• Fighting for Family Medicine

    Fighting for Family Medicine: Recent AAFP Advocacy Wins



    Supporting Family Physicians During the COVID-19 Pandemic

    Family physicians have been on the front lines of the fight against COVID-19 since the start of the pandemic — and so has the Academy, pushing Congress and the administration to deliver what you need to care for your patients, keep yourself safe and sustain your practice.

    These efforts yielded significant wins through the Families First Coronavirus Response Act; the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and other legislation, including the 2020 year-end deal. Advances for primary care also came through regulatory actions by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) that reflected input and advocacy from the Academy, including the following:

    • AAFP and CFSP member Kisha Davis, M.D., testified before the Senate Finance Committee on COVID-19 flexibilities and lessons learned, particularly those related to telehealth.
    • CMS increased rates for in-home COVID-19 vaccine administration.
    • COVID-19 vaccines will be shipped directly to family medicine practices to enable adolescents and other patients to receive doses from their primary care physicians, whom President Biden has acknowledged as the most trusted source for vaccine information.
    • Establishment of a federal program to ensure that underserved populations can access COVID-19 vaccines at community health centers.
    • Implementation of a historic increase in outpatient evaluation and management payment rates following long-term regulatory advocacy, legislative initiatives, and grassroot campaigns.
    • An increased 2021 Medicare conversion factor through funding to offset budget-neutrality requirements amid the COVID-19 pandemic.
    • Nearly doubled Medicare payment rates for COVID-19 vaccine administration.
    • A 6.2% increase in federal matching funds for state Medicaid programs for the duration of the public health emergency.
    • Removal of burdensome and harmful requirements to accessing mifepristone.
    • Freezing current payment and patient count thresholds for physicians participating in advanced alternative payment models, which will ensure that participating family physicians are eligible for incentive payments.
    • A delay in Medicare sequester payment reductions.
    • Improved affordability for patients by banning surprise medical billing.
    • Delayed implementation of electronic health information sharing requirements for physicians until April 2021.
    • Removal of regulatory burdens for physicians and improved patient access to medication-assisted treatment for opioid use disorder.
    • HHS Provider Relief Funding for physicians to recoup some of their pandemic-related financial losses.
    • Paycheck Protection Program funds to provide short-term, forgivable loans to increase cash flow, and a technical fix to the tax treatment of the loans.
    • Medicare accelerated and advance payment program funds to provide advance access to capital for Medicare providers.
    • Widespread Medicare, Medicaid and private-payer coverage of COVID-19 vaccines without cost-sharing for the duration of the public health emergency.
    • Elimination of patient cost-sharing for COVID-19-related diagnostic and treatment services while allowing health plans to waive deductibles for telehealth services.
    • Elimination of prior-authorization requirements for all COVID-19-related diagnostic services.
    • Suspension of Medicare geographic and originating site restrictions for telehealth.
    • Enabling federally qualified health centers and rural health clinics to provide telehealth services.
    • Payment parity for Medicare telehealth services.
    • Medicare coverage and payment parity for audio-only E/M visits.
    • Relief from Medicare Quality Payment Program reporting requirements.
    • Relief for Medicare alternative payment model participants.

    In 2020 the AAFP co-hosted a virtual briefing to educate members of Congress and their staffs on the need to support primary care during COVID-19. The event featured remarks by co-chairs of the Congressional Primary Care Caucus and drew more than 150 attendees. A second event underscored the urgent need for additional legislative action.

    NEXT

    The AAFP continues to advocate for financial support and access to personal protective equipment for primary care practices responding to the pandemic. The AAFP is also working to ensure that  family physicians on the pandemic's front lines are incorporated in distribution plans for the COVID-19 vaccines.


    COVID

    Investing in Primary Care  

    Following long-term advocacy by the AAFP, CMS implemented historic Medicare payment increases for family medicine on January 1, 2021. In 2019, CMS finalized increased payment rates for outpatient evaluation and management (E/M) services, which make up the foundation of family medicine, beginning in 2021. The AAFP strongly supported these payment increases and worked to ensure that CMS implemented them as planned.

