Primary Care Workforce Access Improvement Act of 2011

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board.HR3630, Welfare Integrity and Data Improvement Act, Prevent Medicare physician pay cut effective March 1, 2012. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. No Bill Number, Innovative quality and efficiency recognition reward programs that might be adopted by Medicare, Family physicians are focusing on quality, HIT and the PCMH model to transform practices. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, Conference call on FY2013 HHS spending request, AAFP budget priorities. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician pay cuts scheduled for 2013 No Bill Number, Task force on primary care valuation meeting, Medical home and health care reform No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public No Bill Number, Primary care meeting, Medical home and health care reform. No Bill Number, Meaningful use meetings, Medical home and health care reform. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, SGR, Medicare payment, Include a repeal of the SGR within super-committee deliberations and include a primary care differential. No Bill Number, Medicare Part D, Ensure that CMS continues to hear from practicing physicians on drug issues, including Part D. No Bill Number, GME, Advocate for GME pilot project.

Client expense: $747,230 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office

HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites.HR2119, Ryan Creedon Act of 2011, Opposing a requirement that physicians be specially trained on the dangers of addictive drugs. S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011, Funding for state monitoring of prescription drug use. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. No Bill Number, Title VII Sec 747 primary care grants stakeholders conference call, Supporting Title VII training to family medicine grants No Bill Number, Rural Hospital Residency development meeting and discussions, Increasing the number of slots for family physicians to train in community settings. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, AAFP Board Officers met with HRSA Administrator, HRSA portfolio promoting health care access and workforce.

Client expense: $747,230 · Firm income: Not reported

HR452, Medicare Decisions Accountability Act, Revamping the Independent Payment Advisory Board. HR2055, Military Construction and Veterans Affairs and Related Appropriations Act, Promoting AAFP federal budget priorities - Title VII Sec 747, NHSC, AHRQ, Rural Health and Workforce Commission.HR3630, Welfare Integrity and Data Improvement Act, Prevent Medicare physician pay cut effective March 1, 2012. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR3671, Judiciary Appropriations Act, 2012, Promoting AAFP federal budget priorities - Title VII Sec 747, NHSC, AHRQ, Rural Health and Workforce Commission. HR4013, Temporary Payroll Tax Cut Continuation Act, Ten month extension of the Medicare physician fee schedule. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. S407, Prescription Drug Abuse Prevention and Treatment Act of 2011, Ensure that Senator Rockefeller's bill is not burdensome to family physicians but increases communication among states to allow them to identify prescription drug abusers. No Bill Number, Title VII Sec 747 primary care grants stakeholders conference call, Supporting Title VII training to family medicine grants, NHSC, AHRQ, Workforce Commission, Rural Health. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Budget allocation for the discretionary spending on health programs and agencies, Ensure adequate federal funds for AAFP budget priorities. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, HHS FY2013 conference call, AAFP budget priorities. No Bill Number, SGR, Medicare payment, Include a repeal of the SGR within super-committee deliberations and include a primary care differential. No Bill Number, Rural Hospital Residency development meeting and discussions, Increasing the number of slots for family physicians to train in community settings. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. HR2119, Ryan Creedon Act of 2011, Opposing a requirement that physicians be specially trained on the dangers of addictive drugs. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, Innovative quality and efficiency recognition reward programs that might be adopted by Medicare, Family physicians are focusing on quality, HIT and the PCMH model to transform practices. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for Primary Care Physicians. No Bill Number, Legislation to repeal Independent Payment Advisory Board (IPAB), AAFP is dissatisfied with IPAB's composition and process but have not called for IPAB repeal. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician pay cuts scheduled for 2013 No Bill Number, Task force on primary care valuation meeting, Medical home and health care reform No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public No Bill Number, Primary care meeting, Medical home and health care reform. No Bill Number, Meaningful use meetings, Medical home and health care reform. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Invitation to judge the 2013 Family Physician of the Year competition, competition.

