• Academy Pinpoints Strengths, Weaknesses in Draft Senate Bill

    Legislation Complements AAFP-backed Primary Care Patient Protection Act

    June 26, 2019 04:30 pm News Staff – Robust investment in primary care, beefier safeguards for patients and a five-year reauthorization of the Teaching Health Center Graduate Medical Education program are among the virtues the Academy sees in a bill recently introduced in the Senate.

    The Lower Health Care Costs Act (S. 1895) -- informed by a series of Health, Education, Labor and Pensions Committee hearings for which the AAFP has provided significant input -- includes policies that could benefit family physicians and yield better health outcomes, the Academy said in a June 5 letter(5 page PDF) to the committee in advance of its June 18 hearing on the draft legislation.

    In follow-up correspondence sent June 25,(2 page PDF) the AAFP weighed in on additions made to the legislation after that hearing, including the THCGME reauthorization.

    "Along with the community health center program and National Health Service Corps program, THCGME increases health care access and grows the primary physician workforce," said the Academy's latest letter, which was signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.

    American Capital Building in Washington DC at Dusk.

    Which is why the newly introduced Senate measure should boost THCGME resources, the letter added.

    "As the legislation advances, we strongly recommend increased funding for this vital program, consistent with (that contained in) the Training the Next Generation of Primary Care Doctors Act, which includes modest increased investments that will allow for robust THCGME expansion."

    The June 25 letter also applauded lawmakers for including a revised version of the Tobacco-Free Youth Act, which raises the minimum tobacco purchase age from 18 to 21, in the draft bill.

    The letter provided senators with detailed feedback on several key elements of the bill.


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    Generic Drug Access and Competition

    "The AAFP strongly supports the bill's legislative initiatives to increase access to generic drugs through improved market competition," the letter said. Specifically, these provisions would prevent generic drug applicants from using the "first to file" process to hinder competition for other generic drugs.

    The letter encouraged the committee to review other generic access legislation introduced this session that the Academy has supported.(3 page PDF)

    Cost and Quality Information

    "The AAFP supports the bill's ban on gag clauses in contracts with providers and health plans that prevent enrollees from seeing cost and quality data," the letter noted.

    However, the Academy added, "family physicians must have an opportunity to review payer performance profiles prior to them being publicly reported." And payers "must establish and communicate a reasonable, formalized reconsideration process in which physicians can appeal their performance rating/designation(s)."

    Transparency and Directories

    The Academy expressed support for the bill's recommendations that a nongovernmental, nonprofit entity be convened to improve health care cost transparency and that health plans make up-to-date directories of their in-network physicians available online within 24 hours of inquiry.

    Transparent and Timely Billing

    "The AAFP supports the bill's transparency requirement that patients receive a list of services received upon discharge," said the letter.

    But the Academy voiced strong opposition to the "unreasonable civil penalties" imposed by this section of the draft legislation -- specifically, its requirement that all bills be sent within 30 business days and its stipulation that patients who receive bills after that deadline would not be obligated to pay.

    "The AAFP urges physicians to bill patients in a timely manner and to utilize technology whenever possible," the letter said. "Still, there are variables to consider that are beyond a provider's control, such as patients whose address may have changed and insurers' processing delays."

    Service Cost Transparency

    The Academy also objected to the draft legislation's requirement that providers and health plans give patients a "good faith estimate" of expected out-of-pocket costs within 48 hours of receiving such a request.

    "We believe this goal could be better achieved by utilizing technology and web-based platforms to help facilitate patient decision-making" and providing accurate out-of-pocket cost estimates based on claims data, the AAFP said.

    Vaccine Research and Outreach

    The AAFP encouraged senators to maintain the draft bill's inclusion of the Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety (VACCINES) Act, H.R. 2862. The Academy last month signed a Group of Six letter(3 page PDF) calling for passage of that bill. (In addition to the AAFP, the so-called Group of Six includes the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association.)

    Maternal Health

    Noting that the United States has the highest maternal mortality rate among developed nations, the Academy expressed support for the bill's provisions to improve maternal health quality and to promote associated best practices. The letter also cited the AAFP's ongoing advocacy regarding this issue.

    Patient Privacy and Cybersecurity

    "The AAFP supports the bill's requirement to mandate a Government Accountability Office report on privacy gaps associated with the use of health care applications that do not have to comply with health privacy rules," the letter noted. "But the essential privacy and security standards should be the responsibility of the vendors," the Academy added, reiterating advice sent to CMS in 2018.(4 page PDF)

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