AAFP FEDERAL PRIORITIES

State Legislative ConferenceDenver, ColoradoNovember 1, 2013

Thank You

• SLC Organizers– Michelle Greenhalgh– Amber Melaney

• Additional GR Staff– Lorlita Alexander– Jessie Williams

• Headquarters Staff– Karin Reid

AAFP Federal Priorities – 2013• Implementation of Health Care

Marketplace

• Medicare Physician Payment Reform

• GME and Primary Care Workforce Assistance

Implementation of Health Care Marketplaces

Implementation of Health Care Marketplaces• The AAFP convened an ACA Work

Group with reps from 8 areas to develop educational resources for members and patients.

• The effort was headed by Amber Melaney, AAFP’s analyst in state government relations

Implementation of Health Care Marketplaces• The group created materials in four

components:– Member and Chapter Educational

Resources– Presentation for Family Medicine

Faculty– Webinar for Physician Small

Business Owners (November 6)– ACA Implementation Interactive Map

ACA Implementation Interactive Maphttp://www.healthlandscape.org/ACAMapper2013/index.html

Implementation of Health Care Marketplaces• The AAFP ACA landing page contains

AAFP-developed resources:– Understanding Health Insurance

Marketplaces– Health Care Reform: What It Means for Me– New Health Care Law and Medicare: What

to Expect– How Health Care Reform Will Affect Family

Physicians

Implementation of Health Care Marketplaces• The landing page also contains

information from healthcare.gov that details the costs and coverage of health insurance plans in Marketplaces.

• Congress of Delegates and Scientific Assembly

• Social Media• CMS Champion for Coverage

Designation• Blog by Dr. Blackwelder• aafp.org and FamilyDoctor.org

Carousels• CHEX and ANN Articles

Implementation of Health Care Marketplaces

SGR

• Fee Schedule Conversion Factor will decline 24.7% on January 1, 2014 unless Congress acts.

• Congressional Committees– House Energy & Commerce Com.– House Ways & Means Com.– Senate Finance Committee

SGR

• House Energy & Commerce Committee proposal– Medicare Patient Access and Quality

Improvement Act (HR 2810)– AAFP letters of April 15, June 10 and

July 16. – July 31, 2013 – approved by a vote

of 51 to 0.

SGR- HR 2810 Outline

• Cost: $175 billion over 10 years• SGR repealed• Update of conversion factor for

2014-2018 is 0.5% annually• Eligible Professional Organizations

will create “Peer Cohorts”• Peer Cohorts determine “core

measure sets”

SGR- HR 2810 Outline

• Core measure sets include quality measures and clinical practice improvement activities.

• Physicians will be paid (beginning in 2019) according to their performance in their peer cohort.

• Bonuses up to 1.5%; penalties of as much as 1.5%

SGR- HR 2810 Outline

• Alternative Payment Models– Emphasis on care coordination– Fast track for evaluated models (like

PCMH)– Encourages development of payment

codes for complex chronic diseases– Encourages adjustments for

misvalued physician payments

Finance/Ways and Means• Cost: $150 billion over 10 years• SGR repealed• No peer cohorts• 0% update for 10 years• Emphasis on value-based

purchasing and alternative payment model

Finance/Ways and Means• Care Coordination payments are

authorized in 2015 for all those in PCMH (or other approved APM)

• Appropriate use criteria, provider endorsed, for advanced imaging

• Fix misvalued payments (RUC)• Make Medicare data more

transparent

Finance/Ways and Means• Beginning in 2024, annual update

of -1% for FFS; +2% for APM• APMs are eligible for 5% bonus

and PCMH are qualified• APMs are excluded from value-

based payments and reporting requirements

Finance/Ways and Means• NPs & PAs will be eligible for care

coordination payment• Provides “assistance for smaller

practices” – undefined• Value based purchasing for FFS is

an aggressive one – beginning in 2017 – 8% (increasing to 10%) of Medicare payment at risk

Finance/Ways and Means• No conversations yet about budget

offsets• No clear path or process to get the

measure passed this year• Congress has some 15 legislative

days left this year• Prediction: short-term extension of

SGR, w/ final action in spring 2014

GME & Workforce Issues• Continue to promote the Primary

Care Workforce Access Improvement Act (HR 487)

• Advocate for primary care medical student support

• Title VII Health Professions Grants

AAFP Federal Priorities - 2013• Contact

Kevin J. Burke, Director

AAFP Government Relations

1133 Connecticut Ave., NW (#1100)

Washington, DC 20036

kburke@aafp.org

(888) 794-7481 (toll free)