Making the Rounds on Capitol Hill

Physician Payment, Teaching Health Centers Funding Focus of AAFP Advocacy Efforts

November 26, 2014 09:01 pm Michael Laff

With the current session of Congress nearing its final days and a host of critical primary care issues still awaiting resolution, AAFP officers converged on Capitol Hill on Nov. 20 to advocate family medicine's agenda.

AAFP President Robert Wergin, M.D., left, discusses repeal of the sustainable growth rate formula and funding for teaching health centers with Sen. Lamar Alexander, R-Tenn., center, during a recent visit to Capitol Hill. AAFP Board Chair Reid Blackwelder, M.D., and President-elect Wanda Filer, M.D., M.B.A., also joined the discussion with Alexander and his staff.

In meetings with members of Congress on both sides of the aisle, legislative staff and federal regulatory officials, AAFP President Robert Wergin, M.D., of Milford, Neb.; Board Chair Reid Blackwelder M.D., of Kingsport, Tenn.; and President-elect Wanda Filer, M.D., M.B.A., of York, Pa., covered a wide range of issues, including repeal of the sustainable growth rate (SGR), pending Medicaid payment cuts, funding for teaching health centers and care for veterans.

In a subsequent interview with AAFP News, Wergin laid out the strategy when meeting with elected officials or heads of federal agencies: Offer assistance in solving a problem rather than simply asking for direct, unilateral action.

"Our goal is to ask them, 'How can we help make this happen?'" Wergin explained. "We want to be more informative and less directive by acting as a facilitator."

The result of this strategic approach? "The message we brought was well-received by both parties," Wergin said. "That's the best you can hope for. You identify the issue and how it relates to our members."

Story highlights
  • AAFP leaders went to Capitol Hill last week to discuss major issues affecting primary care such as the sustainable growth rate, Medicaid payment parity and support for teaching health centers.
  • During a meeting with a top Department of Veterans Affairs official, AAFP President Robert Wergin, M.D., also discussed how family physicians can help increase access for veterans.
  • Rep. Earl Blumenauer, D-Ore., also met with Academy leaders to discuss legislation he introduced that calls for payment of CPT codes for end-of-life counseling.

During a meeting with Sen. Lamar Alexander, R-Tenn., for example, the conversation focused on permanently repealing the SGR. Bipartisan, bicameral legislation introduced earlier this year aims to accomplish this goal, but the measure has stalled because lawmakers can't agree on how to fund the fix. In the interim, the House and Senate adopted a temporary patch that is set to expire on March 31. If Congress takes no action before that deadline, physicians face a 21 percent cut in Medicare payments.

"He was disappointed that we had another patch because he is motivated to address SGR and lay it to rest," Wergin said of Alexander. "He gave us a sense of optimism that it could be addressed and that he was not in favor of another patch."

Another pressing issue is pending cuts to FPs and other primary care physicians who provide a defined set of primary care services to Medicaid patients. CMS increased the Medicaid payment for these services to Medicare levels in 2013 and 2014, but the parity provision will expire on Dec. 31 unless Congress acts to extend it.

"We were able to make our point on Medicaid cuts and emphasize that the cuts were extremely time-sensitive," Blackwelder told AAFP News. "Twenty-four percent of people in Tennessee have TennCare as their payment, so Medicaid cuts are particularly pertinent to the state and access to care would be impacted by this."

Alexander, a former Department of Education secretary, also expressed support for funding for teaching health centers, which currently is set to expire in September 2015. Under the Teaching Health Center Graduate Medical Education program established by the Patient Protection and Affordable Care Act, primary care residents receive funding to train in rural health clinics, urban clinics or tribal reservations. If that funding is not continued, residents who began training this year would have to find another program.

"His big focus is on education, and he understands the issue," said Wergin. "He was receptive to the need for adequate funding through fiscal year 2015 and to develop funding sources for the long term."

Care for Veterans

Wergin also met with an official at the Department of Veterans Affairs (VA) to discuss implementation of the Veterans Access, Choice and Accountability Act signed into law in August. The law will make it easier for veterans to meet with a physician outside VA facilities if he/she encounters long waiting periods to obtain an appointment or lives more than 40 miles from the nearest VA hospital.

AAFP Board Chair Reid Blackwelder, M.D., left, and President-elect Wanda Filer, M.D., M.B.A., meet with Rep. Earl Blumenauer, D-Ore., to discuss end-of-life care legislation the congressman has introduced.

During a meeting with Rajiv Jain, M.D., VA assistant deputy undersecretary for patient care services, the pair discussed how family physicians can help increase access for veterans.

"Dr. Jain was impressed that we offered ideas to simplify the process to make it easy for primary care physicians to care for vets who may have difficulty accessing the current system," Wergin said. "We noted that our Health Landscape product( could be used to locate the 40-mile radius to the nearest VA hospital that will identify veterans who can qualify to see a physician outside the VA."

Noting that civilian physicians who wish to treat veterans will be required to sign a provider agreement, Wergin asked Jain to explore whether the contract and credentialing phase could be simplified for physicians in small and rural practices, possibly by using the Medicare application process.

End-of-Life Care

Blackwelder and Filer also met with Rep. Earl Blumenauer, D-Ore., at the lawmaker's invitation to discuss legislation Blumenauer introduced that calls for payment of CPT codes for end-of-life counseling.

"We appreciated his advocacy and support the bill," Blackwelder said. "It's a step in the right direction."

He noted during the meeting that family physicians already provide such care and expressed the AAFP's hope that, if enacted, the legislation would not create an undue administrative burden for FPs documenting such care.

As the Blumenauer meeting illustrated, Capitol Hill visits are about more than simply requesting legislative action. According to Blackwelder, it's important to make a positive connection with decision-makers.

"You have to deliver your message quickly and make it relevant to the person you're meeting with," Blackwelder said. "Hopefully, you have an agreement early on. You like to hear people say that they agree with and support your position or at least that they are open to a conversation about the subject.

"The reality is that decisions are not made in those meetings, but connections are made."