Medicare Physician Payment Reform Gets Top Billing During Capitol Hill Visits

AAFP Leaders Press for SGR Repeal, Replacement

November 26, 2013 01:00 pm Cindy Borgmeyer Washington –

On Capitol Hill last week, AAFP leaders more than made up for a round of congressional visits scheduled for last month that had to be cancelled because of the federal government shutdown. In a span of less than two days, Academy officers and staff tallied up more than a dozen visits with key legislators, congressional staff members and regulatory heads to discuss issues ranging from repeal and replacement of the sustainable growth rate (SGR) to the current timetable for implementation of meaningful use stage two requirements.

AAFP President Reid Blackwelder, M.D., left, emphasizes the need for Medicare physician payment reform during a Nov. 19 meeting with Rep. Phil Roe, M.D., R.-Tenn.

AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., started things off when he and Academy EVP Douglas Henley, M.D., paid a visit to the office of Sen. Johnny Isakson, R-Ga., on Nov. 19. Isakson sits on the Senate Finance and Health, Education, Labor and Pensions (HELP) committees, so the conversation naturally turned to a bipartisan, bicameral proposal currently being floated by the Senate Finance and House Ways and Means committees that aims to repeal the SGR and replace it with alternative payment models that focus on quality of care, such as the patient-centered medical home (PCMH) model.

After extensive deliberation that included soliciting and carefully considering input from Academy members, the AAFP recently expressed its support for the SGR proposal -- which, it's important to note, is not a bill but a so-called discussion draft -- while at the same time offering recommendations to improve it.

Story Highlights
  • Top AAFP leaders were on Capitol Hill last week, meeting with key legislators and congressional staff to discuss numerous issues important to family medicine.
  • A bipartisan, bicameral proposal to repeal and replace the sustainable growth rate was a high-priority topic.
  • Also on the table were various workforce issues, including funding for Title VII primary care health professions training grants and the National Health Service Corps.

In addition to repealing the SGR and moving to replace it with more quality-oriented payment models, the draft proposal

  • provides financial support to assist small practices with practice transformation,
  • directs the Government Accountability Office to study the AMA/Specialty Society Relative Value Scale Update Committee processes for making recommendations on how physician services are valued,
  • establishes care-coordination codes in the Medicare physician fee schedule, and
  • consolidates three existing quality and process improvement programs into a single program.

One particular aspect of the proposal that stands out as needing improvement, however, is a 10-year freeze on Medicare physician payments. In a letter to the Senate Finance and House Ways and Means committees(7 page PDF), the AAFP countered that prospect by recommending higher baseline payments for primary care services.

Despite the current proposal's imperfections, said Blackwelder, it does offer hope that the SGR debacle can be settled once and for all.

"There is truly a sense that in a bipartisan, bicameral fashion, we can move this off the table and finally repeal the SGR," Blackwelder told AAFP News Now. Doing so is essential, he added, because it is only by resolving the yearly Medicare payment melodrama that the SGR has precipitated for the past decade that the Academy can move forward on other important advocacy fronts. "We can't get anything else done; all other areas of advocacy depend upon that finally being resolved."

SGR repeal and opportunities for Medicare physician payment reform were topics that Blackwelder, along with AAFP Board Chair Jeff Cain, M.D., of Denver, and President-elect Robert Wergin, M.D., of Milford, Neb., would address with other congressional leaders and staff during their time on the Hill.

Cain said he, too, emphasized the critical need to repeal the SGR in his visits with lawmakers and staff, although he acknowledged the difficulties inherent in bringing all parties to the table to achieve that goal.

"Not only do the annual threats of up to 24 percent payment cuts threaten patient care, but these potential cuts make it very hard for family doctors to plan for the investments necessary to transform our practices into the new models of PCMH care and invest in the electronic health record technology we need to have better patient care," Cain told AAFP News Now. "It's important to know that our country has now spent more for annual temporary SGR patches over the last decade than we actually would have to pay to be able to fix it permanently."

AAFP President-elect Robert Wergin, M.D., far right, leads a discussion about meaningful use requirements with Acting National Coordinator for Health Information Technology Jacob Reider, M.D., third from left. Reider and his staff met with Academy leaders and staff on Nov. 20.

Moreover, Cain added in his message to members of Congress, as the system moves away from fee-for-service and toward advanced payment models, "We have to make certain we are able to help bring the small private practices along because they find it the most challenging to be able to make those investments." The way to do that, he noted, is to increase the amount of support for small practices.

Cain, in turn, heard an important message from lawmakers: "They stressed to us that if it is important to family doctors to fix the SGR system, they need to hear from our members now. Because if there isn't a member response, then other people who have skin in this game -- hospitals, the pharmaceutical industries -- are there ready and willing to pick us apart."

Although the SGR took center stage in discussions on the Hill, other issues also came to the fore during the trip to Washington.

For example, Wergin headed up a Nov. 20 meeting with Acting National Coordinator for Health Information Technology Jacob Reider, M.D., during which Academy leaders reiterated an earlier call to revise the current aggressive timeframe for compliance with meaningful use stage two requirements.

According to a letter sent last August to CMS and the Office of the National Coordinator (ONC) for Health IT, the AAFP's prime concern with the current implementation deadlines set by CMS and the ONC is that physicians will be unable to obtain the certified electronic health record technology (CEHRT) products, training and support required to meaningfully use 2014 CEHRT in their practices "while continuing to provide the high levels of safety, quality and service that their patients deserve." In its letter, the AAFP outlined a plan that would extend the timeline for compliance with meaningful use stage two requirements by 12 months. Last week's meeting allowed stakeholders from the Academy and the ONC to further explore that plan face-to-face.

Among other concerns Academy leaders addressed during their congressional visits were the effects of sequestration on family physicians who provide Medicare services and their patients. Workforce issues were also on the table, with the AAFP officers laying out the Academy's support for funding Health Resources and Services Administration Title VII primary care health professions training grants, the Agency for Healthcare Research and Quality's work on primary care research, and the National Health Service Corps. These programs, they noted, are vital to ensuring access to high-quality health care for patients in medically underserved communities throughout the nation.

Nowhere was that concern for patients more evident than during a conversation Blackwelder had with one of his own congressional representatives, Rep. Phil Roe, M.D., R-Tenn. As an OB/Gyn, Roe has a grasp of the issues physicians face on a daily basis that few of his colleagues in Congress can match. He also has a keen understanding of the importance of primary care workforce issues, according to Blackwelder.

Generally speaking, said Blackwelder, "There's a good recognition on the Hill of the need to address what we call the triple aim -- the quadruple aim, really -- which is to improve patient outcomes, improve the patient experience of health care, improve our experience of that process and, overall, decrease cost and risks."