PAFP/F: Access to Primary Care in Pennsylvania

Survey findings from the Pennsylvania Academy of Family Physicians, January 2013

PAFP/F: Access to Primary Care in Pennsylvania

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Primary care still waiting on ACA Medicaid pay raise - amednews.com

If the states manage to screw this up, and prevent pay improvement for primary care, it could jeopardize the success of the ACA…

Washington Primary care physicians who qualify for higher Medicaid payments under the Affordable Care Act might not see these rate increases as quickly as anticipated this year.

The Medicaid program has had a long-standing reputation for paying doctors at rates far below what Medicare pays for the same services. The ACA aimed to address this problem by directing states to bump rates for primary care services provided by primary care doctors up to 100% of Medicare rates for calendar years 2013 and 2014. Because the final rule on the provision was issued in late 2012 with an effective date of Jan. 1, many family doctors were hoping to see an immediate boost in their claims payments. However, “there could be a lag of several months even from now” for the enhanced Medicaid rates to take effect, said Jeffrey Cain, MD, president of the American Academy of Family Physicians.

Some physician organizations are concerned that states are missing the opportunity to prop up primary care because they aren't moving quickly enough to pay these higher fees.

Several administrative steps are needed first at the state and federal levels, said Neil Kirschner, senior associate of regulatory and insurer affairs for the American College of Physicians. States have until March 31 to modify their Medicaid plans accordingly and submit those changes to the federal government, which then has an additional 90 days to approve the plans. “It's unclear how many states have done that,” he said.

In recent letters to the National Governors Assn. and the National Assn. of Medicaid Directors, the American Medical Association and other organizations representing primary care doctors called on states to enact the pay bump expeditiously and engage in active communication with physicians to notify them about the timing of the pay increase.

With the ACA provision in effect for only two years, any implementation delays will make it harder for the government to collect data to see if patient access is improving by raising Medicaid payments, Kirschner said. The longer states take, the longer physicians must wait for these enhanced payments, which could affect decisions whether to take new Medicaid patients, he said.

Primary care still waiting on ACA Medicaid pay raise - amednews.com

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After the ACA Ruling: Next Urgent Steps for Family Medicine

After the ACA Ruling: Next Urgent Steps for Family Medicine

Medscape: What was your initial impression when you learned of the Supreme Court ruling on the ACA?

Dr. Stream: I didn't know what to expect. I had a difficult time separating what I wanted the outcome to be from what I could intellectually predict it would be. I'm pleasantly surprised.

Medscape: Will this ruling change any of the AAFP's expectations about the impact of the ACA on family physicians?

Dr. Stream: I don't believe so. We've been working for over 2 years under a strategy that the ACA was the law of the land, and we wanted to focus on those areas important to family medicine and patients and to make those areas as successful as possible. We also wanted to work on provisions that weren't part of the ACA or were not fully addressed by it, particularly replacing the sustainable growth rate (SGR) formula and achieving meaningful medical liability reform.

Having the mandate upheld is consistent with what has been AAFP policy for over 20 years. We have advocated for healthcare coverage for everyone and access to at least basic health services, including good primary care with prevention and chronic illness care. You can argue whether the mandate is the only means to get there, but at least in the analyses that I've seen, it was one of the best identified ways to get everyone covered.

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Organized Medicine on Reform

***Update: Now 8 of the 10 largest organizations are on board!***

Welcome to the blog. To make this a bit easier for everyone, here are the physician organizations FOR either HB 3200 or something close to it: AMA, AOA, ACP, AAFP, ACOG, ACS, AAP, ACC, AGA, ASCO, and SHM.

Squishy middle: AAO, AAOS, ACEP

Mo' money, then we'll talk: ASA, ACR.

Details below...

