Jan. 10, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

We are so close to a big win

Last month in this space, I asked for your help convincing lawmakers to stabilize primary care practices before a historically low proposed 2023 Medicare physician fee schedule conversion factor could take effect.

Thanks to the Academy’s advocacy — and thanks to every member who spoke out as this fight came down to the wire — Congress included some conversion factor relief in the omnibus spending package it passed just before Christmas. That sounds like qualified good news because it is: We asked for complete mitigation of the fee schedule’s potential pay cut and won back about half. More in a minute about this bit of math.

First, though — with help from Stephanie Quinn, the AAFP’s senior vice president of advocacy, practice advancement and policy — I want to emphasize that the $1.7 trillion bill we’re talking about here came with a significant trove of advocacy wins for the AAFP, our specialty and your practices.

Tochi: Stephanie, where did we end up on Medicare physician payment for 2023?

Stephanie: The MPFS final rule had set the 2023 conversion factor (the amount Medicare pays per relative value unit) at $33.06, some 4.5% lower than the 2022 amount. The conversion factor that went into effect Jan. 1, following the omnibus, is better: $33.89. That 83-cent boost means the updated conversion factor is about 2% lower than last year’s. But some family medicine practices could experience reductions in Medicare allowed charges in 2023 as a result.

I want to claim the Academy’s rightful share of credit for this important win, however qualified it feels given what we’ve long identified as a broken system. We were among the largest physician organizations united in the advocacy campaign you told members about in your last post. Our collective action made the difference.

Tochi: Can you outline the Academy’s other wins in the bill?

Stephanie: The federal funding package that President Joe Biden signed into law on Dec. 29 delivered wins to the Academy on several of our biggest advocacy priorities, particularly relative to the winding down of the COVID-19 public health emergency. I expect to write more about this myself later in the month in the In the Trenches blog, but it’s a big deal that the bill’s provisions will

• allow our members to continue offering telehealth to Medicare beneficiaries — including by phone — through the end of 2024, preserving patients’ continuity of care and affording much-needed predictability for physicians;
• secure health care coverage for children enrolled in Medicaid or the Children’s Health Insurance Program for 12 months;
• fund CHIP through 2029;
• enable states to extend postpartum Medicaid coverage for a full year;
• invest in mental health through primary care, as we’ve called for;
• increase the primary care workforce with funding for new Medicare graduate medical education spots;
• extend by one year the advanced alternative payment model incentive;
• provide stable Medicaid funding for U.S. territories; and
• eliminate the X-waiver, as we’ve urged, to improve access to substance use disorder treatment.

These are concrete steps toward affordable, equitable and comprehensive care for all. Taken together, they’ll improve access to primary care, help family physicians maintain strong relationships with their patients and help address disparities in child and maternal health.

Tochi: Big victories! What’s next on the advocacy agenda?

Stephanie: Partly to underscore for this blog’s readers the gravity of our statement on the omnibus, which you signed, I’ll start by quoting you: “Any payment cut puts untenable strain on family medicine.” That includes the de facto payment cut some FP practices will realize this year, so we’re going to push as hard as ever for meaningful, permanent Medicare payment reform.

As you and I are talking, the 118th Congress is, with some hiccups, about to convene. The AAFP's Government Relations team will soon communicate with new and returning lawmakers about our ongoing priorities, including physician payment and administrative simplification. AAFP members will continue to hear from me at least monthly on our progress on those and other fronts, and my team will, as it so successfully did last month, identify opportunities for all of you to engage with your lawmakers on our most crucial advocacy campaigns.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.