Payment Reform, GME Legislation Focus of FP Advocacy Visits by AAFP Leader

AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., returned to Capitol Hill last week to continue his push for Medicare payment reform and to encourage support for a bill that would change graduate medical education (GME) funding for primary care residents training in nonhospital settings.

Stream last visited Capitol Hill in early March as part of a larger group of AAFP leaders who urged lawmakers to support programs and legislation that are key to strengthening the primary care infrastructure.

During his most recent visit, Stream met with officials from CMS and HHS, as well as with House and Senate staff members, effectively dividing his time between Medicare payment issues and rallying support for H.R. 3667, a bill that would establish a pilot project to allow a portion of GME payments to go directly to community-based primary care residency programs. Those programs then would collaborate with local hospitals to provide necessary training in inpatient care.

Stream met separately with Jonathan Blum, deputy administrator and director of the CMS Center for Medicare, and with Sherry Glied, M.A., assistant secretary for planning and evaluation at HHS. In those meetings, Stream outlined recent recommendations made by the AAFP's Primary Care Valuation Task Force to more accurately value and pay for primary care physician services.

On March 12, the AAFP sent a letter (10-page PDF; About PDFs) to CMS Acting Administrator Marilyn Tavenner, M.A., that summarized the recommendations of the task force and asked CMS to adopt those recommendations. The meeting with Blum served as a follow-up to that letter, said Stream, who attended the meeting with Academy EVP Douglas Henley, M.D.

"I provided some background on the task force and explained what our goals are in the near and long terms to improve primary care payment," Stream told AAFP News Now. "We had a copy of the letter that we sent to CMS, and we went over it point by point with Blum."

Blum indicated that CMS would consider the AAFP's input as it develops the 2013 Medicare physician fee schedule, Stream added.

Stream also presented a copy of the March 12 letter to Glied, who, according to Stream, was interested in hearing the Academy's recommendations. "There is excellent content in our letter," said Stream. "When you have something that is written down like that, it is always going to generate questions and some back-and-forth dialogue. It also helps to clarify our suggestions and to move things along."

In his meetings with House and Senate staff members, Stream focused on generating support for H.R. 3667, which has been introduced in the House but not the Senate. Stream paid visits to the offices of Sens. Charles Grassley, R-Iowa, and Jim Risch, R-Idaho, and met with their legislative staffs to urge support for the bill.

On the House side, Stream targeted the offices of House members who have not signed on as co-sponsors of H.R. 3667. These included the offices of Reps. Kristi Noem, R-S.D.; Patrick Meehan, R-Pa.; Bobby Schilling, R-Ill.; and Nan Hayworth, M.D., R-N.Y.

In each of these meetings, Stream noted that he emphasized the advantages of H.R. 3667 and what works for primary care residency programs. In turn, Stream, received some feedback on the chances of H.R. 3667 passing this year, and he is convinced that the AAFP has "made some good incremental progress on pushing the (graduate medical education) bill forward."