The American Medical Association, ~240K members:

[After passage of HB 3200 out of committee -cmhmd]... the American Medical Association sent a letter to House leaders supporting H.R. 3200, "America's Affordable Health Choices Act of 2009." "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform," said J. James Rohack, MD, AMA president. "We urge the House committees of jurisdiction to pass the bill for consideration by the full House." H.R. 3200 includes provisions key to effective, comprehensive health reform, including:

• Coverage to all Americans through health insurance market reforms
• A choice of plans through a health insurance exchange
• An end to coverage denials based on pre-existing conditions
• Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
• Additional funding for primary care services, without reductions on specialty care
• Individual responsibility for health insurance, including premium assistance to those who need it
• Prevention and wellness initiatives to help keep Americans healthy
• Initiatives to address physician workforce concerns

"The status quo is unacceptable," Dr. Rohack said. "We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues."

The American Osteopathic Association ("represents" 67K, per their website; not clear if this is actual membership)

Why is the AOA supporting H.R. 3200?
The “America’s Affordable Health Choices Act” (H.R. 3200) contains several provisions that reflect AOA priorities forhealth system reform. These priorities include: expanding the availability of affordable health care coverage to the uninsured, increased support for prevention and wellness services, investments in the physician workforce, increased Medicare payments for primary care services without cutting payments for other services and, importantly, it represents our best hope for eliminating the current sustainable growth rate (SGR) formula for updating Medicare physician payments. The AOA continues to work with members of the House of Representatives to improve the bill by seeking additions and changes in the legislation. Specifically, we are working to include expanded graduate medical education provisions, medical liability reform, and student loan financing reforms. Favorable action on a House bill is necessary to move the process to the end game negotiations that will determine the specifics of a final bill.

American College of Physicians (ACP, represents 126 K internal medicine physicians including primary care and medical subspecialists like me):

H.R. 3200 does much of what ACP asked Congress to do in terms of coverage, support for the primary care workforce, payment and delivery system reform, based on long-standing policies that have been adopted by this organization. No bill is perfect, but H.R. 3200 delivers on our major priorities in a way that is remarkably consistent with ACP policies, policies that were developed by the College's leadership over many years and always guide how ACP’s leadership, Key Contacts and staff advocate for internal medicine physicians and their patients.

American Academy of Family Physicians, 94K members:

On behalf of the 94,600 members of the American Academy of Family Physicians, thank you for the positive steps you have taken toward broader, affordable coverage that will mean improved health care based on primary care. We believe that the America’s Affordable Health Choices Act (H.R. 3200) will make significant progress toward payment and delivery system reforms and contribute to building a primary care workforce for the future. AAFP supports this legislation and we will be pleased to work with your committees to improve it further.
......
The public plan option developed by your committees reflects most of these principles very well.

American Academy of Pediatrics, 60 K members:

“The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, pediatric medical subspecialists, and surgical specialists, praises the U.S. House Energy and Commerce Committee for its vote today on H.R. 3200, America’s Affordable Health Choices Act, and applauds all three House Committees for their continued and steadfast work in the effort to pass significant health care reform.
“The Academy continues to support the process of bringing comprehensive health care reform to America’s children. While there is still work to be done, H.R. 3200 makes significant progress in achieving the Academy’s priorities of covering all children in the United States, providing children with age-appropriate benefits in a medical home, and establishing appropriate payment rates to guarantee children have access to covered services.

American College of Surgeons, 76 K members:

They have a letter of support for HR 3200, but you can't copy and paste... maybe a little gun-shy about letting the membership see it!

American College of Obstetrics and Gynecology, 52 K members:

"ACOG President Gerald F. Joseph, Jr. MD provides ACOG endorsement of HR3200 (proposed America's Affordable Health Choices Act of 2009)."

[The rest is behind a password protected section.]

American Academy of Ophthalmology, 7 K members:

Have not yet taken a position on any specific bill, but:

Meanwhile, the Academy, AMA and the American College of Surgeons have been up on the Hill pushing medicine and ophthalmology’s agenda. The Senate bill is expected to contain a rate-setting commission proposal that the Academy helped defeat in the House bill and other troublesome provisions affecting medicine and surgery.

and...