    Our efforts included both regulatory and legislative activities as Congress also weighed options to provide additional financial relief to physician practices of all specialties amid COVID-19. In addition to ensuring that the E/M improvements went into effect as planned, the AAFP secured equitable financial relief for family physicians when Congress included a 3.75% increase to all Medicare payments for 2021.

    Together, the E/M improvements and this relief will result in significant Medicare payment increases for family physicians in 2021. While the COVID-related relief is temporary, the payment increases for outpatient E/M services represent a historic step forward in appropriately valuing primary care.

    In December 2020, Congress also passed legislation freezing for two years the thresholds that physicians participating in advanced alternative payment models must meet in order to be eligible for incentive payments. The AAFP had long advocated for such a freeze to ensure that alternative payment models continue to be accessible for family physicians.

    The first performance period of the Primary Care First model began in January 2021. The model is focused on practices that provide advanced primary care and are ready to assume financial risk in exchange for reduced burden and performance bonuses. Many of the components of this model were recommended by the AAFP, and we continue to support alternative payment models that use prospective, risk-adjusted, population-based payments for primary care.

    The AAFP partnered with other physician organizations to help introduce legislation in both the House and the Senate to increase Medicaid reimbursement rates for primary care services to at least Medicare levels.

    NEXT

    The Academy will continue working with its champions in Congress to pass legislation to increase Medicare and Medicaid payments for primary care and support alternative payment models.

    Investing in Primary Care

    After advocacy efforts by the Academy and others, Congress passed a bipartisan agreement to avert the 2% Medicare sequester cuts through Dec. 31, 2021.

    The AAFP successfully secured the implementation of the largest increase in primary care payments in the history of the Medicare program. Beginning Jan. 1, 2021, following long-term advocacy by the AAFP, Medicare relative values for office/outpatient Evaluation and Management (E/M) visits were increased significantly. The Academy also secured equitable COVID-19 financial relief for family physicians when Congress applied a 3.75% increase to Medicare payment rates for 2021. The AMA estimates that together these changes will result in an 11% increase in Medicare payments to family medicine in 2021. While the COVID-related relief is temporary, the increases in the relative values for outpatient E/M services are permanent and represent a historic step forward in appropriately valuing primary care.

    In Dec. 2020, Congress also passed legislation freezing for two years the thresholds that physicians participating in advanced alternative payment models must meet in order to be eligible for incentive payments. The AAFP had long advocated for such a freeze to ensure that alternative payment models continue to be accessible for family physicians.

    The first performance period of the Primary Care First model began in Jan. 2021, and applications for the second cohort of model participants opened in March 2021. The model is focused on practices that provide advanced primary care and are ready to assume financial risk in exchange for reduced burden and performance bonuses. Many of the components of this model were recommended by the AAFP, and we continue to support alternative payment models that use prospective, risk-adjusted, population-based payments for primary care.

    The AAFP partnered with other physician organizations to help introduce legislation in both the House and the Senate to increase Medicaid reimbursement rates for primary care services to at least Medicare levels.

    NEXT

    The Academy will continue working with its champions in Congress to pass legislation to increase Medicare and Medicaid payments for primary care and support alternative payment models. Specifically, the AAFP is advocating for Medicaid pay parity to ensure that physicians can serve a growing Medicaid population that has increased during the pandemic.


    Reducing Administrative Burden for Physicians

    Following ongoing advocacy from the AAFP to reduce and streamline prior authorization requirements, CMS is proprosing a requirement that certain health plans automate prior authorization processes. The AAFP submitted comments in support of this proposal and called on CMS to expand these requirements to additional health plans.

    At the AAFP’s urging, CMS has proposed to again delay full implementation of the burdensome Medicare Appropriate Use Criteria (AUC) program until at least Jan. 1, 2023. A report from Congress also advanced the AAFP’s position on the AUC program.

