Congress Must Invest in the Primary Care Workforce and Telehealth Flexibilities

Transcript

David Tully: Some key policies affecting family medicine will expire September 30 unless Congress acts today. We'll talk about what the AAFP is doing to ensure that these policies aren't interrupted and that lawmakers invest in primary care.

Welcome to Fighting for Family Medicine. I'm David Tully, vice president of government relations and a member of the AAFP's Advocacy team. The clock is ticking toward September 30. That's the deadline Congress has set itself to pass appropriations legislation to fund the government in the coming fiscal year, including support for the Teaching Health Center Graduate Medical Education Program (THCGME), the National Health Service Corps and Community Health Centers.

It's also when Medicare telehealth flexibilities expire unless Congress takes action. Over the past five years, these expanded telehealth provisions have benefited family physicians and become a lifeline for many patients.

Team introductions

To talk about the Academy's advocacy on these issues, I'm pleased to be joined by Government Relations colleagues Natalie Williams, senior manager of legislative affairs, and Megan Mortimer, manager of legislative affairs. Natalie and Megan, welcome back to the podcast.

Natalie Williams: Thanks, Dave.

Megan Mortimer: Thank you, Dave.

Why THCGME and related programs are crucial

DT: Megan, can you talk a little bit about why the Academy has made such a high priority of THCGME and the other related programs?

MM: Yeah. So, in short, the reason why we prioritize these things is because they work and they work very well for primary care physicians, especially for family physicians.

THCGME has graduated over 2,000 physicians; 61% of those alone are family physicians, and the rest make up other primary care specialties, including dentistry, psychiatry, etc.

The reason why it's also very important for us to support THCGME over traditional GME programs is because traditional GME programs have a tendency to disproportionately put physicians in certain areas with large hospital systems. And as we know, a lot of family physicians would prefer to work in a community-based setting and in the communities in which they plan on serving in for the duration of their career upon the end of their residency programs. We do know that when you finish your residency program, you usually practice within a hundred miles of that program.

So again, focusing our efforts on THC graduate medical education supports primary care family physicians, specifically the patients that they serve in those areas, which are often the underserved and rural communities that are having a lack of access to basic care. So we will continue to push for THCGME. in addition to asking for robust reforms to traditional GME to make sure that it works for primary care physicians, not only during their residency programs but also for the career choices they want to make upon completion of those programs.

What Congress should do for THCGME

DT: Can you talk a little bit about how Congress should approach this?

MM: So, in addition to us just asking for funding, as everyone knows we're facing that fiscal cliff and we're asking for the basics by the end of this year. But we also continue to push for multi-year and or permanent authorization for these programs.

We support a bill called the Doctors of Communities Act, or the DOC Act, because everyone loves an acronym, which would support making the funding for these programs permanent. And the reason why that's so important is because it provides consistency and clarity with these programs about what kind of funding they have and what kind of funding they can hope to achieve in the future.

To either expand their programs or encourage their colleagues at other teaching health centers to create a THCGME program all on their own.

What’s at stake for telehealth 

DT: Great. Really appreciate that overview. Natalie, I want to shift over to you to talk a little bit about telehealth. Can you talk about what's at stake right now with telehealth in congress?

NW: Yeah, absolutely. The short answer is that what's at stake, come September 30, is access to essential, comprehensive and continuous primary care. For millions of Medicare beneficiaries, the pandemic really has shone a light on telehealth as a valuable modality, especially for family physicians and the patients that they serve.

Over the last more than five years, Congress has waived existing Medicare coverage and payment restrictions to help expand access to telehealth services for beneficiaries. These telehealth waivers have really allowed, instead of arbitrary policies making the decision on which modality is most appropriate for patients to seek care, it's allowed that to be a choice that exists between the patient and the physician, and so together they can decide if it makes sense for a patient to come into the office to seek care or if it's appropriate for that care to be rendered via telehealth or even audio-only services, which we hear from family physicians is particularly important in many rural communities and with many seniors that they serve.

However, these temporary flexibilities, which again, have existed for more than five years at this point, are set to expire, like the workforce programs that Megan mentioned previously, at the end of September. This will make it difficult if they are allowed to lapse for family physicians to continue to provide high-quality, timely care to patients who, in particular, face transportation challenges, geographic or mobility issues that really allow them to access care they wouldn't otherwise via telehealth.

