Tag Archives: Advocacy

Med School Gap Year: One Student’s Journey Advocating for Health Care

Stanford Tran

Stanford Tran

While my medical school classmates were deep in their sub-I’s, I took a year off and spent my days being chased off parking lots by grocery store managers. I often wondered what I was doing and how did I manage to drift so far from medicine.

I found myself in this unenviable position by trying to change the health care landscape. Health care in America is fragmented, expensive, and often ineffective. This has been self-evident for 20 years, yet the problem is getting worse. We have a health care system shaped largely by government policies and government dollars, and, conversely, we have a federal budget that is shaped largely by health care spending. Since I wanted to be an agent of health care reform, I thought the obvious way to do that was to run for a seat in the House of Representatives.

Sure, it is unconventional to run for federal office as a first-time candidate, to have no money or donors, and to have lived in the district for less than 3 years, but these are, in medical lingo, soft contraindications. The mechanics of running for public office is pretty much the same no matter which office—you spend your days begging for votes or for money, which in turn helps you beg for votes. You get the distinct feeling of being a panhandler, replete with being chased off from grocery stores. The only difference is that as a candidate, you are better dressed. People innately realize this because while many are politically opinionated, few ever imagine slumping to the level of a political candidate.

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Leading the Way

Jen Hartmark-Hill, MD

Jen Hartmark-Hill, MD

One of my top priorities for staying involved in health care advocacy is to promote a better future for my students.

As a medical educator, I often ponder the uncomfortable paradox of training medical students to become “ideal” physicians, only to send them out into a far less than ideal health care system upon graduation. Preparing and educating future physicians to lead health care transformation is essential, but we who serve as educators and role models cannot stop there.

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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?