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  • 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 SGR- HR 2810 Outline • Cost: $175 billion over 10 years • SGR repealed • Update of conversion factor for 2014-2018 is 0.5% annually • Eligible Professional Organizations will create “Peer Cohorts” • Peer Cohorts determine “core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)