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board.HR3630, Welfare Integrity and Data Improvement Act, Prevent Medicare physician pay cut effective March 1, 2012. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. No Bill Number, Innovative quality and efficiency recognition reward programs that might be adopted by Medicare, Family physicians are focusing on quality, HIT and the PCMH model to transform practices. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, Conference call on FY2013 HHS spending request, AAFP budget priorities. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician pay cuts scheduled for 2013 No Bill Number, Task force on primary care valuation meeting, Medical home and health care reform No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public No Bill Number, Primary care meeting, Medical home and health care reform. No Bill Number, Meaningful use meetings, Medical home and health care reform. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, SGR, Medicare payment, Include a repeal of the SGR within super-committee deliberations and include a primary care differential. No Bill Number, Medicare Part D, Ensure that CMS continues to hear from practicing physicians on drug issues, including Part D. No Bill Number, GME, Advocate for GME pilot project.

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill). H.R. 8, American Taxpayer Relief Act of 2012: Medicare reimbursement and hospital rehabilitation rates.

Client expense: Not reported · Firm income: $60,000

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

HR3667, GME Modernization pilot program authorization. HR5707, Repeal Medicare SGR; implement primary care centric payment and care system; offset with Overseas Operations Fund, Prevent Medicare physician pay cut effective January 1, 2013. HR5, Protecting Access to Healthcare Act, Medical liability reform, support extension of current payment rate for Medicare. HR5979 Medicaid Accountability and Care Act of 2012, Prevent per capita cap reform of the Medicaid program. HR6688, Averting the Fiscal Cliff Act, American Tax Payer Relief Act, Prevent SGR sequester Medicare payment cuts, protect Medicaid parity primary care rates. Avoid sequester cuts to title VII primary care training grants, GME, AHRQ, NHSC, Prevention and public health trust funds, stop the 2% cut due January 2, 2013. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Meaningful use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Primary Care meetings. Medical Home and Health Care Reform. No Bill Number, Medicaid payment for primary care, Support for Medicaid payment for primary care services. No Bill Number, Medicaid Expansion, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Patient Centered Medical Homes, Increase support for the model.

Client expense: $633,350 · Firm income: Not reported

HR3667, GME Modernization pilot program authorization. HR5888, Physician Reentry Demonstration Program, Bill to address the shortage of primary care physicians. HR6400, Restoring the Doctors of our Country through scholarships RDOCS Act, Support medical student debt relief, increase family physician workforce. HR6688, Averting the Fiscal Cliff Act, American Tax Payer Relief Act, Prevent SGR sequester Medicare payment cuts, protect Medicaid parity primary care rates. Avoid sequester cuts to title VII primary care training grants, GME, AHRQ, NHSC, Prevention and public health trust funds, stop the 2% cut due January 2, 2013. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants and AHRQ funding. S507, Prescription Drug Abuse Prevention and Treatment Act, Support for national database and opposition to mandated CME.

