Health Care and You
an online resource that gives you and your patients quick access to
important, basic information about the Affordable Care Act. The AAFP
worked with a coalition representing consumers, patients, physicians, nurses, hospitals, and pharmacists to create the site.
Your patients look to you not just as a caregiver but also as a trusted source for information on the health law and how it affects them. You can share HealthCareandYou.org as an important resource with your patients. The site features facts about the law and an exclusive state-by-state listing of health care coverage options. Soon, a chat feature will allow users to ask specific questions about the law.
HealthCareandYou.org can also be a good business resource for your practice. It includes a timeline indicating when elements of the law go into effect and will be updated to reflect any changes Congress may make.
Check out HealthCareandYou.org. We believe it will be a good resource for us and our patients.
A New Congress
January marked the beginning of the 112th Congress. The House of Representatives experienced a historic turnover and the Senate has many new members as well. Most of these newly elected officials are not yet familiar with family medicine.
Here’s how you can help.
is an excellent time for you to get to know your legislators and
educate them about family medicine and the issues you and your fellow
family physicians face on a daily basis. Please email your federal
legislators or better yet consider setting up an introductory meeting
with them. We’ve made it easy for you by providing:
- a template letter for you to email your legislators;
- a guide to meeting with elected officials; and
- issue papers to assist you in your discussions.
Family physicians like you can be an invaluable resource for legislators who continue to grapple with important health care issues that will affect you and your colleagues for years to come. You can help make sure your legislators have the practical, front-line information only you can provide before they make some of these crucial decisions. Think of how much better our health care system could be as a result.
GAO Study: Medicare Vaccination Practices
This winter, the US Government Accountability Office (GAO), a research arm of Congress, is conducting a national survey of Medicare providers regarding their vaccination practices. The survey will be mailed to a random sample of physicians, including family physicians. If you receive the survey in the mail, we encourage you to respond as the results will be included in a report to Congress.
A One-Year Fix
Last week Congress passed a one-month extension to the current Medicare physician payment rate. The measure temporarily postponed a 23 percent reduction in Medicare payments to physicians. Now, leaders in the House and Senate are negotiating a year-long extension of the payment rate. A 12-month extension will give the physician community and Congress time to work together in establishing a three- to five-year SGR patch that hopefully will include a positive differential payment for primary care physicians.
Email your Senators and Representative today. Ask them to pass legislation that extends the current Medicare payment rate through the end of 2011, as the first step toward replacing a disruptive and outmoded formula.
Thank you for all your hard work thus far. Even if you’ve sent a letter before, it’s important to do so once again. Congress needs to hear support from family physicians for a 12-month extension.
Update: Physician Payment Reform
Congress reconvened this week and is expected to address Medicare physician payment along with several other issues. The SGR formula used to calculate annual updates is set to be reinstated on December 1, resulting in a 23-percent cut in payments for physicians.
As we closely monitor this issue, we expect Congress to provide a one-month extension to the current payment rate to buy some time to institute a longer-term extension.
Assuming this happens, the AAFP will urge Congress to pursue a three-step approach to permanent payment reform:
- Extend current Medicare physician payment rates for at least 13 months, through the end of 2011.
- Provide multi-year extension of the SGR with differential payment for primary care physicians.
- Work with physicians on the development and implementation of longer-term payment system improvements.
A letter outlining our approach to payment reform is available on Speak Out. Please consider contacting your legislators today.
Medicare Payment Rule Includes AAFP-Sought Improvements
The Centers for Medicare & Medicaid Services (CMS) issued the 2011 final physician fee schedule on November 2, 2010. Included in it are several improvements as recommended by AAFP in a regulatory comment letter submitted on July 28, 2010.
Of particular interest to family physicians are policies that:
- Significantly improve the eligibly rules for the Primary Care Incentive Program (PCIP) so that “over 80 percent of physicians who currently are enrolled in Medicare with a primary specialty designation of family medicine … would qualify for the PCIP based on CY 2009 claims data,” according to the agency. Compared with CMS’ initial proposals, the final policy will allow considerably more family physicians to successfully qualify for the 10-percent bonus for primary care services as called for in the Affordable Care Act (ACA). Based on suggestions from AAFP and other primary care physician groups, CMS will now exclude all non-physician fee schedule allowed charges (i.e., charges associated with labs, imaging, and durable medical equipment supplies) and hospital E&M codes when determining PCIP eligibility.
- Greatly expedite when newly enrolled Medicare primary care physicians become eligible for the PCIP.
- Reaffirm the agency’s 2010 decision to eliminate consultation codes (which allowed better payment for E & M codes).
- Clarify definitions, patient eligibility requirements, and payment levels for the new ACA-authorized Annual Wellness Visit and the Initial Preventive Physical Examination.
- Finalize CMS’ definition of preventive services.
- Reduce significantly the 2011 e-prescribing reporting burden, as AAFP had recommended: rather than requiring practices to report on 50 percent of all applicable services, CMS will award the entire year’s bonus after a practice reports e-prescribing just 25 times.
- Expand to 12 months (from the agency’s initial proposal of 6 months) the time physicians have to file a Part B claim under an exception to the ACA requirement that all Medicare claims must be submitted within 12 months.
- Expand the list of approved Medicare telehealth services, as AAFP had suggested.
Until it expires at the end of November 2010, the Medicare conversion factor is $36.8729. CMS also included in the final rule information pertaining to the approaching reductions in Medicare physician payments. Unless Congress intervenes, the final 2011 conversion factor as published in the final regulation will be $25.5217 on January 1, 2011.
