2012: Year in Review

AAFP Rallies Support for Family Medicine on Capitol Hill, Works to Protect, Promote FP Issues

January 03, 2013 02:50 pm James Arvantes

In 2012, the AAFP continued to push for the elimination of the sustainable growth rate (SGR) formula and for fundamental payment reform that would better recognize and reward the provision of primary care and family physician services. At the same time, the AAFP strove to protect and preserve programs that are vital to primary care and family medicine and the nation's health care system as a whole.

(Then) AAFP President Glen Stream, M.D., M.B.I., makes a point about the importance of primary care and the patient-centered medical home for improving quality and controlling costs during a roundtable discussion on Medicare physician payment held by the Senate Finance Committee in July 2012.

In late Dec. 2011, Congress passed a two-month extension of the Medicare physician payment rate that postponed a 27.4 percent reduction in Medicare physician payment until March 1. As a result, physicians again were facing a steep reduction in the Medicare physician payment rate called for by the SGR as 2012 began.

The AAFP launched a concerted effort to block the cut, corresponding and meeting with representatives and senators on Capitol Hill, and issuing Speak Out alerts to rally member opposition to the reduction. In one of its first actions in 2012, the Academy designated Jan. 18 as a day of action for Medicare payment reform and urged members to contact their legislators and voice their opposition to the pending reduction on that day.

Congress eventually passed a 10-month extension of the Medicare physician payment rate that averted the cut scheduled for March 1. But the legislation left the flawed SGR formula in place, prompting a swift rebuke from the AAFP.

"Congress has missed an important opportunity to permanently solve the Medicare physician payment crisis, ensure health security for elderly and disabled Americans, and enable physicians to develop the long-term plans needed to redesign their practices into patient-centered medical homes," said (then) AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., in a prepared statement.

The need to block payment cuts and replace the SGR with a more equitable payment system continued to frame much of the AAFP's advocacy efforts in 2012.

For example, the AAFP urged Congress to pass a bipartisan House bill that seeks to revamp the Medicare payment system by eliminating the SGR and initiating various payment reforms to reward the provision of primary care services via a 2.5 percent increase for primary care physicians.

The legislation, known as the Medicare Physician Payment Innovation Act, was sponsored by Rep. Allyson Schwartz, D-Pa., and Rep. Joseph Heck, D.O., R-Nev. If passed, it would begin the transition to a sustainable payment system and recognize the value of primary care.

Rep. Allyson Schwartz, D-Pa., discusses Medicare payment issues with (then) AAFP President Glen Stream, M.D., M.B.I., during an AAFP Board meeting in March. Schwartz is sponsoring a bill to eliminate the sustainable growth rate formula and reform Medicare payment.

During testimony before the Senate Finance Committee on July 11, Stream again addressed the importance of payment reform by calling on Congress to adopt a blended payment model that supports the patient-centered medical home (PCMH) as a way to improve health care quality and control costs.

"The AAFP is convinced that no single alternative payment method will rebuild primary care," said Stream. "We need a combination of methods." He proposed that Congress adopt a payment methodology that includes a fee-for-service component, a care-management fee and quality improvement payments.

Family physician John Bender, M.D., of Fort Collins, Colo., delivered a similar message to Congress during testimony before the House Ways and Means Subcommittee on Health on Feb. 7. In his testimony, Bender said the PCMH "is now being proven and adopted in the private sector." And he urged Congress to mandate the adoption of the PCMH in the public sector to improve the overall quality of care and to help reverse escalating costs that are burdening the American taxpayer.

AAFP leaders also carried family medicine's message during meetings and correspondence with lawmakers and administration officials by stressing the importance of supporting programs that are important to primary care and family medicine. This includes adequate support for Section 747 of Title VII, the only federal program that provides funds specifically to academic departments and programs to increase the number of primary care health professionals.

Stream and AAFP Board member Daniel Spogen, M.D., of Reno, Nev., emphasized the need to support graduate medication education (GME) funding in a meeting with Senate Majority Leader Harry Reid, D-Nev., on March 7. Stream and (then) AAFP President-elect Jeffrey Cain, M.D., of Denver, also visited the office of Sen. Michael Bennet, D-Colo., on March 7, where they talked about GME modernization.

In the meantime, AAFP leaders met with high-ranking HHS and CMS officials throughout the year, including CMS Acting Administrator Marilyn Tavenner, M.A., to advocate on behalf of programs and policies important to primary care and family medicine.

Common Goals

The AAFP also repeatedly partnered with other organizations in 2012 to work toward common goals and solutions to payment problems. In late January, AAFP leaders and representatives from three other physician organizations -- the American College of Physicians (ACP), the American Osteopathic Association (AOA), and the American College of Surgeons (ACS) -- met with key House and Senate members, including Senate Majority Leader Reid, Senate Minority Leader Mitch McConnell, R-Ky., and House Minority Whip Steny Hoyer, D-Md. All three lawmakers expressed a desire to repeal the SGR.

(Then) AAFP Board Chair Roland Goertz, M.D., M.B.A., left, describes the impact of the sustainable growth rate on physician practices to Sen. Mike Crapo, R-Idaho.

"I think we made history today in the sense that we had four of the largest physician groups in the country who represent physicians who take care of Medicare patients -- the AAFP, the AOA, the ACP and the ACS -- all on Capitol Hill with a unified message to fix the SGR," said (then) AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas, at the time.

