As the White House prepares to hold a bipartisan summit on health care reform on Feb. 25, the AAFP and other primary care physician-led organizations have called on congressional leaders and administration officials to agree on a plan that provides patients with access to high-quality, affordable primary care.
"We recognize that disagreements on many elements of health care reform exist; however, ensuring that patients have access to primary care is not one of them," say the AAFP, the American College of Physicians and the American Osteopathic Association in a letter(2 page PDF) to House and Senate members and administration officials.
The three organizations, which represent more than 300,000 physicians and medical students, point out that "bipartisan bills have been introduced in both the House and Senate that would increase funding for primary care training programs, increase Medicare and Medicaid payments for primary care services and accelerate pilot-testing of the patient-centered medical home (PCMH)."
"Many of these policies are included in bills approved by the House and Senate," says the letter. "We strongly believe they should be included in any final agreement on moving forward on a bipartisan basis."
AAFP President Lori Heim, M.D., of Vass, N.C., said in an interview with AAFP News Now, "We are talking about the importance of primary care and the fact that if we do not fix parts of the health care system, then we are going to have a looming shortage -- in fact, a catastrophic shortage -- of primary care physicians."
In the letter, the three organizations call for policies to reverse the growing shortage of primary care physicians, explaining that "providing Americans with affordable health insurance coverage is essential, but it will not ensure that patients have access to care in the absence of policies to increase the numbers of primary care physicians." The groups said Congress and the Obama administration should
- increase Medicare payments for office, nursing home, home and hospital visits by primary care physicians by at least 10 percent;
- increase Medicaid payments for visit services provided by primary care and other physician specialists to no less than Medicare rates;
- increase funding levels for primary care training programs, including the National Health Service Corps, or NHSC, and Title VII health professions funding;
- create a new loan repayment program for "front-line" health professionals facing shortages; and
- create a workforce commission to recommend policies to ensure a sufficient supply of primary care and other specialties facing shortages.
Without these types of policies, says the letter, the United States will experience a shortage of primary care physicians, resulting in longer waits for appointments, delays in getting care, overcrowded emergency rooms, and higher costs and poorer outcomes of care.
The organizations also urge Congress and the White House to "reach a bipartisan agreement on putting a permanent end to the annual cycle of Medicare payment cuts caused by the sustainable growth rate formula, which particularly endangers access to primary care."
President Obama, meanwhile, unveiled his own health care reform plan on Feb. 22, putting forth a proposal that makes several references to primary care and preventive services while urging greater support for programs that train family physicians and primary care physicians.
The president's proposal represents a recognition of the value of primary care and an acknowledgement on the part of the Obama administration that any health care reform plan must provide more support for primary care, said Heim.
For example, the Obama plan would provide payment bonuses to primary care physicians, and it calls for investments in "grant programs that support the training of primary care providers, including family medicine, pediatrics, general internal medicine and physician assistantship," according to a proposal summary.
The plan also provides significant funding for scholarships and loan repayment for physicians, nurses and other health workers through the NHSC, according to the proposal summary. At the same time, the plan provides additional flexibility for providers to meet their service requirements under the NHSC.
"The act also supports scholarships and loan repayments for disadvantaged students who commit to work in medically underserved areas and who serve as faculty in participating institutions," the proposal says.
Obama's proposal is more of an outline than an actual plan in that it lacks specific details. But, if enacted, the proposal would "reward innovative practices where doctors and nurse practitioners provide more primary care that is coordinated with every doctor or (sub)specialist involved with a patient's care," according to the summary of the proposal.
The Obama plan also would eliminate copayments for most preventive services under Medicare while fully covering annual wellness visits and personalized prevention plans for American seniors enrolled in the Medicare program.
"That recognizes the impact of primary care," said Heim. "Most preventive services are provided by primary care and family physicians."
"This means that prevention and screening are priorities," she added.
In addition, the Obama plan addresses tort reform by establishing grant programs that would allow states to develop, implement and evaluate medical malpractice reforms. Although the president's proposal does not go far enough in this area, Heim said, it represents a "good way of moving forward on this issue on a state-by-state basis.".