President Obama released his 2015 proposed federal budget last week. The budget met a significant number of AAFP goals for the future, prompting the Academy to support funding requests in the budget, including programs to encourage medical students to enter family medicine and to improve the quality of family medicine practices.
The administration's proposed budget(www.whitehouse.gov) requests $5.23 billion during the next 10 years to train 13,000 primary care residents in high-need communities and accountable care organizations. The goal of the proposal is to increase the number of residents who choose to enter primary care and other specialties where a shortage exists.
"The AAFP applauds the proposal … included in the President's 2015 budget, which would invest significantly in the primary care workforce," said AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., in a prepared statement. "The policies proposed by the President are consistent with recommendations the AAFP has long advanced as important steps needed to meet the primary care workforce needs of our country."
Research indicates the United States will need at least 40,000 more primary care physicians within a decade to meet current and anticipated demand.
- President Obama's proposed 2015 federal budget includes funding that encourages medical students to enter primary care.
- The budget also calls for a solution to the flawed Medicare sustainable growth rate formula, but no funding mechanism is offered to finance repeal of the payment model.
- The proposed budget calls for extension of a program that increases Medicaid payments rates to physicians to at least Medicare rates.
The budget also seeks $37 million for Title VII, Section 747 of the Public Health Service Act, which is the only federal program that provides funds specifically to academic departments and programs to increase the number of primary care health professionals, as well as $33 million for geriatric medicine programs.
In addition, the budget proposes funding workforce initiatives, including $4 million for rural physician training grants that were authorized by the Patient Protection and Affordable Care Act to help rural training programs recruit and graduate students who are most likely to practice medicine in underserved rural communities. The AAFP supports funding for these grants.
"A budget that focuses on building the primary care physician workforce would do much to help resolve projected shortages in family physicians, general internal medicine physicians and general pediatrics," Blackwelder said. "Since research demonstrates that newly minted physicians tend to practice within 50 miles of their residency training programs, it is important that we identify and finance training sites that may be outside the traditional hospital setting."
To continue encouraging provider participation in Medicaid, the budget also provides increased payments of $5.44 billion for primary care services delivered by certain physicians and nonphysician health professionals through 2015. The program, which is set to expire at the end of 2014, ensures that primary care services provided to Medicaid patients by family physicians, internists, pediatricians, and associated subspecialties are paid at no less than the comparable Medicare rates.
According to the AAFP, if this program is allowed to expire, it could result in deep cuts in payments to primary care physicians who are taking care of the most vulnerable populations at a time when millions more are becoming eligible for Medicaid. The AAFP recommends the extension of the program to ensure continued access for patients while allowing physicians to transform their practices into patient-centered medical homes.
"The AAFP has urged Congress to extend parity between Medicaid and Medicare payments for primary care services, and (we) look forward to working with our lawmakers to make such a proposal possible," Blackwelder said.
The administration's budget also calls for permanent reform to Medicare payments to physicians. Legislation that would repeal the controversial Medicare sustainable growth rate (SGR) payment system is pending in Congress, but the legislation lacks a way to pay for a transition. The proposed budget also does not identify a method to pay for a repeal of the SGR formula. Instead the budget only "applauds the bipartisan reform efforts in the Congress and is committed to working with the Congress to continue progress toward reforming Medicare physician payments to provide predictable payments that incentivize quality and efficiency in a fiscally responsible way."
Finally, the proposed budget calls for an increase in funding to $4 billion during the next 10 years for the National Health Service Corps. The program's trust fund expires at the end of 2015, and provides $310 million in funding during 2015.
"As an advocate for improving health access for people in underserved areas, the AAFP is also very pleased by the proposed expansion of the National Health Service Corps to almost double its current size," Blackwelder said. "We have strongly supported growth in this critical program."
Related AAFP News Coverage
Primary Care Education at Forefront of Obama Budget Proposal (2/17/2014)