On Dec. 13, the AAFP, AOA, ACP and ACS, along with the AMA, returned to Capitol Hill and met with lawmakers in a final push to avert deep cuts in the Medicare physician payment rate on Jan. 1 and Jan. 2.

During the Dec. 13 meetings, Stream and the other physician leaders implored lawmakers to not pay for a Medicare payment extension by cutting funding for GME or by eliminating a provision in the health care reform law to bring Medicaid payment rates at least to Medicare levels for the next two years. The AAFP spearheaded opposition to a House proposal that would pay for a yearlong extension of the Medicare physician payment rate by eliminating the Medicaid/Medicare parity provision.

"We were not there asking for more money just to prevent payment cuts to physicians," said Stream. "We recognize that the current system is unsustainable -- that it doesn't promote quality. We want to transition to a better system, and we want certainty and stability during that transition."

AAFP Pushes Key Pieces of Legislation in 2012

The AAFP championed a few key pieces of legislation in 2012 that are designed to strengthen the nation's primary care infrastructure and to ultimately achieve the simultaneous goals of higher quality, enhanced access to health care and better controlled costs.

For example, in addition to urging Congress to act swiftly on the Medicare Physician Payment Innovation Act mentioned above, the AAFP also urged support of H.R. 3667, a bill sponsored by Cathy McMorris Rodgers, R-Wash., that would establish a pilot project to allow a portion of graduate medical education (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.

Another bill, introduced by Rep. Jim McDermott, D-Wash., would establish a state-based scholarship program for primary care medical students who would agree to practice in medically underserved areas for five years after residency.

The legislation, known as Restoring the Doctors of Our Country Through Scholarships Act, H.R. 6400, also would prioritize scholarships for students enrolled in six-year accelerated family medicine programs, as well as programs that include clinical training in underserved communities.

In the end, the lame-duck Congress pushed off solutions to the SGR by applying a one-year patch that keeps Medicare payment levels for 2013 at 2012 levels. The bill also delays for two months a 2 percent cut called for by the Budget Control Act's sequestration provision, and it does not cut the funding that will bring Medicaid payments at least to Medicare payments for the next two years.

Friend-of-the-Court Brief

The AAFP's ability to partner with other organizations transcended physician payment issues in 2012. For example, the AAFP and the Council of Academic Family Medicine (CAFM) joined forces in calling on Congress to spare GME funding from reductions that could result from ongoing deficit-reduction negotiations.

In a Nov. 28 letter to House and Senate leaders, both the AAFP and the CAFM, which represents the four academic family medicine organizations, urged Congress to not cut GME funding. The letter also said, however, that if Congress decides to reduce funding for GME, it should prioritize and make only selective reductions rather than across-the-board cuts. Specifically, the groups called on lawmakers to target GME programs that lead to a second certification and protect residency programs that lead to initial certification.

The AAFP also joined with other major physician organizations in filing a friend-of-the-court brief in a lawsuit that seeks to overturn a Florida law prohibiting physicians from asking patients and their families about guns in their homes and from noting a patient's gun ownership in his or her medical record.

In the brief, the AAFP and nine other physician organizations said the statute, known as the Firearm Owners' Privacy Act, prevents physicians from communicating openly with their patients and from providing medical care according to accepted standards.

"Not only do physicians lose the right to express themselves freely, but their patients are deprived of the full range of medical care and professionalism that they should and do expect from their physicians," said the brief.

The brief also noted that "the statutory restraint on record keeping prevents physicians from taking a routine precaution that might enhance their defense against charges of medical malpractice."

"The Florida law -- our opposition to it -- has nothing to do with gun ownership," said Stream in an interview with AAFP News Now. "The issue is whether are there are firearms in the house, and if there are, the physician should be able to talk to patients about gun safety -- the safe storage and maintenance of guns, for example, and keeping guns out of the reach of children."

The friend-of-the-court brief came on the heels of a New England Journal of Medicine article written by the AAFP and four other physician-led organizations that calls on states to stop promoting and passing laws that infringe on the patient/physician relationship and that are not based on science and evidence.

Turning Point

Also in 2012, the Supreme Court issued a landmark ruling upholding nearly all of the provisions of the Patient Protection and Affordable Care Act. Within minutes of the June 28 ruling, Stream said that "as a result of this decision, more Americans will have access to meaningful insurance coverage and to the primary care physicians who are key to high-quality, affordable health services."

"Broad, individual responsibility for health care is the foundation for successful implementation of the Affordable Care Act's patient protection," said Stream. "Economic realities dictate that ensuring coverage for all Americans depends on participation of all Americans."

Then, in November, voters re-elected President Obama while leaving Republicans in control of the House and Democrats with a majority in the Senate. With the power structure in Washington left virtually unchanged, federal agencies moved to implement various provisions of the ACA.

To help members with new and changing regulations, the AAFP released several summaries explaining various provisions of the health care law. For example, the AAFP released a summary in November that discusses the final Medicaid-Medicare parity regulation.

In the summary, the AAFP identified which physician groups are eligible for enhanced payments and what physicians need to do to qualify for increased payments. In addition, the AAFP created a dedicated Web page to help members better understand how the rule will affect payment for primary care and some preventive health care services provided as a part of the Medicaid program.

The AAFP also issued an informational summary(18 page PDF) documenting the opportunities, challenges and benefits of implementing various provisions of the ACA, including Medicaid expansions and the establishment of state-based health insurance exchanges.

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2012: Year in Review