Family Medicine Advocacy Rounds, July 2023

2024 proposed Medicare physician fee schedule reaffirms need for sustainable payment system

Why it matters:

The Centers for Medicare and Medicaid Services released its 2024 Medicare physician fee schedule (MPFS) proposed rule, which includes proposals to strengthen primary care. However, inadequate Medicare payment rates strain physician practices and create barriers to care for patients enrolled in Medicare. 

The threat of Medicare cuts underscores the urgent need for Congress to invest in a more sustainable Medicare physician payment system — the only Medicare payment system lacking an annual inflationary update. 

Many other health systems and payment schedules base their payment rates on the Medicare physician fee schedule, including TRICARE, state Medicaid agencies, and other insurers, so it’s important that Medicare rates accurately reflect the way physicians serve their patients and communities.

What we’re working on:

• AAFP released a press statement on the 2024 MPFS. Family physicians applaud several proposals aimed at strengthening primary care but are concerned that the proposed nearly 3.4% reduction in the Medicare conversion factor will prevent physicians and their patients from fully realizing the benefit of these new investments. While we appreciate that Congress enacted limited conversion factor relief for 2024, more must be done to protect access to care.
• AAFP is pleased to see several proposals that are consistent with our strong advocacy to strengthen and invest in primary care. Most notably, CMS plans to move forward with implementing the G2211 add-on code, which is meant to more appropriately value the physician work involved in providing continuous, longitudinal primary care. The advancement of new coding and payment regulations to value primary care more accurately is an incremental but meaningful step in the right direction.
• AAFP acknowledged that outdated and inadequate Medicare payment rates are undermining the move to value-based payment as physician practices struggle to keep their doors open, unable to invest in the tools, staff, and other supports required to transition into alternative payment models.
• Modernizing Medicare payment rates will help transform our health care system, combat consolidation, and meet the needs of a growing and aging population.
  
• AAFP continues to call on Congress to end unsustainable physician payment cuts and invest in community-based primary care.

AAFP asks CMS to improve access to care for Medicaid beneficiaries

Why it matters:

CMS recently released two major proposed regulations aimed at improving access to care for Medicaid beneficiaries. They include several major proposals aimed at improving Medicaid beneficiaries’ access to, and physicians’ payment for, primary care services—including implementing appointment wait-time standards and strengthening the transparency of payment rates.

What we’re working on:

• AAFP submitted two letters in response to the proposed rules. The AAFP has a long history of advocating for federal access standards for Medicaid managed care patients and higher Medicaid physician payment rates. This helps increase investment in primary care, supports primary care practices caring for Medicaid beneficiaries, and strengthens equitable access to care. 
• AAFP continues to advocate for CMS to finalize payment rate transparency requirements and strengthen its access-monitoring approach for payment rate reductions and restructuring.

Recent Supreme Court cases undermine equitable representation in medicine

Last month’s Supreme Court decisions dealt blows to the quest for equitable representation in Medicine, said AAFP President Dr. Tochi Iroku-Malize. The lack of a diverse physician workforce has significant implications for public health. AAFP remains committed to advocating for equitable representation and opportunities in medicine and ensuring that individuals from underrepresented communities can pursue a career in family medicine.

AAFP tells Congress about challenges with MACRA

Why it matters:

The House Energy and Commerce Subcommittee held a hearing titled “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” The Medicare Access and CHIP Reauthorization Act sought to create incentives in Medicare to provide seniors with better-quality care rather than just greater volume of care. However, MACRA has left most Part B clinicians in a state of financial insecurity as Medicare payment rates have failed to keep pace with practice costs amid a dearth of value-based payment model options. 

AAFP has long supported the transition to value-based payment through alternative payment models for family physicians ready to move away from fee-for-service toward payment policies that promote and finance comprehensive, continuous, coordinated primary care.

What we’re working on:

• AAFP shared a letter that highlighted many of the challenges family physicians are experiencing with MACRA implementation and policy recommendations to reform Medicare physician payment. This included strongly advocating for greater federal support to ensure that primary care physicians who want to are able to meaningfully transition to value-based payment through alternative payment models. 
• In June, AAFP CEO Shawn Martin testified before the Senate Finance Committee about the ways in which piecemeal fee-for-service payment and the MPFS’ undervaluation of primary care undermine the whole-person approach integral to primary care. 
• We continue to urge Congress to collaborate with the physician community to address MACRA’s shortcomings and protect beneficiaries’ timely access to care.

AAFP applauds White House proposal to reverse low-quality insurance plans

Why it matters: 

The AAFP applauds the White House’s proposed rule to add more protections for patients in short-term limited-duration health care plans. Short-term, limited-duration plans are meant to be a bridge, not a substitute for long-term, meaningful coverage.

What we’re working on:

• AAFP President Dr. Tochi Iroku-Malize responded on social media and expressed encouragement that the administration will take steps to ensure affordable, comprehensive health care for all.
• AAFP commented on the 2018 proposed rule to expand the availability of STLD. In 2019, we wrote another letter emphasizing our opposition to insurance plans that do not cover all of the essential health benefits.
• In our first letter to President Biden, we called on the administration to reverse regulations expanding STLD plans.
• AAFP’s Health Care for All position paper outlines features of insurance that are critical to comprehensive, equitable coverage.

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