SGR Repeal and Teaching Health Center GME Extension: What Does it Mean for You?

Hope Wittenberg

Hope Wittenberg, MA
Director, Government Relations

The long-sought-after repeal of the failed Sustainable Growth Rate (SGR) formula has finally happened. Earlier this week the Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2), which repealed SGR and extended several key programs of importance to family medicine.

Changes to Physician Payments

The bill permanently replaces the SGR formula with stable annual payment increases of 0.5% for 5 years. It also includes incentives for physicians to move into one of two value-based payment systems, based on their practice model, beginning in 2019.

Merit-Based Incentive Payment System (MIPS)

MIPS consolidates existing Medicare fee-for-service incentive programs (PQRS, Meaningful Use, and Value-based Modifier). One can think of this payment system as the default system. Payments will be based on improved performance of specific criteria, resulting in a base payment being increased or decreased up to 4% beginning in 2019, rising to up to 9% by 2022. Starting in 2026, physicians participating in the MIPS will be eligible for a 0.25% annual increase in their payments.

  • This consolidation is intended to streamline complex quality reporting measures.
  • It adds incentives for physicians to engage in clinical improvement activities (e.g., same-day appointments, care coordination, etc.).
  • It rewards physicians based on their own measured improvement, rather than through a “tournament style” system that mandates winners and losers.

Of note, the legislation includes ABFM maintenance of certification as a MIPS clinical-improvement activity.

Alternative Payment Methodology (APM)

The other method of payment is for physicians who receive a certain percentage of their revenue from alternative payment models such as patient-centered medical home and accountable care organizations. Eligible practices paid under the APM model will receive a 5% bonus on their Medicare billings for years 2019 to 2024. Starting in 2026, physicians participating in an APM qualify for a 0.75% annual increase.

  • APM provides safe harbor from the downside of MIPS assessment and most EHR meaningful use requirements.
  • It rewards movement away from the fee-for-service model and into models that reward value and outcomes rather than activity or volume.

Our hope is that both of the tracks will allow family medicine practices to garner better payment for providing improved care; however, the larger bonus payments in the alternative payment models intentionally encourage a shift from focusing on solely on patients to improved care of communities and populations. The underlying premise is that this type of payment system, in contrast to fee-for-service, will incentivize practices to achieve the triple aim of improving the health of the population, enhancing the patient outcomes and reducing costs.

Funding of Critical Programs

There were several other primary care priorities that were included in the bill that our advocacy staff and many of our members have worked very hard to achieve. The bill includes 2 years of additional funding for:

  • Children’s Health Insurance Program
  • Community health centers
  • National Health Service Corps
  • Teaching Health Center Graduate Medical Education program.

Our academic family medicine advocacy staff has been actively working for over 3 years to achieve an extension of the Teaching Health Center GME program. Its 2-year extension in this legislation provides funding for the current crop of residents—including those who just matched into these programs for the 2015–2016 academic year. Without this extension the program was at risk of running out of money. The HRSA had given notice that the per-resident amount might be reduced from its current $150,000, to as low as $70,000, depending on this year’s match and fill rates. The bill allows us some breathing room to continue to work for a more permanent solution—but we don’t have time to rest on our laurels!

Thank You CAFM Advocacy Network and Members!

Take a moment to enjoy the success! I would like to extend a very great thank you to those who advocated for this bill and the programs contained in it. Many of you answered our call and were committed to moving the process forward.  We will need to continue our advocacy efforts to move our national agenda forward. I look to your help in efforts to obtain overall graduate medical education reform, increased funding for primary care research, and better funding for primary care training under Title VII.

Advocacy is not all about national agendas, either of our specialty, or of academic family medicine. I’d also like to hear ideas about your personal advocacy journey.

What issues, causes, or problems matter to you? What do you see as your next personal advocacy cause? And when you read the summary above of what’s contained in the SGR legislation, what ideas did it stimulate in you for your advocacy agenda in the future?

How Can New Faculty Get Everything Done?

Sarina Schrager, MD, MS

Sarina Schrager, MD, MS

New faculty members are bombarded with a plethora of new duties. Clinical and teaching work tends to take precedence because of their urgency, while scholarship and professional development is at risk of neglect until those tasks becomes urgent as well. So how does a faculty member stay on top of all of these tasks?

Many faculty make weekly to-do lists and day to day lists in order to stay up to date on current projects. I have found that using a structured to-do list is very helpful in getting more done. The list helps me navigate the academic workload and maintain a sense of purpose and accomplishment.

Another benefit to using to-do lists is that it increases my productivity. Psychology studies show that by writing down what you have to do, you unburden the brain from worrying about what you need do to and can actually accomplish more (The Zeigarnik effect).

Elements of an Effective To-Do List

So what does the perfect to-do list look like? The most effective to-do lists are written in the SMART goal format, organized by urgency, and encompasses short-term and long-term tasks.

1. Use SMART goals

Edwin Locke has written about setting SMART goals (specific, measurable, attainable, relevant, time bound). Instead of writing, “Finish grant” on your list, you’d write “Complete introduction to grant by March 4.” Being specific in writing the goal helps focus the limited time you have.

2. Organize your lists by urgent/non-urgent and important/not-important tasks

Organizing to do lists into urgent and non-urgent tasks will help you strategize what to do first. Ideally, you should try to delegate non-important tasks because they are maybe not a great use of your time.

3. Have separate lists for short-term tasks and long-term tasks

It is great to write down a few things that you want to accomplish during an academic day. Many people use small pieces of paper so that they cannot fit more than a few tasks, which helps you be realistic about how much you can accomplish in a short amount of time. It is also a good idea to keep a list of what you want to accomplish over the next month, 6 months, or year. Have a little extra time? Think about a 5-year to-do list to help you strategize and prioritize your time.

Paper Versus Electronic Lists

People have strong opinions about what types of to-do lists to use. I have always liked paper lists since the act of crossing something off my list is very reassuring.

There are lots of to-do list apps for people who want a list on their phone, computer, or tablet.  (Check out Forbe’s article The 9 Best To-Do List Apps For 2014). I tried an app and hated it. Every time I looked at my phone, there was an icon showing me that I hadn’t completed my tasks for the day. I quickly switched back to paper. But, many people have successful experiences with electronic lists. Paper lists can be lost while web-based lists are maintained online. The key to being organized is to keep to one system.

Do you have a to-do list system you use? Let me know in the comments below.