2011: The Year in Review

Medicare Payment Reform, SGR Repeal Top AAFP's Legislative, Advocacy Agenda

January 05, 2012 04:50 pm James Arvantes

Medicare payment reform and the need to replace the sustainable growth rate, or SGR, formula continued to drive much of the AAFP's legislative and advocacy efforts in 2011, as the Academy repeatedly pressed Congress for fundamental Medicare payment reform.

Academy leaders and staff members met regularly with both lawmakers and their staff members to generate support for payment reform that would accomplish the Academy's three main goals:

  • repeal of the SGR,
  • a specified payment rate for the next three to five years to allow time for various demonstration programs and alternative health care delivery models to generate sufficient data to determine which payment methods make the best fiscal and quality sense, and
  • at least a 3 percent higher payment rate for primary care physicians delivering primary care services.

During the past several years, the SGR has called for steep reductions in the Medicare physician payment rate that have been averted only by last-minute congressional action. Although Congress passed a yearlong Medicare payment patch in 2010 that postponed Medicare payment reductions until Jan. 1, 2012, the impending payment reduction, coupled with federal budget deficit questions, caused a great deal of uncertainly and angst in the physician community and posed a direct threat to patient care.

Thus, the AAFP spent much of 2011 working with members to rally support for a repeal of the SGR and Medicare payment reform. A number of Speak Out alerts from the AAFP encouraged members to contact their representatives and senators in Washington in support of these goals. The AAFP also joined forces with other organizations in pushing for repeal of the SGR. In the process, the AAFP remained one of the nation's leading voices in calling for a new and more equitable Medicare payment system in 2011.

Efforts to repeal the SGR, however, were stymied by the cost of replacing the payment formula, and, in the end, Congress only managed to pass at the last minute a two-month Medicare payment patch that averted the 27.4 percent Medicare payment cut set to take effect on Jan. 1. A conference committee now is charged with agreeing to measures to extend the Medicare physician payment formula beyond Feb. 29.

But none of this activity made the Academy happy. "Eleventh-hour legislation that fails to meet the needs of constituents is no way to conduct the nation's business," said AAFP President Glen Stream, M.D., M.B.I., of Spokane Wash., in a prepared statement. "That is particularly true when millions of Americans' health and welfare are at stake. But last-minute inadequate legislation is exactly what Congress has done with passage of an absurdly short reprieve from the 27.4 percent cut in physician payment mandated by the deeply flawed SGR formula for Medicare."

Powerful Message

The debate about the SGR was greatly affected by the debate regarding deficit reduction, which emerged as a powerful rallying cry on Capitol Hill in 2011. The AAFP continued its legislative and advocacy efforts to preserve and protect programs essential to the future of family medicine, even as Congress created a bipartisan Joint Select Committee on Deficit Reduction -- also known as the "supercommittee" -- to develop a plan for achieving federal budget cuts and possible revenue increases. However, the supercommittee failed to produce a consensus on how to reduce the deficit and whether to repeal the SGR, promoting a swift rebuke from Stream.

He accused the supercommittee of dropping the ball by failing to reach a consensus, saying, "This is no way to address the federal budget deficit. Nor is it the way to serve (Congress') constituents. Allowing the Medicare physician payment issue to fester worsens the health insecurity of millions of elderly patients and military families."

Stream, who acknowledged the tremendous grassroots efforts of AAFP members, stressed that the inability of the supercommittee to reach an agreement on a deficit-reduction plan was a reflection of the complexity of the deficit issue itself and not a result of members' advocacy efforts.

In the meantime, various congressional proposals were put forth that called for severe funding reductions for graduate medical education, or GME, programs and Title VII health professions training grants. In response to these proposals, the AAFP launched a nationwide Family Medicine Matters, campaign to rally member and congressional support for

  • repealing the SGR formula,
  • protecting GME funding, and
  • preserving funding for Title VII health professions training grants.

Family Medicine Matters employed a variety of methods to generate support for the three issues, including issuing short videos that framed and put each of the issues into perspective and using Speak Out alerts to urge members to contact their representatives in Washington in support of the three goals.

The AAFP also asked members to send in their stories about how the impending 27.4 percent cut in Medicare payments called for by the SGR would affect them and their patients, what fewer residency programs would mean for their FP training programs, and what funding decreases for family medicine programs would mean for their studies. The AAFP is sharing these real-life stories with lawmakers and putting actual names and faces on issues to personalize the challenges facing family medicine because of continuing payment uncertainty.

AAFP members' response to the campaign was overwhelming. By the end of 2011, more than 2,443 members had sent 6,208 letters to Congress.

"I am very proud of our members in being that engaged on important issues and their willingness to put so much energy and time in this advocacy effort on behalf of themselves and their patients," Stream said in a November interview with AAFP News Now.

Unfurling the Banner of Family Medicine

The AAFP also took other steps to strengthen primary care and family medicine in 2011. In May, more than175 AAFP advocates, educators and leaders met in the nation's capital for the annual Family Medicine Congressional Conference.

After spending one day learning about the issues and the lobbying process, they visited numerous congressional offices and delivered a strong message about the importance of primary care. Approximately 300 congressional legislators and staff met with the AAFP advocates.

In late October, Academy leaders, including Stream; AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas; AAFP President-elect Jeffrey Cain, M.D., of Denver; and AAFP EVP Douglas Henley, M.D., took their message to Capitol Hill. The group met with both congressional staff members and officials from CMS and the Office of the National Coordinator of Health Information Technology.

In a meeting with Richard Baron, M.D., director of the seamless care models group for the CMS Center for Medicare and Medicaid Innovation, the AAFP leaders voiced support for 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."

Cain returned to Capitol Hill in early November to continue pressing for a long-term Medicare payment solution and adequate funding for GME programs during meetings with key congressional staff members.