House Appropriations Bill Would Cut Vital Funding for Primary Care

The AAFP has moved quickly and forcefully to express grave concerns about a House bill that would abolish funding for programs that are considered vital to primary care and family medicine in the 2013 fiscal year, including funding for the Agency for Healthcare Research and Quality (AHRQ) and the Center for Medicare and Medicaid Innovation (CMMI).

In a letter (2-page PDF; About PDFs) to the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies Committee on Appropriations, AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas, said the proposal fails to provide sound and appropriate investments in patient-centered research and the nation's primary care infrastructure.

"We feel the provisions included in the proposed legislation are not supportive of your goal and ongoing efforts to improve quality and reduce the overall costs of health care," said Goertz, in the letter to the chair of the subcommittee.

Goertz pointed out that AHRQ's mission is to improve the quality, safety, efficiency and effectiveness of health care for all Americans. That mission closely mirrors the AAFP's own mission, Goertz said. "AHRQ supports important research to improve clinical decision making, reduce costs, advance patient safety, decrease medical errors, and enhance health care quality and access."

In addition, Goertz emphasized that the AAFP supports the important work of the CMMI. The center provides CMS with a "degree of nimbleness and creativity that is unusual in the private sector, much less the federal government," said Goertz.

The AAFP is working closely with the CMMI to encourage selected family physicians to participate in the Comprehensive Primary Care Initiative, which allows CMS to work with commercial and state health insurance plans to support primary care practices that deliver coordinated and seamless care based on the tenets of the patient-centered medical home (PCMH).

"The importance of this initiative is that it contains more than just Medicare patients," said Goertz. "Since only about 20-25 percent of the patients in an average family physician's practice are in the Medicare program, it has been difficult for many of these practices that want to transform themselves into a PCMH to find the upfront finances needed to pay for the required investments.

"By including other payers in a specific market, the chances that the family physician will have access to the necessary capital are greatly increased, and practice transformation is much more feasible."

Goertz also expressed concern that the subcommittee's proposal does not include sufficient funding for the Health Resources and Services Administration to provide $71 million in needed funding for Section 747 of Title VII of the Primary Care Training and Enhancement program.

"Title VII primary care training grants are vital to departments of family medicine, general internal medicine and general pediatrics," said Goertz. "They strengthen curricula and they offer incentives for training in underserved areas."