Client expense: $633,350 · Firm income: Not reported

HR6688, Averting the Fiscal Cliff Act, American Tax Payer Relief Act, Prevent SGR sequester Medicare payment cuts, protect Medicaid parity primary care rates. Avoid sequester cuts to title VII primary care training grants, GME, AHRQ, NHSC, Prevention and public health trust funds, stop the 2% cut due January 2, 2013 and medical liability reform. HR3667, GME Modernization pilot program authorization. HR5, Protecting Access to Healthcare Act, Medical liability reform. HR5707, Repeal Medicare SGR; implement primary care centric payment and care system; offset with Overseas Operations Fund, Prevent Medicare physician pay cut effective January 1, 2013. HR5979 Medicaid Accountability and Care Act of 2012, Prevent per capita cap reform of the Medicaid program. HR6400, Restoring the Doctors of our Country through scholarships RDOCS Act, Support medical student debt relief, increase family physician workforce. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants and AHRQ funding. No Bill Number, Meeting with OMB Public Health Program Examiner, Supporting AAFP federal budgetary priorities. No Bill Number, Coalition for Health Funding Townhall, Supporting AAFP federal budgetary priorities. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Patient Centered Medical Homes, Increase support for the model. No Bill Number, SGR Fix, Stop the 27% cut due to go into effect January 1st, 2013. No Bill Number, Briefing on ONDCP/NIDA e-Learning tools on opioid prescribing, monitor federal activities on tools for prescribers, support policies which do not burden family physicians. No Bill Number, Meeting with ONDCP director to eliminate CME mandates from National Drug Control strategy. No Bill Number, Meeting with AHRQ director on primary care research HIT promotion and work to support family physicians. No Bill Number, Promote expanding primary care physician workforce, Increase family physician workforce. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Health Insurance Exchanges, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Essential Health Benefits, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Center for Medicare and Medicaid Innovation, Comprehensive Primary Care Initiative. No Bill Number, Medicaid Expansion, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Meaningful use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Primary Care meetings. Medical Home and Health Care Reform. No Bill Number, Veterans health, Access of veterans to community physicians. No Bill Number, Health research, Primary care research agenda. No Bill Number, Medicare physician payment system, Support for transition care provision of the payment schedule. No Bill Number, Medicaid payment for primary care, Support for Medicaid payment for primary care services. No Bill Number, Health labels for smokeless tobacco products, Opposition to changes in health safety warning for smokeless tobacco products.

Sustainable Growth Rate Formula Reform (general); H.R. 452, Medicare Decisions Accountability Act; S. 688, Health Care Bureaucrats Elimination Act; Imaging (general); Medicaid (general); H.R. 2020/ S.1096, Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act; Strong Start Initiative; Primary care payment bonuses; H.R. 5707, Medicare Physician Payment Innovation Act of 2012. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act; H.R. 3667, Primary Care Workforce Access Improvement Act of 2011; H.R. 3269/S. 2347, Diagnostic Imaging Services Access Protection Act of 2011.

Client expense: $245,727 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the 26.5 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2013. Sequestration: October through December 2012, advocated strongly that Congress develop and pass a fiscally responsible, bipartisan agreement to prevent the implementation of across-the-board budget sequestration cuts that would endanger critical programs related to medical research, public health, workforce, food and drug safety, and health care for military families, as well as trigger cuts in Medicare payments to physicians and graduate medical education programs that will endanger patient access to care. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate AHRQ. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons at or below 133 percent of the Federal Poverty Level and ensure fair payments to participating physicians, as enacted in the ACA; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation, H.R. 3667, would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Physician Fee Schedule/August 2012: Advocated on an on-going basis that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the 26.5 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2013. Sequestration: October through December 2012, advocated strongly that Congress develop and pass a fiscally responsible, bipartisan agreement to prevent the implementation of across-the-board budget sequestration cuts that would endanger critical programs related to medical research, public health, workforce, food and drug safety, and health care for military families, as well as trigger cuts in Medicare payments to physicians and graduate medical education programs that will endanger patient access to care. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate AHRQ. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons at or below 133 percent of the Federal Poverty Level and ensure fair payments to participating physicians, as enacted in the ACA; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation, H.R. 3667, would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Physician Fee Schedule/August 2012: Advocated on an on-going basis that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service.

