Rep. Allyson Schwartz, D-Pa., is a health care policy expert and a leading congressional proponent of primary care and the patient-centered medical home. As a former health care executive and social worker, Schwartz is well aware of the critical role primary care plays in improving health care quality, enhancing access to care and containing costs.
In 2012, the five-term congresswoman, along with Rep. Joseph Heck, D.O., R-Nev., introduced the Medicare Physician Payment Innovation Act(www.govtrack.us) which would immediately eliminate the sustainable growth rate (SGR) formula by using savings from reductions in military operations in Iraq and Afghanistan to cover the $300 billion cost of a repeal. In the process, the bill would block a 26.5 percent reduction in the Medicare payment rate scheduled to take effect on Jan. 1.
Rep. Allyson Schwartz, D-Pa., shown here with (then) AAFP President Glen Stream, M.D., M.B.I., says there is an understanding in Congress that family physicians are critically important to making sure patients get the care they need.
The bill also would provide a 2.5 percent increase in payments for primary care physicians during the next four years in an attempt to address the undervaluation of primary care services, preventive care and care coordination services.
Schwartz is the vice ranking member of the House Budget Committee and co-chair of the New Democrat Coalition Health Care Task Force. She also is a former member of the House Ways and Means Committee, and, in the upcoming 113th Congress, she will serve on that committee again.
AAFP News Now recently spoke with Schwartz about health care issues and the role of primary care and the PCMH in the nation's health care system.
Q. Why did you want to introduce the Medicare Physician Payment Innovation Act?
A. It is important for us to not only repeal the SGR policy that has failed to contain the growth in costs or improve quality, but to actually replace it with a policy that moves health care providers and all Medicare beneficiaries in the direction of improved quality (and) improved outcomes while containing the rate of growth in costs. This means providing the right kind of care in a timely fashion.
Q. What role did the AAFP play in helping draft this legislation?
A. I have appreciated all of the input and ideas from the AAFP, as well as their expertise. It is very important for me to be informed in terms of what is happening in delivery system reform -- where the AAFP has taken some leadership -- and also to be sure that we are providing incentives and greater availability for primary care as a way to improve quality and improve coordination of care for our seniors, particularly those with chronic diseases.
Q. Why did you feel it was important to include a 2 percent increase for primary care in the bill?
A. Access to primary care for seniors in our country, particularly those with serious chronic diseases, is extremely important in ensuring that seniors have access to the care they need and that they are getting the kind of health care to maintain their health. Primary care physicians are extremely important in that process.
Q. What are your views on the PCMH?
A. The patient-centered medical home has already shown that it can reduce costs and improve quality of care. The PCMH gives the primary care physician the ability to be (better) reimbursed for coordinating care and to reach out to patients with other health care personnel to make sure patients are getting the right kind of care when they need it.
Rep. Allyson Schwartz, D-Pa., is convinced that Congress finally will succeed in repealing the sustainable growth rate (SGR) formula in 2013 as part of a larger budget deal between Congress and the White House.
"I see full SGR repeal as paid for and a replacement in how we pay physicians done in the next few months as part of a broader fiscal package," said Schwartz in a recent interview with AAFP News Now.
Schwartz cautioned, however, that this is contingent on an actual budget deal.
"If we actually avoid the fiscal cliff and set ourselves on a path to deficit reduction and fiscally sustainable budget scenarios and sustainable Medicare, SGR repeal and a new system of paying doctors should be a part of that," said Schwartz.
Like other lawmakers, Schwartz cited the cost of a SGR repeal as the reason why the formula still is in place. Although the SGR has not been repealed, it has never really been implemented.
"The SGR stays in the budget calculations as an anticipated savings," said Schwartz. "It is real money, and in budget terms, we have to find a way to pay for those anticipated savings, to make up for those anticipated savings. In tough fiscal times, that is not easy to do."
In the short term, Congress is focused on preventing a 26.5 percent cut in Medicare physician payment scheduled to take effect on Jan. 1 as a result of the SGR, according to Schwartz. But it is important, she added, to lift the consistent threat to physician payment caused by the SGR. "In the longer term," Schwartz said, "we have to set ourselves on a path to repeal (the SGR) and pay for (the repeal)."
Q. Do you feel that the PCMH represents the future of primary care?
A. I think it is a very important part of primary care and has been embraced by many primary care practitioners. It already has been shown to improve health outcomes for patients, improve satisfaction among physicians and contain the rate of growth in health care costs in the right way.
Q. Does the PCMH represent the future of health care in this country?
A. It is a part of it. There is no question that for many of us, we are looking for more coordinated care, better coordinated care between the primary care practitioner and the patient, between primary care physicians and the (sub)specialists, and between institutions of care.
Q. What would you say is the role of family physicians in the nation's health care system?
A. Family physicians, as primary care physicians, are critical to making sure that patients get the care they need and are referred to (sub)specialists when they need to be referred to (sub)specialists. They also follow up with the patient's health care needs. Family physicians are very much the linchpin to some of the health care reform efforts we are facing. They are really very important to ensuring continuity of care.
Q. How do you think family physicians are perceived in Congress?
A. They are thought of as the physicians who are there for patients. There is a greater understanding in Congress of family physicians being critically important to making sure our patients get the care that they need and reducing costs in the right way.
Q. Is there an understanding among lawmakers that many family physicians also are small business owners?
A. I think there is less of an understanding of that. I think there is an understanding that family practice physicians are not paid as highly as (sub)specialists. There is a keen understanding of that. There probably is a smaller group of us who understand the distinctions between the different specialties. I believe family practice physicians are valued by members of Congress.
Q. You have talked about the critical role primary care and family physicians play in the health care system. Why do you think the role of primary care and family physicians is not better recognized and rewarded among public and private payers?
A. The system of health care reimbursement certainly has rewarded procedures and interventions much more so than office visits and chronic disease management and many of the things that primary care physicians do -- things that are harder to quantify. There is an increased understanding of how important it is to reimburse for the time that it takes to know patients and understand their medical issues so (physicians) can make the right kind of diagnosis and develop appropriate strategies for their care.
Q. Do your colleagues in the House have the same knowledge of primary care that you have?
A. To some extent, yes. But it is always important to have that dialogue with members of Congress. I always encourage people, and certainly physicians, to talk with their members of Congress about the critical role primary care and family physicians, in particular, play in providing quality of care for our seniors and all Americans.
Q. Why do you have such an interest in health care?
A. I have worked in health care. I have run a health center. I have done health care policy for a number of years here in Congress and previously in the (Pennsylvania) state senate. It is something I am knowledgeable about and look forward to continuing to work on to make sure all Americans have access to affordable, meaningful health coverage. That includes a health system that provides the right kind of care in a cost-efficient manner and improves the outcomes of health status for all Americans.