AAFP: Congress Must Take 'Bold Steps' to Steady Primary Care
Pandemic a Chance to Transcend Fee-for-Service System
April 14, 2020 11:58 am News Staff – Congress' next legislation to address the impacts of COVID-19 "must do more to provide targeted solutions and support for primary care and patient access," the Academy told House and Senate leaders in an April 13 letter.
"More" in this case means hazard pay and other concrete disbursements and considerations -- but also deeper, more lasting changes.
"This public health crisis has identified significant cracks in our country's primary care infrastructure," said the letter, which was signed by AAFP Board Chair John Cullen, M.D., of Valdez, Alaska. "Population health will only be achieved when we identify and remove the barriers that exist."
The crisis now presents Congress, the Academy added, with "the opportunity to address systemic issues that have been plaguing primary care and the health care system more broadly."
The letter was sent to House Speaker Nancy Pelosi, D-Calif.; House Minority Leader Kevin McCarthy, R-Calif.; Senate Majority Leader Mitch McConnell, R-Ky.; and Senate Minority Leader Charles Schumer, D-N.Y.
The Academy acknowledged the immediate benefits of key telehealth rule changes and other support for physicians that Congress already passed in the Coronavirus Aid, Relief and Economic Security Act and the two stimulus and appropriations packages that preceded it. (The AAFP lobbied Congress extensively ahead of these wins.) Yet these temporary adjustments won't deliver financial viability for many of the family physicians working on the pandemic's front lines, the letter said.
STORY HIGHLIGHTS
The financial stress of COVID-19 has forced the closure of some physician practices and threatens many more, AAFP Senior Vice President for Advocacy, Practice Advancement and Policy Shawn Martin told the Los Angeles Times recently -- proof, the Academy wrote in its letter, "that the current fee-for-service structure puts the primary care delivery system one pandemic away from complete collapse."
And as primary care goes, so goes the health of Americans, including millions with chronic health conditions. The contraction of family medicine practices would send a disruptive ripple across the entire U.S. health care system, affecting countless patients.
"We fear these closures will continue unless dramatic interventions are undertaken soon," the AAFP said. "Congress must take bold steps to repair the damage that has already been done and put primary care on a sustainable path for the future."
The Academy urged Congress to adopt specific measures to safeguard primary care physicians' financial viability.
Hazard Pay
Noting the widely documented risks now permeating the medical field, the AAFP said CMS should pay primary care physicians $200 for each attributed Medicare beneficiary.
"We urge Congress to include medical residents in any hazard pay proposal," the letter added, "and recommend $25,000 per resident who is or may be exposed to COVID-19 as part of their work."
Prospective Payments
Medicare's Accelerated and Advance Payment program remains valuable and necessary, the Academy wrote -- and must continue for at least three additional quarters beyond its initial mandate, through March 2021.
Congress also should allocate funding to forgive the full cost of these advance payments to physicians for 2020, the letter said.
Additionally, qualifying primary care physicians should receive a 10% increase on all evaluation and management codes for new and existing patients for services provided through December 31, 2021.
Student Loan Interest
"The AAFP urges Congress to lift the income limitation on the deductibility of student loan interest payments for primary care physicians for tax years 2020 and 2021 as a means of acknowledging the critical role primary care has played on the front lines during this national health crisis," the letter said. "This would allow all physicians with student loan debt to deduct 100% of the interest paid on those loans."
The letter also outlined two patient protections that would help reknit the primary care safety net in the aftermath of COVID-19.
Standard Primary Care Benefit
Recent temporary waivers of copays and deductibles for telehealth visits and COVID-19 testing "recognize that the structure of high-deductible health plans can create dangerous barriers to seeking timely care that could lead to poor outcomes," the AAFP said.
"We urge Congress to pass the bipartisan Primary Care Patient Protection Act (H.R. 2774/S. 2793). Allowing individuals enrolled in HDHPs to see their primary care provider two times per year, in addition to their annual wellness visit, prior to meeting their deductible will ensure that those plans provide more meaningful health care coverage."
Reinsurance and Market Stability
Sharp increases to premiums for patients seeking care for COVID-19-related illness "could put health care coverage financially out of reach for patients" and lead to "skyrocketing premiums" for those who have critical health needs, the letter warned. To prevent such a systemic shock, the AAFP added, any further COVID-19 relief legislation "must include reinsurance funding to protect those in the individual and small group market from adverse impacts on premiums and reduce the likelihood that patients are left uninsured."