Presidents Budget, 2013, Department of Health and Human Services Unnumbered House subcommittee bill/S.3295 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for National Institutes of Health (NIH), human embryonic stem cell research, Health Resources and Services Administration (HRSA), Title VII and Title VIII health professions and nursing education programs, National Health Service Corps, Childrens Hospitals graduate medical education (GME), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and CDCs National Center for Health Statistics. Restore NIH salary cap to Executive Level I. Oppose elimination of AHRQ, and research policy provisions in House subcommittee bill H.R. 6400, RDOCS Act of 2012 Issue: Support additional scholarship opportunities for medical students. President's Budget, 2013, Department of Health and Human Services Issues: Oppose proposed reduction in Medicare Graduate Medical Education (GME) support and proposed Medicaid reductions and reforms. Presidents Budget, 2014, Department of Veterans Affairs H.R. 5854/S. 3215, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. P.L. 111-148, Patient Protection and Affordable Care Act, Section 4002 and Title V Issue: Support the Prevention and Public Health Fund and preserve PPHF funds for workforce training. P.L. 111-148, Patient Protection and Affordable Care Act, Title V and Section 10503 Issue: Funding for Community Health Centers and the National Health Service Corps. Debt in Health Education Loan programs (Dbt HELP) bill proposal (draft) Issue: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 1627, Resident Physician Shortage Reducation Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. P.L. 111-148, Patient Protection and Affordable Care Act, Title V Issue: Implementing provisions reauthorizing health professions education programs under Title VII of the Public Health Service Act, and reauthorizing National Health Service Corps. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Increase Medicare Graduate Medical Education (GME) accountability H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 Issue: Redistribution of residency positions Issue: Implementation of Teaching Health Center Graduate Medical Education programs under section 340G of the Public Health Service Act. H.R. 1852/S. 958, Children's Hospital GME Support Reauthorization Act of 2011 S. 1440, The Prematurity Research Expansion and Education for Mothers who Deliver Infants Early Act. Issue: Support reauthorization of Children's Hospitals Graduate Medical Education. H.R. 1855/H.R. 2405, Pandemic and All-Hazards Preparedness Reauthorization Act. Issue: Complete reauthorization of preparedness legislation Act. H.R. 5707, Medicare Physician Payment Innovation Act Issue: Repeal of Medicare's sustainable growth rate (SGR) formula. H.R. 1513/S. 810, Great Ape Protection and Cost Saving Act of 2011 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparency. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on the number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments. Issue: Promote interprofessional education and training of the health care workforce. S. 799, Commercial Privacy Bill of Rights Act of 2011 Issue: Collection, retention, and dissemination of personal health information. Issue: Discuss with Administration impact of Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act on AAMC member institutions. Issue: Funding for the National Healthcare Workforce Commission. H.R. 2954/S. 2474, Health Equity and Accountability Act of 2011 Issue: Developing health care workforce that promotes health equity. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies Issue: Support Medicare physician payment reform Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. Issue: Oppose Medicare Graduate Medical Education (GME) spending cuts through sequestration. Issue: 340b Drug Discount program eligibility Issue: Oppose nondefense discretionary spending cuts through sequestration, including NIH and Title VII and VIII health professions and nursing education programs. Issue: Preventing, Identifying, and Treating Prescription Drug Abuse Issue: Primary Care Workforce Development Issue: Funding for Title VII and VIII in President's FY 2014 Budget Issue: Implementation of ACA Exchanges and Medicaid Expansions. Submitted comments on: AHRQ's Consumer Reporting System for Patient Safety Events Enhancing Community-Engaged Research Through the Clinical and Translational Science Awards Program

President's Budget, 2013, Department of Health and Human Services Issue: Oppose proposed reductions in Medicare GME support and proposed reductions and reforms in Medicaid. S. 1627, Resident Physician Shortage Reduction Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. Issue: Implementation of Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies. Issue: Support Medicare physician payment reform Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Support legislation to increase Medicare GME accountability and support H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 (Redistribution of Residency Positions) Issue: Redistribution of residency positions Issue: Support draft legislation to create womens hospital Graduate Medical Education program H.R. 5707, Medicare Physician Payment Innovation Act Issue: Repeal of Medicare's sustainable growth rate (SGR) formula. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparancy. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments Issue: Discuss with Administration Impact of Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act on AAMC member institutions Issue: Preventing, identifying, and treating prescription drug abuse Issue: Primary Care Workforce Development Issue: Implementation of ACA Exchanges and Medicaid expansions

See addendum Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program - H.R. 3667 Teaching Health Centers Primary Care Exception under Teaching Physician Regulation Comprehensive Primary Care (CPC) Initiative

Client expense: $46,099 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription Drug Abuse Prevention and Treatment Act, funding for state monitoring of prescription drug use. No Bill Number, Labor HHS Appropriations Bill, Support for funding Health Professions grants program and funding for HRSA and AHRQ.