    NEXT

    The Academy is working with Congress and CMS to halt implementation of the Medicare Appropriate Use Criteria program.


    Ensuring Access to Primary Care

    HHS has proposed a rollback of several harmful regulations that the AAFP previously opposed because they would have limited access to comprehensive, affordable health care coverage. In the same proposed rule, HHS would create a new ongoing special enrollment period for low-income individuals.

    CMS has also proposed to permanently cover audio-only telehealth services for the diagnosis, evaluation, and treatment of mental illness in established Medicare patients, for which the AAFP has long advocated.

    Additionally, two family physicians have been appointed to the Medicaid Reentry Workgroup.

    After the AAFP’s repeated support for the Kids’ Access to Primary Care Act in 2020 and 2021, the Energy and Commerce Committee held a hearing on the bill in March 2021. This marks a significant step toward passing the legislation, that which would waive cost-sharing for vital pediatric primary care services.

    CMS announced that it would not move forward with a new flexibility for the Part D Modernization model that the AAFP opposed. The flexibility would have allowed participating plans to bypass protected drug class requirements in calendar year 2022, which could have negatively affected access to essential treatments for complex conditions.

    The AAFP consistently opposed a 2019 Title X regulation that dictated what medical information a family physician could give patients in the evidence-based family planning program. In March, after ongoing advocacy, the Biden administration reversed this regulation.

    In April, the AAFP applauded new prescribing guidelines for physicians and other clinicians who have a waiver to provide buprenorphine treatment for opioid use disorder. Consistent with the AAFP’s advocacy to remove regulatory barriers to prescribing buprenorphine, the new guidelines exempt physicians who are treating 30 or fewer patients at a time from certain burdensome reporting requirements.

    Following opposition by the AAFP, CMS rescinded and then withdrew the Medicaid Fiscal Accountability Regulation, which would have reduced federal funding for state Medicaid programs already facing significant budget shortfalls.

    CMS finalized regulations encouraging Medicare Advantage plans to improve coverage and access to telehealth services for Medicare Advantage beneficiaries.

    Support for primary care access legislation continues to increase in Congress, specifically to reduce barriers for those who have high-deductible health plans. Since the AAFP helped create the Primary Care Patient Protection Act, a bill to ensure that patients can access primary care prior to meeting their insurance deductibles, legislation was introduced during the 116th Congress with the same intent, including an identical bill introduced in the Senate and another proposal to waive deductibles for chronic-disease care.

    NEXT

    The AAFP will continue working with Congress on legislation that prioritizes the health of all Americans by expanding coverage for, and eliminating barriers to, comprehensive primary care services, including robust access to telehealth services beyond the public health emergency and waiving high deductibles for primary care.


    Health Equity

    The Biden administration has made health equity a top priority for responding to the COVID-19 pandemic and its broader health agenda. The AAFP was pleased that the White House quickly established a Health Equity Task Force and launched a federal program to ensure that underserved populations could access COVID-19 vaccines at community health centers.

    In April, HHS announced approval of the first 1115 waivers in Illinois, New Jersey, and Missouri, extending postpartum coverage beyond 60 days, up to 12 months. This move is in line with AAFP advocacy and marks a significant step forward in continuity of care for postpartum patients.

    On April 29, the FDA announced a ban on menthol cigarettes and flavored cigars after years of advocacy from the AAFP. This life-saving move will stop the manufacture and sale of cigarettes and cigars with menthol and other flavors that largely appeal to young people and are more addictive than non-flavored tobacco products. After decades of predatory marketing in Black communities, this is a major step toward addressing U.S. health inequities.

    The House Ways and Means Committee recently released a report outlining Chairman Richard Neal’s vision on health and economic equity. The document reflected several of the AAFP’s priorities, as submitted to the committee in October, including addressing systemic racism and health disparities.

    In a letter to HHS, the AAFP urged federal officials to improve the collection and reporting of COVID-19 health disparities data. In response to these concerns, Congress approved language to strengthen data collection requirements within the CARES Act.

