1. AAFP FEDERAL PRIORITIES
State Legislative Conference
Denver, Colorado
November 1, 2013

2. Thank You
• SLC Organizers
– Michelle Greenhalgh
– Amber Melaney
• Additional GR Staff
– Lorlita Alexander
– Jessie Williams
• Headquarters Staff
– Karin Reid

3. AAFP Federal Priorities – 2013
• Implementation of Health Care
Marketplace
• Medicare Physician Payment
Reform
• GME and Primary Care Workforce
Assistance

4. Implementation of Health
Care Marketplaces

5. 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

6. 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

7. ACA Implementation Interactive Map
http://www.healthlandscape.org/ACAMapper2013/index.html

8. 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

9. 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.

10. Implementation of Health Care
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

11. 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

12. 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.

13. 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• SGR repealed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”

14. 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%

15. 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

16. 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

17. 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

18. 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 valuebased payments and reporting
requirements

19. 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

20. 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

21. 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

22. 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)