Client expense: $767,597 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, White House Office

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care.

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5, Medical liability reform and IPAB repeal Protecting Access to Healthcare Act, Medical liability reform. HR452, Medicare Decision Accountability Act, Revamping the Independent Payment Advisory Board. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. HR5888, Physician Reentry Demonstration Program Act, Revise bill so sub-specialists do not reenter practice as primary care docs in CHCs, VA clinics and school based centers. S3187, Synthetic Drug Abuse Prevention Act of 2012, discussion on Opioid abuse and pain management as part of PDUFA reauthorization. Support appropriate prescription drug monitoring which is not burdensome to family physicians. S3295, Department of Labor Appropriations Act 2013, Support increased appropriations for Agency for Healthcare Research and Quality in FY2013, AHRQ funding budget priority, Support increased FY13 spending on Title VII Sec 747 primary care training grants. No Bill Number, FDA/CDER meeting on chronic pain management, Effective pain management. No Bill Number, 2013 Family Physician of the Year competition judge. No Bill Number, Protect access to healthcare act, Medical liability reform. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, National Priorities and Research Agenda, PCORI should focus research on more common medical conditions first. No Bill Number, National School lunch program, Improve school nutrition programs accessed through state education by providing incentives for school nutrition providers to replace foods with little or no nutritional value. No Bill Number, Oppose repeal of subsidies for health insurance exchanges. No Bill Number, Medicare physician fee schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Comprehensive Primary Care Initiative, Promote the CPCI to family physician practices in the seven geographic markets. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, White House meeting on improving health care coordination and quality. Support for Patient Centered Medical Home as a health care delivery model to improve coordination of care. No Bill Number, White House meeting on implementation of meaningful use of HIT, Support for standards of interoperability of HIT systems. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Patient Centered Medical Home, Increasing support for the concept in discussing delivery system reform.

President's Budget, 2013, Department of Health and Human Services Issue: Oppose proposed reductions in Medicare GME support and proposed reductions and reforms in Medicaid. S. 1627, Resident Physician Shortage Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. Issue: Implementation of Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies. Issue: Support Medicare physician payment reform Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Support legislation to increase Medicare GME accountability and support H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 (Redistribution of Residency Positions) Issue: Redistribution of residency positions Issue: Support draft legislation to create womens hospital Graduate Medical Education program H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparancy. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments Issue: Discuss with Administration scenarios for Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act and impact on AAMC member institutions Submitted comments on: CY 2013 End Stage Renal Disease Quality Incentive Program CDC Request for Information Regarding Inclusion of Work Information in EHR CY 2013 Physician Fee Schedule Proposed Rule CY 2013 Hospital Outpatient and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs

Issue: Support highest possible 302(b) allocation for Labor-HHS-Education Appropriations Subcommittee. Presidents Budget, 2013, Department of Health and Human Services Unnumbered House subcommittee bill/S.3295 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for National Institutes of Health (NIH), human embryonic stem cell research, Health Resources and Services Administration (HRSA), Title VII and Title VIII health professions and nursing education programs, National Health Service Corps, Childrens Hospitals graduate medical education (GME), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and CDCs National Center for Health Statistics. Restore NIH salary cap to Executive Level I. Oppose elimination of AHRQ, research policy provisions in House subcommittee bill H.R. 6400, RDOCS Act of 2012 Issue: Support additional scholarship opportunities for medical students. President's Budget, 2013, Department of Health and Human Services Issues: Oppose proposed reduction in Medicare Graduate Medical Education (GME) support and proposed Medicaid reductions and reforms. Presidents Budget, 2014, Department of Veterans Affairs H.R. 5854/S. 3215, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. P.L. 111-148, Patient Protection and Affordable Care Act, Section 4002 and Title V Issue: Support the Prevention and Public Health Fund and preserve PPHF funds for workforce training. P.L. 111-148, Patient Protection and Affordable Care Act, Title V and Section 10503 Issue: Funding for Community Health Centers and the National Health Service Corps. Health professions loans reform bill proposal (draft) Issue: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 1627, Resident Physician Shortage Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. P.L. 111-148, Patient Protection and Affordable Care Act, Title V Issue: Implementing provisions reauthorizing health professions education programs under Title VII of the Public Health Service Act, and reauthorizing National Health Service Corps. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Increase GME accountability H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 Issue: Redistribution of residency positions Issue: Implementation of Teaching Health Center Graduate Medical Education programs under section 340G of the Public Health Service Act. H.R. 1852/S. 958, Children's Hospital GME Support Reauthorization Act of 2011 Issue: Support reauthorization of Children's Hospitals Graduate Medical Education. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparency. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on the number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments. Issue: Promote interprofessional education and training of the health care workforce. S. 799, Commercial Privacy Bill of Rights Act of 2011 Issue: Collection, retention, and dissemination of personal health information. Issue: Discuss with Administration scenarios for Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act and impact on AAMC member institutions. Issue: Funding for the National Healthcare Workforce Commission. H.R. 2954/S. 2474, Health Equity and Accountability Act of 2011 Issue: Developing health care workforce that promotes health equity. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies Issue: Support Medicare physician payment reform Issue: Support draft legislation to create womens hospital Graduate Medical Education program Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. Issue: Oppose Medicare Graduate Medical Education (GME) spending cuts through sequestration. Issue: 340b Drug Discount program eligibility Issue: Oppose nondefense discretionary spending cuts through sequestration, including NIH and Title VII and VIII health professions and nursing education programs. Submitted comments on: CY 2013 End Stage Renal Disease Quality Incentive Program CDC Request for Information Regarding Inclusion of Work Information in EHR CY 2013 Physician Fee Schedule Proposed Rule CY 2013 Hospital Outpatient and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs IRS Proposed Rule for Additional Requirements for Charitable Hospitals

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill).

Client expense: Not reported · Firm income: $50,000

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

See addendum Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program - H.R. 3667 Teaching Health Centers Primary Care Exception under Teaching Physician Regulation Comprehensive Primary Care (CPC) initiative

Client expense: $42,360 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

Sustainable Growth Rate Formula Reform (general); H.R. 452, Medicare Decisions Accountability Act; S. 688, Health Care Bureaucrats Elimination Act; Imaging (general); Medicaid (general); H.R. 2020/ S.1096, Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act; Strong Start Initiative; Primary care payment bonuses; H.R. 5707, Medicare Physician Payment Innovation Act of 2012. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act; H.R. 3667, Primary Care Workforce Access Improvement Act of 2011; H.R. 3269/S. 2347, Diagnostic Imaging Services Access Protection Act of 2011.

Client expense: $312,442 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost;. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5888, Physician Reentry Demonstration Program, Bill attempts to address the shortage of primary care physicians. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription Drug Abuse Prevention and Treatment Act, funding for state monitoring of prescription drug use. No Bill Number, Labor HHS Appropriations Bill, Support for funding Health Professions grants program and funding for HRSA and AHRQ. J. J. Res. 117, Labor HHS Appropriations Bills, Support for funding Health Professions Grant Program and HRSA and AHRQ. No Bill Number, Advisory Committee on Training in Primary are Medicine and Dentistry supporting Title VII training grants to family medicine.

