First, our longtime push to fortify the Teaching Health Center Graduate Medical Education program paid a strong dividend last month when the Health Resources and Services Administration said it would spend $19.2 million of American Rescue Plan money to fund 120 full-time THCGME residents. The move will strengthen community-based residency programs for primary care and dental residents in rural and underserved areas — as the AAFP has for years worked to do. We’ve been fighting for this: a path toward a more robust workforce pipeline and improved health care for the communities most in need.

Second, Congress in late February sent the Dr. Lorna Breen Health Care Provider Protection Act to President Joe Biden’s desk. It’s designed to address physicians’ mental health needs by investing in programs to protect their mental health and ending the stigma medical professionals often face when seeking necessary treatment and support. The Academy took every opportunity to call for its passage in the months since its introduction, and we’re pleased that it’s ready for a signature. We continue to lobby the CDC to study and address mental health issues and increased burnout in the medical workforce, particularly among primary care physicians.

Your patients’ behavioral health is also an important part of our advocacy right now, as I told you last time. With COVID-19 having exacerbated feelings of anxiety, depression and post-traumatic stress disorder amid a shortage of behavioral health clinicians, primary care physicians have stepped into the breach. You’ve often served as the first point of contact for patients needing mental health diagnoses; but when 40% of all visits for depression, anxiety or cases defined as “any mental illness” are with primary care physicians, there’s new urgency in the Academy’s support for integrating behavioral health services into the medical home.

That’s one of the high-level messages the AAFP’s Board just delivered to influential members of Congress during our latest day of concentrated Capitol advocacy this past week. It was a full, productive slate of meetings, and I’m confident we’ll see positive results on behavioral health as well as the other two topics we brought to the table: Medicaid pay parity and telehealth policy. We’re asking lawmakers to

• pass legislation to improve behavioral health integration and promote research to identify additional evidence-based models of integrated care, as the Collaborate in an Orderly and Cohesive Manner Act would do;
• pass legislation establishing a Medicare add-on code for primary care physicians that have the capacity to provide integrated behavioral health services;
• reauthorize the Pediatric Mental Health Care Access program, set to expire at the end of this year, to ensure that pediatric primary care practices can continue to integrate behavioral health using telehealth;
• pass legislation to establish a Medicaid demonstration program providing infrastructure, technical assistance and sustainable financing for expanding access to integrated mental health care — especially for children in primary care, schools or other critical settings, and including virtual and audio-only services;
• increase Medicaid payment rates to at least Medicare levels (to do this, we’ve endorsed the Kids Access to Primary Care Act, H.R. 1025, and the Ensuring Access to Primary Care for Women and Children Act, S.1833);
• extend temporary Medicare telehealth flexibilities for at least one year beyond the COVID-19 public health emergency;
• commission further studies of telehealth policies to determine whether they are improving access to care for underserved communities, protecting patient safety and advancing health equity, as well as to examine utilization and patient outcomes and analyze impact by race, ethnicity, gender, language and income; and
• ensure a distinction between telehealth provided by a patient’s regular physician and care by virtual providers with whom the patient does not have an established relationship.

That sounds like a lot, but our advocacy across these areas is interwoven to support the most obvious goal: stabilizing payment for primary care practices — an outcome achievable with the actions we’ve outlined for Congress.

We’re two full years into a pandemic that has reshaped our health system’s very foundation, driving an influx of new patients (including those seeking behavioral health care) to Medicaid while that program continues to pay family physicians only a fraction of the rates paid by Medicare and private payers. At the same time, practices that have made a necessary leap into virtual care, which has been a boon to patients, need to find solid ground waiting for them on the far side.

The Academy, speaking last week through its Board members, has again unrolled a simple map for how Congress can restore strength and security to the country’s primary care practices. We’ll keep pointing the way for them as long as we have to.