Acknowledging that the status quo in health care is unsustainable and that issues of access to coverage, quality of care and cost control must be addressed, and given legislative momentum in Congress, the Academy is advancing components for bills that protect patients and physicians. While reform discussions are still ongoing and no pending legislation is perfect, we are committed to continue collaborating with health leaders in Congress to improve bills being considered. The Academy is actively engaged with other physician organizations as key House and Senate committees debate legislation that puts a long-term sustainable growth rate (SGR) fix in play, in addition to other top issues.

American Association of Orthopedic Surgeons, ~17 K members:

The AAOS is committed to ensuring that the final bill be as beneficial as possible to the Orthopaedic community, including our patients. We will not make any decisions in support or opposition until something closer to a final bill is available.

Ooops! Perhaps phrased poorly!

American College of Cardiology, 37 K members:

On behalf of the American College of Cardiology (ACC), representing 37,000 cardiovascular members, I am writing to commend you for H.R. 3200, the "America’s Affordable Health Choices Act of 2009.” This legislation makes a significant financial commitment to comprehensive health system reform and we are committed to working with you on this effort.
ACC is especially pleased that H.R. 3200 takes extraordinary measures to extend coverage to every American and takes positive steps to strengthen Medicare. Among the Medicare provisions the College supports include:
• Funding to eliminate the accumulated debt from the flawed Sustainable Growth Rate (SGR);
• Establishment of a positive Medicare physician payment update (MEI) for 2010
and favorable spending targets for updates in the future;
• Significant payment and delivery reform models such as incentives for physicians to participate in Accountable Care Organizations; and
• Expansion and improvements to the Physician Quality Reporting Initiative (PQRI) to encourage successful participation;

American Society of Clinical Oncology:
Can't find anything on their website. The American Cancer Society, on the other hand, has made access to health care via serious reform their top priority. And, by the way, on palliative care? They're for it.

American Gastroenterological Association, 17 K members:

On behalf of the American Gastroenterological Association (AGA), representing over 17,000 physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver, I am writing to express our appreciation and support for several provisions in H.R. 3200, America’s Affordable Health Choices Act. The AGA appreciates your leadership and shares in your goal to expand health care coverage to the uninsured, improve coordination of care, and enhance quality.

American College of Emergency Physicians, 27 K members:

"It is important to note, however, that a common theme supported by members of the House and Senate (Democrats and Republicans), as well as the White House, is to extend coverage to nearly all Americans, although there are differences of opinion as to how this objective is best achieved. ACEP supports this endeavor to provide universal health care as a benefit for patients and its outcome of drastically reducing the burden of uncompensated care provided by emergency physicians.
ACEP encourages you to discuss and promote these issues with your members of Congress during the August recess. Your message to lawmakers:
These provisions will improve your constituents' access to vital emergency medical care services and they must be part of the final health care reform package that is sent to President Obama.
Due to the fragmented, unpredictable nature of the process, and the lack of a final product in the House or Senate, ACEP has refrained from taking a public position on the overall legislative proposals. This has been, and remains, a very fluid process and we want to assure you that ACEP will continue to monitor these plans and advocate
for the needs of emergency physicians and your patients."

American Society of Anesthesiology, 43 K members:

"ASA members may be confused by a request for support of H.R. 3200 by other medical associations, including most recently the AMA. ASA CANNOT AND WILL NOT SUPPORT THE BILL IN ITS CURRENT FORM. Members are strongly encouraged NOT to respond to AMA’s request to support H.R. 3200. The bill, the ‘America’s Affordable Health Choices Act,’ includes a public plan option based upon Medicare payment rates for anesthesia services. A Medicare rate-based public plan would be detrimental to the medical specialty of anesthesiology.

