AAFP President Delivers Senate Testimony on
Medicare Payment  

Furr’s comparison was part of the strong testimony he delivered to an April 11 Senate Finance Committee hearing titled “Bolstering Chronic Care Through Medicare Physician Payment.” At the committee’s invitation, Furr offered written and oral comments and answered questions to make the AAFP’s case that 

• fee-for-service payment, including the Medicare physician fee schedule, has underinvested in primary care;   

• the transition of primary care practices into alternative payment models requires prospective, sustainable revenue streams; and   

• patients, including those with chronic conditions, must have access to the comprehensive, continuous care that family physicians and other primary care physicians provide.   

“Fee-for-service is not the future the AAFP envisions for primary care,” the testimony noted, “but it is the present.” To allow primary care to evolve beyond that present, the Academy and Furr urged lawmakers to pass policies that would   

• more appropriately value the work of primary care in the MPFS, which is the framework for many value-based payment arrangements;   

• reform budget neutrality requirements that unnecessarily pit physician specialties against one another while undermining investment in total patient care; and   

• waive cost-sharing to alleviate financial barriers that dissuade patients from using chronic care management and other primary care services.   

Fee-for-service medicine “doesn’t just underinvest in primary care,” Furr added. “It also makes it extremely complex to get paid. We must submit unique codes for each and every service we provide — documenting both what we did and why we did it.” 

Such coding includes billing for chronic-care management — the hearing’s focus — which family physicians routinely provide while enduring considerable documentation burdens just to ensure status quo payment.  

To address this issue, Furr reiterated the AAFP’s support for the Chronic Care Management Improvement Act (H.R. 2829), which would waive patient cost-sharing for Medicare’s chronic-care management code.  

The AAFP also joined an April 11 letter to the committee to urge passage of Medicare legislation “waiving the beneficiary coinsurance to manage chronic care conditions and improve patients’ health more effectively.” Among the more than two dozen other co-signatories were the AMA and the Primary Care Collaborative. 

“I’ve had patients in my practice opt out of receiving these services simply because the $15 or so a month they faced in cost-sharing was not financially feasible,” Furr testified, referring to existing CCM requirements. “In almost every case these were the very patients that would most benefit from CCM.” 

Backing up this call to action, the AAFP’s testimony cited research indicating that nearly 95% of adults 60 years and older have at least one chronic condition; nearly 80% have two or more; and the number of Americans 50 years and older with at least one chronic disease is expected to increase by almost 100% by 2050, ballooning to some 142.66 million people. Today, however, nearly three-quarters of U.S. adults say the health care system is not meeting their needs. 

Furr and the AAFP called on Congress to provide CMS with authority to help more family medicine practices escape fee-for-service payment by passing the Value in Health Care Act (S. 3503), which the Academy has endorsed.  

The testimony lauded a pair of recently announced CMMI alternative payment models. ACO Primary Care Flex aligns with Academy advocacy by providing low-revenue accountable care organizations participating in the Medicare Shared Savings Program with a one-time upfront shared-savings payment and a prospective per-member-per-month payment. And the Making Care Primary model, which launches in July, “builds upon lessons learned from CPC+ and Primary Care First, and provides participants who are new to value-based care with upfront payments to develop infrastructure and build advanced care delivery capabilities,” the AAFP said.  

To capitalize on these efforts, the testimony added, “Congress should also consider providing CMMI with additional flexibility in how it evaluates the success of primary care models” by allowing the agency to widen the limited metrics it now applies. When models have short test periods and are measured nationally rather than regionally, the Academy warned, “more complexity and financial instability for participating physician practices” results. 

Furr’s appearance is the latest high-profile AAFP congressional testimony as the Academy presses lawmakers on two top advocacy priorities: improving physician payment and reducing administrative complexity for family medicine practices.  

In March, AAFP member Bob Rauner, M.D., M.P.H., FAAFP — who also is president of the nonprofit community organization Partnership for a Healthy Nebraska — testified about primary care investment for a Senate budget committee hearing titled “How Primary Care Improves Health Care Efficiency.”  

As AAFP president-elect, Furr testified last fall before the House Energy and Commerce Health Subcommittee. That hearing, too, centered on strengthening Medicare payment and ensuring the program’s ability to care for seniors.  

And last spring, Academy EVP and CEO Shawn Martin testified before the Senate Finance Committee on the need to support the viability of independent practices by improving fee-for-service physician payment and transitioning to value-based care, among other topics.