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Tuesday Apr 03, 2018

AAFP Payment Model Clears Another Hurdle

"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(aspe.hhs.gov) (PTAC), sent a letter(aspe.hhs.gov) 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.  

[blue piggy bank with stethoscope]

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(3 page PDF) 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:

  • Opioid epidemic -- The bill included $4.6 billion in new funding for the CDC, the Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration to combat the opioid epidemic. This is a $3 billion increase compared to FY 2017.
  • Agency for Healthcare Research and Quality -- The bill provides $334 million for AHRQ -- which is $10 million more, or a 3 percent increase -- compared to FY 2017 level. It also provides $1 million (presumably for the National Academy of Medicine) to study health services and primary care research focusing on research gaps and areas for consolidation, as well as proposed strategies for better coordination of the federal government's health services research enterprise.
  • HRSA -- The bill increased discretionary budget authority for HRSA by nearly 8 percent to $6.737 billion in FY18. Community health centers received a $135 million increase. The agreement calls for not less than $200 million of funding to be awarded to expanding and improving access to quality mental health and substance use disorder prevention and treatment services nationwide.
  • Gun violence research -- The bill took significant steps toward establishing a research program charged with evaluating violence that involves a gun at CDC. Such research, historically, has been indirectly prohibited by the so-called Dickey Amendment. The bill expressly supports and reinforces the ability of CDC to conduct "research on the causes of gun violence." The full provision reads: "While appropriations language prohibits the CDC and other agencies from using appropriated funding to advocate or promote gun control, the Secretary of Health and Human Services has stated the CDC has the authority to conduct research on the causes of gun violence." The legislation also included provisions that strengthen the National Instant Criminal Background Check System(www.fbi.gov) (NICS).
  • Tobacco control -- The bill provides CDC's Office on Smoking and Health with $210 million for FY18, a $5 million increase from FY 2017. The agreement did not include policy riders that would have exempted so-called large and premium cigars from FDA oversight.
  • National Health Service Corps -- The bill includes $105 million for the NHSC and expands eligibility for loan repayment awards to include substance use disorder counselors.
  • Rural residency programs -- The bill provides new money totaling $15 million to fund a new Rural Residency Program designed to expand the number of rural training programs and develop programs that are sustainable beyond their current federal funding levels. The funds will support planning and development costs accrued while achieving program accreditation through the Accreditation Council for Graduate Medical Education. The agreement encourages HRSA to support rural hospitals, medical schools and community-based ambulatory settings with rural designation along with a consortium of urban and rural partnerships.

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.

Wonk Hard -- Baseball Edition

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.

Posted at 08:00AM Apr 03, 2018 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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