“ASA has consistently urged lawmakers to address anesthesiology’s ‘33 percent problem’: the fact that Medicare pays 33 percent of what private insurers pay for anesthesia services (while Medicare pays an average of 80 percent of what private insurers pay for most other medical specialties). This 33 percent payment level simply does not reflect the costs of providing anesthesiology medical care. As such, Congress must not use this payment level as a model for any health care plan.

“We acknowledge that there are many laudable provisions included in H.R. 3200. Still, many issues remain unresolved, and questions linger about how various provisions would impact anesthesiology. We must remember that there is no other organization involved in the reform debate that is speaking for anesthesiology. In fact, some groups are actively lobbying for provisions that would harm our specialty. Anesthesiologists’ shared voice is the only way to ensure that the important and unique concerns of our specialty, our practices and our patients are heard in the halls of Congress. "

American College of Radiology, 32 K members:

Best I could find on their website:

Unfortunately, it seems ACRs position regarding the House version of healthcare reform, HR 3200, has been incorrectly characterized. As many of the details of overall health care legislation remain fluid, the College has not taken a position, for
or against, any of the current overall congressional proposals, including HR 3200.
Regarding HR 3200, we continue to educate congressional leaders that the imaging and radiation therapy provisions, including a raise in the equipment utilization rate assumption to 75 percent and a further 25 percent cut to contiguous imaging, are flawed ideas that will ultimately harm patient access to care particularly in rural areas.
Until negotiations regarding such provisions are complete or are clearly at an impasse, ACR will not take an official position on the entire House bill. Any information that ACR has offered its support or opposition to HR 3200 is incorrect.

Update: I almost forgot to include some rather contrarian sentiments from the South Carolina Medical Association, as well as some "Old School" conservative physicians to round out the round up. They are not alone, as some other deeply red states' Medical Societies have expressed similar dire warnings. But for them, this is really about ideology, not solutions.

Update II:

Society of Hospital Medicine ( ~6 K members, represents hospital based physicians):

On behalf of the Society of Hospital Medicine (SHM), I am writing to express our support for provisions in H.R. 3200, the “America’s Affordable Health Choices Act of 2009” regarding delivery system reform. SHM represents the nation’s hospitalists—physicians whose primary professional focus is the general medical care and management of hospitalized patients. We agree that the time has come for comprehensive health reform and appreciate your leadership and commitment in pursuit of this worthy goal.

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450,000 Doctors Demand: ‘Heal Health Care Now’ -- Media Center -- American Academy of Family Physicians

450,000 Doctors Demand: ‘Heal Health Care Now’ -- Media Center -- American Academy of Family Physicians:

Today marks the launch of “Heal Health Care Now.” This Web-based initiative (HealHealthCareNow.org) consists of several elements, including a provocative video of family doctors speaking in support of the health system reform legislation Congress is debating currently. The video culminates with a call to action encouraging viewers to let their legislators know they stand behind nearly half a million doctors to support reform. The Web site also provides a quick and easy tool that encourages viewers to contact their legislators directly.

Also today, organizations representing 450,000 doctors signed and delivered a joint letter indicating their support of health care reform to Sen. Harry Reid (D-Nev.) and his colleagues in the U.S. Senate. The American Academy of Family Physicians along with the American College of Physicians, the American Osteopathic Association, the American Medical Student Association, Doctors for America and the National Physicians Alliance signed the letter which reads in part, “We are confident that the reforms being proposed will allow us to provide better quality care to our patients, while preserving patient choice of plan and doctor.”

Two national nonpartisan health care organizations — the AAFP and the Herndon Alliance — developed the online “Heal Health Care Now” initiative in a strategic effort to counter some of the most potent anti-reform arguments with the most trusted spokespersons — front-line family doctors. The AAFP represents more than 94,000 family physicians and medical students. The Herndon Alliance is a nationwide coalition of more than 200 minority, faith, labor, advocacy, business, and health-care provider organizations, including the American Nurses Association, the American Academy of Pediatrics, the AARP, the Mayo Clinic and Families USA.

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