."