"Put me in coach, I'm ready to play today. Look at me, I can be centerfield."
-- John Fogerty
This past week the Physician-Focused Payment Model Technical Advisory Committee (PTAC), sent a letter to HHS Secretary Alex Azar recommending that the AAFP's Advanced Primary Care Alternative Payment Model (APC-APM) be tested. The PTAC recommended the APC-APM on Dec. 19.
The transmittal of the official recommendation to Secretary Azar sets in motion the next phase of our work to transform payment for primary care services. In its letter to Secretary Azar, the PTAC stated: "There is an urgent need to preserve and strengthen primary care and recommends the APC-APM proposal to the Secretary for limited-scale testing, while emphasizing that limited-scale testing of the proposed model is a high priority." The AAFP is pleased with the PTAC recommendation and echoes a few key words from that sentence -- "urgent" and "high priority."
The AAFP sent a letter to Secretary Azar on March 19. In our letter, we called on him to move quickly to approve the proposal for testing and to direct the Center for Medicare and Medicaid Innovation (CMMI) to design and implement the model in the Medicare program. AAFP Board Chair John Meigs, M.D., summarized the importance of the APC-APM as follows: "If fully implemented, it would allow more than 200,000 primary care physicians to engage in an advanced APM that promotes the value of primary care, facilitates comprehensive and continuous patient-centered primary care, provides the financial resources to enable physicians to transform and sustain their practices, and reduces the administrative burden associated with modern day medical practice."
We are optimistic about securing the approval of Secretary Azar and excited about the progress made to date with respect to the APC-APM. However, we recognize fully the work and challenges that lie ahead. In late February, we brought together a group of physician payment thought-leaders, which included a handful of family physicians, to discuss key elements of the APC-APM and how the model should be designed for testing. We will use the feedback received to inform our future communications with CMMI on the model. More to come on this important work, but I am pleased to report that progress is being made.
Speaking of progress, Congress actually made progress on a key piece of legislation before adjourning for its annual spring recess on March 23. Prior to adjourning, both the House and Senate passed the Consolidated Appropriations Act of 2018, which provides $1.3 trillion in federal funding for the current fiscal year -- through Sept. 31, 2018. In the finest traditions of Congress, lawmakers mustered the will to fund the operations of the federal government six months into the current fiscal year. If you detect a hint of sarcasm, your intuition is correct. Congress gets to do this all again in the coming months as it attempts to fund the federal government for FY 2019 on or before Sept. 30, 2018. Adding to the drama, the president briefly hinted that he might veto the bill due to the excessive spending and the fact that the bill did not provide full funding for the Mexico border wall. Then the president held a press conference during which he informed the nation that, yes, he would sign the bill, and the government stayed open.
Passage of the Consolidated Appropriations Act of 2018 brought to a close one of the more disorderly appropriations processes in our nation's history, which included an uncharacteristic number of short-term continuing resolutions and political bickering. Despite the horrible process, the actual legislation and the provisions contained therein are favorable and supportive of many AAFP priorities. Here are a few key provisions:
Despite the inclusion of many AAFP-supported provisions, there is one glaring omission that will have an immediate, negative impact on health insurance markets. Congress failed to include so-called market stabilization provisions in the bill. There had been some speculation (wishful thinking) that the bill would include a bipartisan package of provisions aimed at stabilizing the small group and individual insurance markets. The AAFP had called on Congress to restore cost-sharing reduction payments and reinsurance payments as a means of stabilizing the market and preventing dramatic premiums spikes in 2019. The omission of these provisions will not impact insurance markets this year, but likely will have a negative impact on premiums, in some markets, in 2019.
On April 16, 1940, Bob Feller -- "The Heater from Van Meter" -- threw the only opening day no-hitter in the history of major league baseball. Feller's Cleveland Indians defeated the Chicago White Sox 1-0.
Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy. Read author bio »