Client expense: $449,038 · Firm income: Not reported

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5, Medical liability reform and IPAB repeal Protecting Access to Healthcare Act, Medical liability reform. HR452, Medicare Decision Accountability Act, Revamping the Independent Payment Advisory Board. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. HR5888, Physician Reentry Demonstration Program Act, Revise bill so sub-specialists do not reenter practice as primary care docs in CHCs, VA clinics and school based centers. H. Con. Res. 112, Oppose repeal of subsidies for health insurance exchanges. H.J. Res117, Labor, HHS Appropriations Bills, Support for funding health professions grant program and funding for HRSA and AHRQ. S3295, Department of Labor Appropriations Act 2013, Support increased appropriations for Agency for Healthcare Research and Quality in FY2013, AHRQ funding budget priority, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription drug abuse prevention and treatment Act, support state programs to monitor prescription drug abuse. No Bill Number, National Drug Control Strategy, State Grants for screening, brief intervention and referral to treatment. New CME for prescribers of opioid analgesics - support drug control policies that are not burdensome to family physicians. No Bill Number, Advisory committee on training in primary care medicine and dentistry, supporting Title VII training grants to family medicine. No Bill Number, Medicare physician payment reform of the sustainable growth rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Comprehensive primary care, medical home and health care reform, promote CPCI to family physician practices in the seven geographic markets. No Bill Number, Observation care, 2013 proposed inpatient PPS. No Bill Number, Home Health Documentation requirements, Face to face documentation requirements in the 2013 proposed home health regulation. No Bill Number, Primary Care Meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use Meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, National Priorities Research Agenda, PCORI should focus research on more common medical conditions at first. No Bill Number, Medicare Physician fee schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Medicaid Payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Health Delivery Transformation, White House meeting to support Patient Centered Medical Home as a health care delivery model to improve coordination of care. No Bill Number, SGR Fix, Stop 27% cut due to go into effect January 1, 2013. No Bill Number, Sequester fiscal cliff, stop 2% cut due January 2, 2013.

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Medicare physician Fee Schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Medicare coverage advisory, Nominating an AAFP member to serve on MEDCAC. No Bill Number, Observation care, 2013 proposed inpatient PPS. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care. No Bill Number, Patient Centered Medical Homes, Increase support for the model. No Bill Number, SGR Fix, Stop the 27% cut due January 1, 2013. No Bill Number, Sequester fiscal cliff, Stop the 2% cut due January 2, 2013.

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Medicare physician Fee Schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Medicare coverage advisory, Nominating an AAFP member to serve on MEDCAC. No Bill Number, Observation care, 2013 proposed inpatient PPS. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care. No Bill Number, Patient Centered Medical Homes, Increase support for the model. No Bill Number, SGR Fix, Stop the 27% cut due January 1, 2013. No Bill Number, Sequester fiscal cliff, Stop the 2% cut due January 2, 2013.

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5888, Physician Reentry Demonstration Program, Bill attempts to address the shortage of primary care physicians. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription Drug Abuse Prevention and Treatment Act, funding for state monitoring of prescription drug use. No Bill Number, Labor HHS Appropriations Bill, Support for funding Health Professions grants program and funding for HRSA and AHRQ. J. J. Res. 117, Labor HHS Appropriations Bills, Support for funding Health Professions Grant Program and HRSA and AHRQ. No Bill Number, Advisory Committee on Training in Primary are Medicine and Dentistry supporting Title VII training grants to family medicine.