    Policymakers also approved the Paycheck Protection Program and Health Care Enhancement Act; the latter requires HHS to stratify data by race, ethnicity, age, sex, and geographic region.

    NEXT

    The Academy will engage the 117th Congress and the Biden administration to support health equity through policies and regulations that  increase primary care access, improve data collection, address social determinants of health and enhance health care quality. The AAFP provides ongoing expert recommendations to address the disparities that exist within maternal health and rural health.


    Strengthening the Workforce

    After continued advocacy from the AAFP, Sen. Murray and Rep. Pallone introduced the Doctors of Community (DOC) Act, which is the first bill permanently authorizing and expanding the Teaching Health Center Graduate Medical Education (THCGME) program.

    The AAFP successfully secured a three-year extension of the THCGME program and $330 million of additional funding. To date, the THCGME program has trained more than 1,148 primary care physicians and dentists, 65% of whom are family physicians. HRSA has also made new planning and technical assistance grant programs available for THCs.

    Additionally, the current administration recently rescinded a J-1 visa rule the Academy opposed because it would have been burdensome for medical students and residents who hold such visas.

    Previously, the year-end package enacted Dec. 27 extended mandatory funding for the THCGME program, community health centers and the National Health Service Corps at current levels through fiscal year 2023. The extension, included as a result of AAFP advocacy efforts, provides critical funding to ensure stability for these vital programs. 

    The year-end package also extended the Conrad 30 waiver program for physicians working in underserved areas, added 1,000 additional Medicare-funded GME residency positions and included several other provisions investing in family medicine.

    In July 2020, the Health Resources and Services Administration announced seven new THCGME program grants for the 2020-21 academic year, marking the first new awardees in seven years. The announcement marked the first new awardees in seven years and occurred due to the AAFP’s successful, years-long effort to increase THCGME program funding and stability.

    NEXT

    The Academy will work with the 117th Congress to pass legislation that increases residency training for family physicians, permanently extends the THCGME program and invests in strategies that strengthen the family physician pipeline.


    Providing Research Basis for Clinical Expertise to Improve Individual and Population Health

    The AAFP successfully supported a 10-year reauthorization of the Patient-Centered Outcomes Research Institute in order to fund primary care research vital to extending the nation's capacity to design and implement patient-centered outcomes research.

    NEXT

    The AAFP will continue to advocate for the primary care research funding necessary to expand the capacity for practice-based research, which is particularly critical in the face of changes imposed by COVID-19.


    State Level Support and Advocacy

    During the 2020 state legislative session, the Center for State Policy worked with state chapters across the country to develop resources, track legislation and provide policy analysis to complement their advocacy efforts. The Center announced new priority issues and additional resources for states to achieve their advocacy goals, including template letters, state-by-state fact sheets and legislative policy backgrounders, with a special emphasis on resources to address the COVID-19 pandemic. The Center also offers $40,000 in grant opportunities for state chapters looking to expand their lobbying efforts through increased outreach to state legislators and amplified advocacy on topics such as primary care spend.

    Over the course of 2020, the Center tracked more than 28,000 bills across the 46 state legislative and four territorial bodies in session last year and responded to more than 300 chapter inquiries in the first half of 2020 on issues including scope of practice, payment reform, and administrative burden. The COVID-19 pandemic forced the Center’s 2020 State Legislative Conference to convene online, in the form of four in-depth webinars on topics of interest to state chapters, including the annual State Roundtable, which highlighted innovative policies being pushed by state chapters during an extraordinary year.

    During its two-year stint as first co-chair for the nonpartisan Partnership for Medicaid, the Center for State Policy reinvigorated the group and met with key congressional staff, administrative agencies, and policy speakers to secure Medicaid payment and coverage improvements. Under the AAFP’s leadership, the Partnership for Medicaid played a role in successfully calling on CMS to withdraw the agency’s Medicaid Fiscal Accountability Regulation, which would have hurt state budgets and threatened beneficiaries’ access to care during a public health emergency.