AAFP Leaders Blitz Capitol Hill to Press for Payment Reform, Halt Looming Program Cuts

AAFP leaders returned to Capitol Hill last week and launched a renewed effort to eliminate the sustainable growth rate (SGR) formula and enact payment and workforce policies that would better recognize the value of primary care and family physician services.

In a series of meetings with House and Senate staff members Feb. 11-12, AAFP President Jeff Cain, M.D., of Denver, and three other AAFP leaders -- AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash.; AAFP President-elect Reid Blackwelder, M.D., of Kingsport, Tenn.; and AAFP EVP Doug Henley, M.D. -- repeatedly stressed the need to replace the flawed SGR formula with a blended payment model that would reward family physicians for the skill and expertise they bring to the nation's health care system.

"One of the most important things we accomplished is carrying forward the message that family medicine needs to be valued and that payment needs to be reformed," Blackwelder told AAFP News Now.

That message resonated with House and Senate staff members, raising renewed hopes that Congress soon will eliminate the SGR and replace it with a more equitable physician payment system. AAFP leaders met with staff members who work for Democratic and Republican House and Senate members, as well as with staff members who serve on key House and Senate committees.

"In contrast to years past, we heard from Democratic leadership and Republican leadership that the SGR is broken, and that they are committed to moving forward with a solution," said Cain. "The methods of how to move forward differ from party to party and from House to Senate, but this year, leaders on both sides of Capitol Hill and in both parties are committed to working toward a long-term solution."

The AAFP visits came at an opportune time. The Congressional Budget Office (CBO) recently said the cost of repealing the SGR now stands at $138 billion, a decrease of $107 billion from the previous CBO score of $245 billion, thereby bolstering arguments for outright repeal. "We are not going to get a better opportunity," said Blackwelder. "The analogy that was being used was locking in a mortgage rate where you are able to say, 'This is the best opportunity to get a better rate that we ever had.'"

The congressional visits occurred about a week after Rep. Allyson Schwartz, D-Pa., and Rep. Joseph Heck, D.O., R-Nev., reintroduced a bill that would fundamentally reform the Medicare payment system by eliminating the SGR and boosting Medicare payments for the provision of primary care services. The legislation also would encourage adoption of innovative payment models, such as the patient-centered medical home.

"One of the profitable aspects of having our leadership on the Hill is we were able to take good ideas from the Schwartz/Heck bill and share them with the House and Senate committees" via these meetings with congressional staff, said Cain.

During their Capitol Hill visits, the AAFP leaders also confronted impending budget cuts that are scheduled to take effect on March 1 as a result of the Budget Control Act's sequestration provision. If enacted, the across-the-board sequestration reductions would cut the Medicare physician payment rate by 2 percent and other key primary care programs by as much as 8 percent.

In every meeting, AAFP leaders forcefully argued against the cuts, saying the reductions threaten access to care for millions of patients, including seniors and disabled Americans. "A 2 percent cut may not sound like very much, but for many physician practices, especially those that serve a large number or percentage of Medicare patients, it is a significant reduction," said Stream.

He and the other AAFP leaders also pointed out that the sequestration cuts would hurt programs that help produce family physicians, thereby undercutting the supply of FPs in the workforce pipeline. For example, sequestration would cut funding for Medicare graduate medical education, the National Health Services Corps and health professions training grants provided by Title VII, Section 747 of the Public Health Service Act, which is the only federal program to provide funds specifically to help train family physicians.

"The sequestration cuts may save money in the very short term," Stream said. "But it would be very costly in the long term, especially if Congress is not doing everything possible to improve the pipeline of new family physicians. This means that in the long run, fewer people are going to have access to family physicians, resulting in lower quality and higher health care costs."

Although Medicare payment reform and sequestration were the main topics of discussion during the meetings with congressional staff, the AAFP leaders also focused on issues important to individual lawmakers and committees, such as medical liability reform and the role of primary care and family medicine in slowing health care costs and improving health care quality.

These types of advocacy efforts have produced enormous dividends during the past several years, carving out a prominent place for primary care and family medicine, according to the AAFP leaders. For example, the AAFP's presence on Capitol Hill allowed the Academy to help develop the Schwartz/Heck bill.

"There is now use on Capitol Hill of the term 'primary care' more than ever before," said Blackwelder. "People are now talking about primary care in a way they did not before, but it is important that our representatives also understand family medicine's foundational place in providing true primary care," he added.