Family Medicine Advocacy Rounds, October 2023

AAFP fights on Capitol Hill for Medicare payment reform, primary care workforce support, mental health parity, and more

By AAFP’s Federal Advocacy Team
October 24, 2023

AAFP president-elect testifies before Energy and Commerce Committee

On October 19, AAFP president-elect, Dr. Steve Furr, testified before the U.S. House Energy and Commerce Subcommittee on Health during a hearing titled: "What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors." The hearing highlighted two of the most pressing issues impacting physicians and workforce shortages: inadequate Medicare payment and overwhelming administrative burden. 

Dr. Furr focused on the importance of fine-tuning Medicare payment to best serve seniors and strengthen the program, including by increasing physician payment and easing administrative burden. You can read Dr. Furr’s testimony here.

We need Congressional action to fix our Medicare physician payment system. I strongly urge Congress to reform budget-neutrality requirements, enact an annual inflationary update for physician payments, support physician practices moving into value-based payment models, and pass the Lower Costs, More Transparency Act.

Steven P. Furr, MD, AAFP president-elect

 

Family physicians continue to support G2211 add-on code

Why it matters:

Primary care visits are thoughtful, complex, and all about ensuring patients’ health care needs are met. Here's the catch, though: All that work physicians do isn’t appropriately paid for.

One Medicare physician billing code — set to go into full effect in 2024 — is specifically designed to pay more accurately for the complex, high-value visits that primary care physicians provide as part of a continuous relationship with a patient. The equation is simple. Better payment equals better patient access and better outcomes. G2211 can make this a reality.

Unfortunately, this important policy, poised to improve health care nationwide, has attracted opposition. But the misperceptions driving criticism of G2211 do not stand up to scrutiny.

What we’re working on:
  • AAFP’s president, Dr. Tochi Iroku-Malize, and American College of Physicians President Dr. Omar Atiq wrote in Healthcare Dive that reform of the national Medicare physician payment system—particularly the implementation of G2211—is needed.
  • AAFP continues to call on Congress to end unsustainable physician payment cuts by enacting an annual inflationary update, reform arbitrary Medicare budget neutrality requirements, and invest in community-based primary care. Learn more facts about G2211 here.

AAFP recently submitted recommendations to the House Ways and Means Committee on rural health highlighting the need for sweeping Medicare payment reform.


AAFP advocates for primary care workforce legislation

Why it matters:

The physician shortage is a complex issue affected by growing demand, a history of underinvestment in primary care, an aging physician workforce, and economic pressures on the rural health system. 

The U.S. faces a projected physician shortage of up to 124,000 physicians by 2034, with demand for physicians outpacing supply, according to the Association of American Medical Colleges. Further, the Health Resources and Services Administration estimates that, by 2025, there will be a shortage of more than 250,000 mental health professionals, including psychiatrists.

For physicians — in communities both urban and rural, in hospitals, clinics, and independent practices—a workforce shortage contributes to burnout, inability to take on new patients, shortened visit times, financial challenges, and increased administrative burden. 

AAFP has consistently advocated in support of federal policies to address the shortage and maldistribution of adult and pediatric primary care, psychiatric, and other high-need specialties.

What we’re working on:

AAFP continues to support the bipartisan Lower Costs, More Transparency Act, which includes reauthorization for seven years of the THCGME program and will ensure that Medicare and its beneficiaries are paying the same rates for physician-administered drugs in off-campus hospital outpatient departments as they do in physician offices.

 

AAFP weighs in on mental health parity

Why it matters:

Mental health is just as important as physical health. The departments of Treasury, Labor and Health and Human Services released a proposed rule on mental health parity, specifically focused on improving coverage and payment. 

Family physicians provide longitudinal care across a patient’s lifespan, which often includes comprehensive mental health services and, when needed, care coordination with other mental health professionals. However, coverage of mental health services and network adequacy remains an issue, preventing patients from receiving specialized care and requiring primary care physicians to fill the gap while navigating timely and burdensome referral processes.

What we’re working on:
  • AAFP has long advocated for mental health parity to improve access to care and ensure that physicians have the tools and resources they need to address unmet mental health needs and successfully integrate behavioral health care into primary care.
  • In our comments on the proposal, the AAFP applauded the departments for taking steps to ensure that plans and issuers are providing appropriate behavioral health benefits and access to care.
  • Specifically, the AAFP recommended that the departments
    • implement appropriate guardrails to ensure plans and issuers continue to improve access to primary care while remaining in compliance;
    • clearly establish metrics and recommendations for how plans should consider primary care physicians who provide MH/SUD care; and
    • finalize proposals to implement data reporting and analyses, including for nonquantitative treatment limitations, and penalties for third-party administrators.


AAFP provides recommendations for Veterans Affairs standards of care

Why it matters: 

While the AAFP supports a wide variety of efforts by policymakers to improve access to health care services, we believe physician-led, team-based primary care is what’s best for patient care and outcomes. Patients are best served when their care is provided by an interprofessional, interdependent team led by a physician to support comprehensive care delivery and achieve better health, better care, and lower costs. 

Nowhere is this more important than at the Department of Veterans Affairs, which delivers multifaceted medical care to veterans, including those with traumatic brain injuries and other serious medical and mental health issues. Family physicians are uniquely trained and positioned to holistically address patients’ health care needs in the context of their communities, including by managing multiple chronic and acute conditions. 

What we’re working on: 
  • AAFP wrote to Sec. McDonough in September, urging the agency to
    • prioritize veterans’ safety and health outcomes by retaining scope of practice safeguards;
    • ensure physician-led, team-based primary care provided through the successful Patient Aligned Care Team model remains a priority and is not disrupted by the development of national standards of practice;
    • maintain safeguards that will prevent non-physician practitioners, including physician assistants, from performing services and procedures that are outside the scope of their licensure and for which they are not appropriately trained; and
    • support veterans’ longitudinal patient-physician relationships and care continuity by integrating pharmacists into the primary care team, which would allow them to appropriately address issues of medication use and tolerability, patterns of medication use, and dosing adjustments.


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