Physician Briefing Call
On Friday, October 29 at 2:30 pm EDT, CMS Administrator Dr. Don Berwick, MD, MPP will hold a briefing call with physicians to discuss what physicians and patients can expect under the new health reform law.
This is our opportunity to inform Dr. Berwick about how to improve Medicare and Medicaid. I hope you take the time to dial in and take part in this important discussion.
Physicians Briefing Call: The Future of Medicare and Medicaid
Friday, October 29
Start Time: 2:30 PM EDT
After the call, please leave your thoughts in the comments section below.
Stand together for payment stability
This week, AAFP members from across the country are gathered in Denver for our Annual Scientific Assembly. We encourage all members in Denver to stop by our Medicare Action Center in the AAFP Exhibit & Marketplace to send an e-mail urging Congress to address pending cuts to Medicare physician payment.
If you’re in Denver, you can still be part of the action and send the e-mail from home.
Now is the time to stand together and remind members of Congress about the importance of creating stability for patients and physicians as the first step down a path toward permanently replacing the sustainable growth rate (SGR) formula with a new Medicare payment and delivery model.
We want Congress to:
Understand that cuts scheduled to take effect on December 1 and January 1 can not be allowed to occur.
Stabilize physician payment for at least 13 months, through the end of 2011.
Work with physicians on the development of longer-term payment system improvements.
Where reform happens
2010 State Legislative Conference
New Orleans, Louisiana
Make reform a reality. Influence health care legislation where it really counts—at the state level.
The Federal health reform bill is just the beginning. Governments will need strong family physician advocates to fight for issues, such as health care coverage, delivery system redesign (around the patient-centered medical home), a greater primary care workforce, and appropriate scopes of practice.
Open to AAFP members, chapter executives, and chapter lobbyists, you will:
- Discuss policy implications for family physicians.
- Gain skills to become an effective advocate in your state.
- Build relationships with colleagues and AAFP leadership.
Tools to help you advocate
Use the AAFP's Medicare Action Tool Kit to advocate for yourself and for family medicine.
The tool kit includes:
- a fact sheet on the Medicare physician payment issue, which includes talking points and tips;
- a sample letter you can give to your patients, enlisting their help in contacting Congress to urge an extension of the temporary patch and a permanent solution that will preserve their access to your services; and
- a sample letter patients can send to their U.S. Senators and Representatives, urging them to act on Medicare physician payment.
Please use these tools as we gear up for a full-court press on the Medicare physician payment issue this fall. Every voice -- that of you and your patients -- must be heard. Together we can make a difference.
We’re still here fighting
Please stay with us as we turn our attention to the future of family medicine. Join Connect for Family Medicine by selecting, Yes! I want to join AAFP Connect for Family Medicine, in the upper right-hand corner of this page.
This members-only advocacy program will update you regularly about our advocacy work – and let you know how you can help in easy, efficient ways.
Issues that Connect for Family Medicine will cover include:
- Physician payment (including the primary care bonus)
- Patient-Centered Medical Home, Accountable Care Organizations, and Other Practice Models
- Medicaid Primary Care Payment Parity with Medicare
- Graduate Medical Education
- Health Information Technology and Quality Reporting
- Comprehensive Medical Tort Reform
- Comparative Effectiveness Research and Primary Care Research
Watch for an upcomming GAO survey
This summer, the US Government Accountability Office (GAO), a research arm of Congress, is conducting a national survey of primary and specialty physicians regarding their participation in Medicaid and CHIP programs. The survey will be mailed to a random sample of physicians, including family physicians. If you receive the survey in the mail, we encourage you to respond as the results will be included in a report to Congress.
Earlier this year we asked how you would like to stay engaged and how Connect for Reform could most effectively serve you. The response was overwhelmingly positive. We found most of you feel Connect for Reform would continue to be a valuable tool as the AAFP shifts from focusing on securing health reform to securing family medicine’s future. As a result, we’ve decided to continue the program and change its name to Connect for Family Medicine.
While we hope that the health reform legislation is a good step forward in improving health care in this country, there are several issues of concern to Family Medicine that are subject to either legislative or regulatory action. As a member of Connect for Family Medicine, you’ll be informed and provided opportunities to take action.
Stay tuned to Connect for Family Medicine for the latest developments on issues important to family medicine. Also, feel free to submit your comments and suggestions for future content via the comments section on the blog.
White House Health Care Tele-Town Hall Tomorrow
On Tuesday, June 8 at 11:25 am EDT President Barack Obama and Health and Human Services Secretary Kathleen Sebelius hold a town hall meeting at a senior center in Wheaton, MD to discuss health care issues.
The hall will be broadcast live online at C-SPAN.org and you can participate toll-free at 800-837-1935, passcode: 80272058.
Health Care Tele-Town Hall
Tuesday, June 8
Start Time: 11:25 AM EDT
Participant Call-In Number: 800-837-1935
After the call, please leave your thoughts in the comments section below.
Congress fails to stop cuts
For the second time in as many months, Congress has failed to stop Medicare payment cuts based on the sustainable growth rate (SGR) formula from going into effect. As of yesterday, physicians are facing a 21.3 percent reduction in Medicare payments.
The executive committee of the AAFP Board of Directors has decided that if Congress cannot provide a permanent fix for the SGR, then the AAFP will not support legislation that provides a temporary payment update unless the bill includes a positive primary care payment differential and extends at least through Dec. 31, 2012.
Call, write, or meet with your Senators this week while they are home for Memorial Day recess. Ask them to rescind your Medicare pay cut and institute a long-term fix to the flawed SGR formula.