• In The Trenches

    We’re Working to Turn Short-term Spending Wins Into Concrete Gains

    Dec. 5, 2023

    By David Tully
    Vice President, AAFP Government Relations

    As stopgap measures go, the continuing resolution Congress passed before Thanksgiving could have been worse. Yes, lawmakers avoided shutting down the government. And crucially, they passed this temporary funding of the federal government without tacking on any spending cuts or policy riders — which is why you may have heard it called a “clean” resolution.

    A resolution larded with spending cuts or riders could have been bad news for the AAFP’s advocacy priorities. Instead, we picked up a couple of short-term wins, along with more time for us to turn them into real gains for family physicians.

    U.S. Capitol

    More time, but not a lot of time. The new fiscal cliff is Jan. 19, the first of two deadlines the continuing resolution set for finalizing the federal budget. That is, some agencies and programs will run out of money that day, the rest on Feb. 2.

    What’s Good?

    The continuing resolution maintains 2023-level funding for community health centers, the National Health Service Corps and the Teaching Health Centers Graduate Medical Education program. These programs are vitally important to family medicine, which is why we have consistently pushed Congress to permanently and robustly fund them. In particular, the Academy strongly supports the Lower Costs, More Transparency Act, which would reauthorize the THCGME program and act as a guardrail against health care consolidation. You can add your voice to this call to action in a Speak Out campaign.

    We’re pleased that the resolution also maintains the floor for the work Geographic Practice Cost Index though Jan. 19 — mitigating a cut to Medicare clinician pay in areas with lower costs of living — and delays by one year Medicare laboratory pay cuts that the AAFP opposed.

    Ahead of that deadline, the AAFP is fully engaged with Congress to halt the forthcoming Medicare payment cuts without interfering with the Jan. 1 implementation of the G2211 billing code. I encourage you to add your voice to this campaign, too. We continue as well to work with policymakers on improving the physician workforce.

    What’s Next?

    The day after Congress passed the continuing resolution, AAFP President Steven Furr, M.D., FAAFP, and President-elect Jen Brull, M.D., FAAFP, met with members of Congress to talk about physician payment and related concerns. Our key takeaway from these conversations: Any health-related package with legislation we support likely won’t be taken up until after the new year — closer to that Jan. 19 deadline.

    For now, there’s cause for optimism in the fact that the Senate Finance Committee unanimously advanced a bipartisan health care package last month, the Better Mental Health Care, Lower-Cost Drugs And Extenders Act, which would partly mitigate the pending Medicare payment cut for physicians as well as extend certain expiring Medicare and Medicaid provisions.

    Specifically, the legislation contains a one-year 1.25% increase to physician Medicare reimbursement rates, helping to offset 2024’s planned 3.4% cut. The bill also would extend advanced alternative payment model bonuses (at a lower rate of 1.75%) through 2026 as well as extend through 2024 the floor value of 1.0 for the physician work geographic index used in the calculation of payments under the Medicare physician fee schedule. We expect this bill to become part of a broader health care package. The committee plans a closer look at Medicare payment reform next year.

    On Nov. 15, the House Energy & Commerce Health Subcommittee took up a wide range of legislative proposals, including bills targeting physician payment. These got the nod and will advance to the full committee.

    From this slate, the Academy staunchly backs the Provider Reimbursement Stability Act of 2023, which would raise the budget neutrality threshold from $20 million to $53 million in 2025, then, starting in 2030, increase it every five years by the cumulative increase in the Medicare Economic Index. It also would

    • require CMS to analyze its utilization estimates compared with actual use;
    • require CMS to update, at least every five years, the direct cost inputs for practice expense relative value units of clinical staff wage rates, medical supplies and equipment; and
    • limit fluctuations to the conversion factor to no more than 2.5% each year.

    This, too, may be included in a broader health care package in January.

    Workforce Wins

    In November, CMS awarded the next 200 graduate medical education residency slots allocated in the 2021 appropriations bill. Following the Academy’s advocacy, family medicine has about 35 of those slots. Last month, we called on policymakers to build on this momentum by prioritizing physician training programs in underserved areas when determining the next GME allocations.

    In other good news for family physicians, the Health Resources and Services Administration has added a Maternity Care Target Area Supplemental Award of up to $40,000 for eligible clinicians, including family physicians who practice obstetrics on a regular basis. For more information, application instructions and a link to the application portal, see HRSA’s webpage.

    On this same front, a reminder that the National Health Service Corps Students to Service Loan Repayment Program application cycle is open through Dec. 7.


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    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.