For summary, some of the policies that are set to exist on September 30, which I'm sure many of our listeners are very familiar with, do include allowing patients to receive telehealth services for services that are not just mental and behavioral health care in their home. It also includes removing geographic restrictions on the originating sites for telehealth services, as well as allowing all Medicare providers to be eligible to provide telehealth services.

It also allows Federally Qualified Health Centers and rural health clinics to serve as Medicare distant-site providers for telehealth services. And then finally, but certainly not least important, permitting audio-only non-behavioral and mental telehealth services, which we hear frequently from family doctors is a lifeline for their patients who don't have broadband or aren't familiar with the technology and able to use video capabilities.

And so ensuring that they can continue to provide and get paid for those services is really important. And then additionally, one provision that has a little bit more of a runway in terms of deadline is the existing waiver of a requirement for there to be an in-person visit within six months of an initial behavioral or mental telehealth service that is set to expire at the end of this year rather than September 30.

But again, very important in terms of acknowledging that many patients live in communities in which there just simply is not a behavioral or mental health clinician available to them. So ensuring that this waiver continues to exist is very important for mental and behavioral health access. I will note, however, that Congress can, and as we've been calling for them to do, must act to extend these flexibilities before the end of this month, which is coming up very quickly.

We firmly believe at the Academy that doing so, extending these flexibilities to either be permanent or at a minimum for several years, will preserve this essential modality and allow family doctors to continue to meet patients where they are, whether that's in person in the office or via telehealth in their home.

The state of these priorities in Congress

DT: Great. I appreciate that, Natalie. I was hoping you could take a second and lay out for our listeners how we may see these topics addressed in the coming weeks. We know that they, Congress has to fund the government by the end of the month. Can you talk a little bit about how these issues might interplay within some of the other moving legislative vehicles that Congress is considering?

NW: Definitely. I think it's always a dangerous game to try and look into your crystal ball when it comes to Congress, but we've been down this path several times over the last few years, so it's become, I think, to the extent one can say Congress is predictable, a little predictable.

I will say, on telehealth in particular, this is an extremely bipartisan, if not the single most bipartisan, issue in Congress at this moment. So it is all but a guarantee that they are going to act to extend telehealth in addition to programs like the workforce programs Megan referenced, including THCGME and Community Health Center funding. It's really just a question of for how long. Historically, how Congress has addressed this is attaching the telehealth extensions as well as the workforce programs to what is known as the federal appropriations or spending bills. We’ve become very accustomed to, instead of those 12 bills being passed individually, them being passed as one big bill, what we in the D.C. beltway generally refer to as an omnibus.

And so the question is, largely, will that omnibus, which we expect to come to fruition before September 30, be extended for one month, for two months, or through the end of the year. And I think that's sort of the million-dollar question for now. Along with that is the question of how long do these telehealth and workforce programs get extended. Are we looking at a 30-day extension, and then we have to come back to this, or are we looking at a three-month extension? I think in both of these instances, that's not the outcome that the Academy is hoping for. We continue to stress the importance of consistency and predictability and sustainability when we're looking at the long-term outcome for these programs.

But I think knowing that Congress is likely to do something to extend these programs over the next few weeks is at least one silver lining these days.

DT: Yeah, for sure. Well, I really appreciate you looking into the crystal ball, and as we talk here right now, we're preparing to send a letter to the hill this week that outlines a number of the things that Megan and Natalie talked about, and our Advocacy Ambassadors spent a great deal of time over the month of August elevating these issues with lawmakers while they're back home.

So Natalie and Megan, thank you again for your insights. I appreciate you coming back to the podcast and appreciate all the work that you guys are doing and helping advance these priorities in your conversations with lawmakers and their staffs on a daily basis.

How to add your voice to these advocacy priorities

These are crucial issues for family physicians, so I urge you to add your voice to our advocacy by clicking the links to speak out campaigns in the episode's how notes. It's quick and effective. Our Speak Out tool provides email templates and auto fills the addresses for your district's lawmakers.

I also want to remind you of the Academy's Advocacy Ambassador program, which sets you up for success as family medicine advocates. Our ambassadors are building relationships with their lawmakers and are moving the needle. It's really easy to join. You'll find the link in the episode show notes to find out how you can be become an Ambassador today.

We also have a number of active Speak Out campaigns that allow you to add your voice to the AAFP's advocacy efforts. You'll find a link to the AAFP's grassroots advocacy resource webpage in our show notes so you can connect with your members of Congress today.