AAFP CONTINUES TO FIGHT FOR PAYMENT REFORM

doi:10.1370/afm.829

Payment reform for primary care physicians and, in particular, for family physicians is a top priority for the AAFP. Once again in 2007, the Academy fought long and hard to ensure members of Congress and federal officials recognized the importance of payment reform to ensure the health of the nation.

As 2006 drew to a close, Congress narrowly averted a scheduled 5% payment cut for family physicians, leading the Academy to immediately jump into the payment fray once again. Early in January, an AAFP-inspired group of 10 medical associations called on Congress to implement comprehensive health system reform that abides by 11 principles, including access to health care, medical liability reform, and management of health care costs. The “Principles for Reform of the U.S. Health Care System” calls on Congress “to take action on health system reform this year,” said (then) AAFP President Rick Kellerman, MD, of Wichita, Kansas.

Then in March, the Academy, responding to a report on physician payment rates from the Medicare Payment Advisory Commission, urged Congress to replace the current payment structure with a system that compensates physicians for care-coordination services and creates incentives for the establishment of patient-centered medical homes.

Kellerman testified before the House Ways and Means Committee’s Subcommittee on Health in May. He urged committee members to adopt a Medicare physician payment system that reimburses physician practices for providing a patient-centered medical home. “More than 20 years of evidence shows that having a health care system based on primary care reduces costs and benefits the patient’s health,” said Kellerman.

May also saw the formal introduction of the Patient-Centered Primary Care Collaborative. Members of the collaborative—which include the AAFP and other physician groups, health care organizations, and employers—agreed that placing primary care and the patient-centered medical home “center stage” in the health care debate would help put America’s ailing health care system back on the road to recovery.

Late in May, some of the nation’s largest professional health care organizations, including the AAFP, sent a proposal to Congress asking lawmakers to phase in a repeal of Medicare’s sustainable growth rate, or SGR, formula by 2016 if they could not immediately eliminate the program. According to (then) AAFP Board Chair Larry Fields, MD, of Flatwoods, Kentucky, Congress needs to create a “stable payment system” for the next few years while working on a “permanent fix for the broken system we have now.”

The Academy’s efforts for payment reform continued in July, when Kellerman and other primary care leaders sat down with congressional leaders and asked them to stop the scheduled 10% reduction in Medicare payment rates for 2008 and provide positive payment updates in 2008 and 2009. “Everyone agrees this formula does not work,” said Kellerman.

For a while in August, it looked as if fixing the payment cuts called for by the SGR would not have to wait until the end of the year when the House passed a bill that would provide slight increases in Medicare physician payments in 2008 and 2009. The provision, which was passed as part of a bill to reauthorize the State Children’s Health Insurance Program, or SCHIP, would have provided a 0.5% increase in physician payments in both 2008 and 2009. Unfortunately, the payment update did not survive the reconciliation process between the House and the Senate.

With the collapse of the House SCHIP bill, the Academy intensified its advocacy efforts to stop Medicare payment cuts. In September, Kellerman met with staff members in the offices of 3 senators on the Senate Finance Committee and urged them to support a 2-year physician payment increase. “There is a growing understanding that primary care physicians and family physicians in particular are being undervalued in the current system, and that is having an adverse effect on access and quality of care and medical student specialty choice,” said Kellerman.

In October, the Academy unveiled a new attitude about advocacy with its “Bold Champions” initiative. The 2-year, multimillion-dollar strategic initiative is designed to represent members with assertive actions, forceful language, and a new brand identity to telegraph the change in its approach. “This new campaign expresses the AAFP’s commitment to play a central role in reforming the health care system for the benefit of all,” said newly installed AAFP President Jim King, MD, of Selmer, Tennessee.

The threat to legislation seeking to alleviate the scheduled payment cut spurred the Academy to mobilize its members in November and December. The AAFP urged members to call their senators to stop the pending cuts, and members responded by bombarding Capitol Hill with phone calls saying that Medicare pay cuts were unacceptable. These efforts were rewarded somewhat in the waning hours of December, when the Senate and House passed legislation that provided for a 0.5% increase for the first 6 months of 2008. However, it was a poor attempt at a fix in the Academy’s eyes. Congress is engaged in a delaying action, said King, postponing “what needs to happen, which is a complete reevaluation of the payment system and an elimination of the SGR in order to bring some sanity to our present payment formula.”

The new year dawned with the Academy working hard to once again mobilize members to call Congress’ attention to the Medicare payment crisis. While the Senate Finance Committee and members of the House quickly turned their attention to finding a way to fix or extend the temporary increase, AAFP members worked on a campaign to ensure the Medicare issue remained front and center.

Although the outcome of members’ efforts is still unknown, the Academy has succeeded in bringing the critical issue of payment reform to the attention of key legislators, as well as presidential candidates, with the hope that the patient-centered primary care medical home soon will become the model for health care across the nation.

AAFP News Now Staff