Tag Archives: STFM

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 Earlier this week the Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2), which repealed SGR and extended several key programs of importance to family medicine.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?

Growing the Impact of Family Medicine Through Advocacy

Nicholas Cohen, MD

Nicholas Cohen, MD

Since medical school, I have seen the unrivaled value family physicians provide to the patients they see. I was unaware—until this month—of the impact family physicians can have beyond their clinic walls on the health of their community at the local, regional, and national level. Our potential impact in this expanded sphere became clear to me on a visit to Capitol Hill with the Family Medicine Congressional Conference.

 What is the Family Medicine Congressional Conference?

FMCC attendees outside the office of Senator Sherrod Brown, D-OH.

FMCC attendees outside the office of Senator Sherrod Brown.

It is a 2-day conference in Washington, DC, open to anyone in family medicine. Day one I learned about the current priorities in family medicine and received practical, hands-on training in advocacy. Day two I visited  members of  Congress with others from my state in prearranged meetings to engage legislators in issues important to me and my patients.

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Day in the Life: My Visit With OHSU and STFM’s President-Elect

Stacy Brungardt, CAE STFM Executive Director

Stacy Brungardt,
STFM Executive Director

Most of you will not have the opportunity to serve on the staff of an amazing nonprofit organization like STFM. This is the first of a new blog series that will highlight some behind-the-scenes work at our staff offices and with our members to transform health care through education.

Wednesday, March 6, 2013

10:35 am PT
Hello Portland, Oregon! Picked up by STFM President-Elect John Saultz, MD, at the airport. (Pretty nice to have the incoming president meet me at the airport!) Great lunch at Mother’s—I highly recommend the pulled pork sandwich and homemade rolls. A brief Oregon Health and Sciences University tour set the tone for good conversations throughout the day. This visit had dual purposes: for John and me to discuss our STFM work for the upcoming year and for me to see and hear some of the amazing work going on in the Oregon family medicine department.

1–3 pm       
Met with John. This is where John and I began the first of several conversations about how we’re going to work together to move the strategic plan forward using his specific talents and interest. Getting a glimpse of members’ offices is a side benefit that shares insight into a person’s personality.

3–4 pm    
Met with first-year family medicine residents. This was a treat. I meet a lot of faculty but don’t get to interact with residents very often. This group of bright doctors was willing to share their thoughts about teaching and how they see themselves (or don’t) in this role. Thank you for your time and candor.

4–4:15 pm 
Surprise visit with second-year resident Laurel Witt, MD. I coached Laurel when she played for Power Angle Juniors, her high school volleyball club team. What a pleasure to reconnect after all these years. I’m still proud to have been a part of her life.

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