AAFP Leaders Press Congressional, Agency Staff on Need to Repeal SGR, Preserve GME Funding

On Oct. 20, AAFP leaders carried the banner of family medicine to Capitol Hill when they met with congressional staff and regulatory officials to discuss issues essential to sustaining and strengthening primary care and family medicine.

"We are continuing to build momentum in the direction we need to," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., one of four Academy leaders who met with congressional staff and health care officials. "Change never comes as fast we would like. But in the uncertainty of the current budget climate, we had an opportunity to make our case about how family medicine improves quality and saves costs, and how family medicine can be hard-wired into the system."

Stream was joined by AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas; AAFP President-elect Jeffrey Cain, M.D., of Aurora, Colo.; and AAFP EVP Douglas Henley, M.D. The four AAFP leaders met separately and in groups with congressional staff and officials from CMS and the Office of the National Coordinator of Health Information Technology.

In meetings with congressional staff, the AAFP leaders stressed the need for eliminating the sustainable growth rate, or SGR, formula and the importance of protecting funding for graduate medical education, or GME.

"Every single person we talked to on Capitol Hill understood that the SGR is broken," said Cain. "All of them also understood there is a need to think about primary care and make sure we value primary care.

"The question is -- how is that going to be actualized?" he added.

In discussing GME, Cain and the other AAFP leaders warned of the consequences of an across-the-board cut in GME funding, saying it would disproportionately affect primary care and, in particular, family medicine residency programs. Both Congress and the Obama administration have proposed cuts in GME funding as part of deficit reduction proposals.

Stream, Goertz and Cain also met with staff of the Joint Select Committee on Deficit Reduction, which was created by Congress to develop a plan to achieve reductions in the federal deficit. If the government fails to enact the committee's recommendations by Dec. 23, across-the-board cuts totaling $1.2 trillion will be triggered automatically and go into effect in 2013.

The AAFP leaders targeted various House and Senate health committees, as well. Cain, for example, met with the health policy adviser for the House Energy and Commerce Subcommittee on Health, and Goertz met with majority staff for the Senate Finance Committee.

"These folks heard us and shared with us the concern and the need for improved primary care and improved payment for primary care," said Cain.

On the programmatic side, Stream, Cain, Goertz and Henley met with Richard Baron, M.D., director of the seamless care models group for the CMS Center for Medicare and Medicaid Innovation. They discussed the Comprehensive Primary Care Initiative, a public-private project that will pay medical home practices a per-patient, per-month fee for providing coordinated care.

"The initiative is a game-changer for us," said Stream. "It really aligns with the model that we have been promoting to support practice transformation to the patient-centered medical home."

Baron "was very excited to see our interest and our desire in aligning our efforts to make this initiative successful," Stream noted.

Stream and Henley also met with Farzad Mostashari, M.D., the national coordinator for health information technology, or health IT, about the implementation and use of health IT in family physician practices. "We had a great conversation about how challenging it is for primary care practices to implement (health) IT, and yet how important it is," said Stream.

In the meantime, Cain met with Steve Larsen, deputy administrator and director of the Center for Consumer Information and Insurance Oversight or CCIIO, at CMS. The two discussed health insurance exchanges and the Consumer Operated and Oriented Plan, or CO-OP, program enacted as part of the Patient Protection and Affordable Care Act.

"CCIIO is very interested in working with us to help our members understand the CO-OPs and exchanges that are coming and to work well with them," said Cain.