2015: Year in Review

SGR Victory Tops Year of Success on Capitol Hill

January 04, 2016 04:35 pm News Staff

Family physicians deliver the very best care possible when they can stay focused on their patients, and the AAFP celebrated several victories in 2015 that promise to make it easier for them to do just that. In particular, the Academy helped secure federal changes that improved physician payment, expanded access to care and reduced administrative burdens.

[President Obama greeting AAFP President Robert Wergin, M.D.]

(Then) AAFP President Robert Wergin, M.D., thanks President Obama for his leadership at a White House ceremony to mark repeal of the Medicare sustainable growth rate formula.

Saying Goodbye to the SGR

The biggest victory by far came in April, when the long-reviled Medicare sustainable growth rate (SGR) formula was finally repealed after 12 years of work by the Academy, 17 congressional "doc fixes" and $170 billion in federal spending. Over that period, the SGR had threatened to cut Medicare payments by as much as 21 percent, leaving many physicians unable to plan for their long-term needs.

(Then) AAFP President Robert Wergin, M.D., of Milford, Neb., shook President Obama's hand during a signing ceremony in the White House Rose Garden where Obama thanked Congress for reaching a bipartisan agreement. But legislators were not the only ones Obama credited for pushing through reform that focuses on paying for value rather than volume.

"The family physicians of America thank you for your leadership, and we'll move forward to work with you," Wergin told Obama.

"Thank you for your support," Obama responded.

The Medicare Access and CHIP Reauthorization Act (MACRA) replaced the SGR with two new payment models that will be phased in over the coming years. Physicians can choose between the Merit-based Incentive Payment System (MIPS) or alternative payment models (APMs) that include accountable care organizations (ACOs) or other payers.

In addition to paving the way for new payment systems, MACRA included two years of extended funding for the Children's Health Insurance Program, the National Health Service Corps, the Teaching Health Center Graduate Medical Education program and the federal community health center program.

The Academy now has launched a huge effort to educate CMS about what family physicians need from the new payment models and to help members decide which payment model to adopt.

Even before the SGR was repealed, HHS had announced a plan to move away from the fee-for-service model. In a roundtable discussion last January, HHS Secretary Sylvia Burwell set an aggressive timetable for the shift. The agency plans to convert 30 percent of fee-for-service payments to payment models such as ACOs or medical homes by 2016 and 50 percent by 2018. HHS also plans to tie 85 percent of traditional Medicare payments to quality or value measurements by the end of 2016, increasing that to 90 percent by 2018.

Douglas Henley, M.D., EVP and CEO of the AAFP, attended the roundtable discussion and stressed the importance of replacing the singular focus on fee-for-service with better systems that promote value rather than volume.

In November, the AAFP sent CMS a detailed response to the new payment models that urged action to ensure primary care services are paid equitably.

"Despite our strong support for MACRA, the AAFP remains very concerned that the MIPS and APM programs will be built upon the biased and inaccurate relative value data currently used in the fee-for-service system," said the letter(53 page PDF). "We strongly recommend that more be done to ensure Medicare pays appropriately for primary care physician services in these new payment models rather than paying based on this biased actuarial data that further exacerbates the undervaluation of primary care services."

Celebrating SCOTUS' ACA Ruling

Another victory for family medicine came in June, when the U.S. Supreme Court ruled 6-3 to uphold a key component of the Patient Protection and Affordable Care Act (ACA), a position the AAFP had supported by signing on to an amicus curiae (friend of the court) brief.

The court decided King v. Burwell in favor of the federal government's position that all individuals who applied for health insurance should be eligible for premium subsidies provided by the law. The plaintiffs had challenged the notion of a premium subsidy for individuals who purchased insurance in states that declined to set up their own exchanges.

Surgeon General Vivek Murthy, M.D., M.B.A., center, speaks about his public health initiatives with (then) AAFP President Robert Wergin, M.D., right, and (then) Board Chair Reid Blackwelder, M.D., at left. Murthy met with the Academy's Board of Directors in March.

The subsidies allow many newly insured patients to see a primary care physician and obtain necessary medical care, a major reason why the AAFP praised the court's decision. And the subsidies are integral to the ACA, which has helped to reduce the number of Americans without health insurance by 7.5 million since 2014 and spurred three additional states -- Alaska, Indiana and Montana -- to expand their Medicaid programs in 2015.

Welcoming a New Surgeon General

Surgeon General Vivek Murthy M.D., M.B.A., and Jeanne Lambrew, Ph.D., Obama's deputy assistant for health policy, met with AAFP Board members in March.

Vivek outlined his priorities, and he acknowledged the role that the AAFP played in solidifying his confirmation. Wergin had voiced strong support for Murthy -- who waited more than a year between his nomination and confirmation -- and visited Washington, D.C., to pressure the Senate to confirm him.

Murthy said he will focus his work as surgeon general on immunizations, childhood obesity, substance abuse and mental health, all issues that are important to primary care physicians.

For her part, Lambrew discussed Medicaid expansion in what was for her a rare visit with a medical specialty organization.

"She seemed to be very supportive of the Academy," said (then) AAFP President-elect Wanda Filer, M.D., M.B.A., of York, Pa. "We have a long track record of supporting health care coverage for all."

Championing Other Primary Care Causes

The AAFP threw its support behind the October creation of a Congressional Primary Care Caucus in the House of Representatives that is intended to keep the concerns of primary care physicians squarely in the minds of legislators.

Reps. David Rouzer, R-N.C., and Joe Courtney, D-Conn., co-chairs of the caucus, noted the continuing shortage of primary care physicians, particularly in rural areas, during a caucus launch event where they heard two physicians describe caring for patients who needed the kind of coordinated care that is difficult to obtain without a primary care physician.

[AAFP President Robert Wergin, M.D., testifying at Senate HELP Committee hearing]

(Then) AAFP President Robert Wergin, M.D., tells senators how EHRs have helped and hurt the care he provides in his practice.

Academy leaders weighed in on a wide range of other legislative and regulatory issues throughout the year. In March, for example, Wergin testified before the Senate Committee on Health, Education, Labor and Pensions about his difficulties using electronic health records (EHRs). He told the committee EHR systems have great potential to improve patient care but that in their current form, they make it more difficult for physicians to interact with patients, and he suggested replacing penalties with incentives to encourage their use.

The campaign to reduce regulatory burdens continued throughout the year. In November, AAFP Board members met with House and Senate officials to tell them that difficulties associated with stage three of the meaningful use criteria for participating in the Medicare and Medicaid EHR Incentive Programs should spur legislators to delay implementation of those requirements.

And when members of the Senate Finance Committee's Chronic Care Working Group sought input on their work, the Academy sent a detailed letter recommending that in addition to making changes to Medicare Advantage, Congress should establish a risk-adjusted per-patient, per-month care management fee for primary care practices.

Safeguarding Veterans' Health

Alarming media reports about the inability of many military veterans to make timely appointments with physicians in Department of Veterans Affairs (VA) facilities first surfaced in 2014. In 2015, Congress and President Obama made changes to veterans' health policy to move toward a solution.

As a result, veterans who live more than 40 miles from the nearest VA facility or who have to wait longer than 30 days for an appointment can see a physician who is not affiliated with the VA. The new rule uses the actual driving distance rather than an originally proposed "as the crow flies" straight-line measurement, doubling the number of veterans who can see a physician who is not affiliated with the VA.

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