Client expense: $449,038 · Firm income: Not reported

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5, Medical liability reform and IPAB repeal Protecting Access to Healthcare Act, Medical liability reform. HR452, Medicare Decision Accountability Act, Revamping the Independent Payment Advisory Board. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. HR5888, Physician Reentry Demonstration Program Act, Revise bill so sub-specialists do not reenter practice as primary care docs in CHCs, VA clinics and school based centers. H. Con. Res. 112, Oppose repeal of subsidies for health insurance exchanges. H.J. Res117, Labor, HHS Appropriations Bills, Support for funding health professions grant program and funding for HRSA and AHRQ. S3295, Department of Labor Appropriations Act 2013, Support increased appropriations for Agency for Healthcare Research and Quality in FY2013, AHRQ funding budget priority, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription drug abuse prevention and treatment Act, support state programs to monitor prescription drug abuse. No Bill Number, National Drug Control Strategy, State Grants for screening, brief intervention and referral to treatment. New CME for prescribers of opioid analgesics - support drug control policies that are not burdensome to family physicians. No Bill Number, Advisory committee on training in primary care medicine and dentistry, supporting Title VII training grants to family medicine. No Bill Number, Medicare physician payment reform of the sustainable growth rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Comprehensive primary care, medical home and health care reform, promote CPCI to family physician practices in the seven geographic markets. No Bill Number, Observation care, 2013 proposed inpatient PPS. No Bill Number, Home Health Documentation requirements, Face to face documentation requirements in the 2013 proposed home health regulation. No Bill Number, Primary Care Meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use Meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, National Priorities Research Agenda, PCORI should focus research on more common medical conditions at first. No Bill Number, Medicare Physician fee schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Medicaid Payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Health Delivery Transformation, White House meeting to support Patient Centered Medical Home as a health care delivery model to improve coordination of care. No Bill Number, SGR Fix, Stop 27% cut due to go into effect January 1, 2013. No Bill Number, Sequester fiscal cliff, stop 2% cut due January 2, 2013.

President's Budget, 2013, Department of Health and Human Services Issue: Oppose proposed reductions in Medicare GME support and proposed reductions and reforms in Medicaid. S. 1627, Resident Physician Shortage Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. Issue: Implementation of Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Modify Accountable Care Organization (ACO) proposed rules and implementation Issue: Applications for participation in CMS Bundled Payment Initiative. Issue: Address workforce shortages and primary care workforce development. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Establishment of consumer operated and oriented plans (CO-OPs) H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings P.L. 111-148, Affordable Care Act, Sec. 5503 and 5506 Issue: Redistribution of unused residency slots and residency slots from closed hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Support legislation to increase Medicare GME accountability and support Issue: Support Medicare physician payment reform Issue: Support draft legislation to create womens hospital Graduate Medical Education program Issue: Communicated concerns regarding Medicare value modifier and the physician quality reporting system (PQRS) Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Documentation and coding adjustments to inpatient payment rates. Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. Submitted comments on: Meaningful Use State 2 Proposed Rule Health Care Consolidation and Competition after PPACA SGR Replacement Medicare Primary Care Proposed Rule Inpatient Prospective Payment System (IPPS) Rule

H.Con. Res. 112, FY 2013 Budget Resolution Issue: Oppose discretionary spending cuts and Medicare and Medicaid cuts and reforms. Issue: Support highest possible 302(b) allocation for Labor-HHS-Education Appropriations Subcommittee. Presidents Budget, 2013, Department of Health and Human Services S. 3295/S. Rept. 112-76, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for National Institutes of Health (NIH), human embryonic stem cell research, Health Resources and Services Administration (HRSA), Title VII and Title VIII health professions and nursing education programs, National Health Service Corps, Childrens Hospitals graduate medical education (GME), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and CDCs National Center for Health Statistics. Restore NIH salary cap to Executive Level I. President's Budget, 2013, Department of Health and Human Services Issues: Oppose proposed reduction in Medicare Graduate Medical Education (GME) support and proposed Medicaid reductions and reforms. Presidents Budget, 2013, Department of Veterans Affairs H.R. 5854/S. 3215, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. P.L. 111-148, Patient Protection and Affordable Care Act, Section 4002 and Title V Issue: Support the Prevention and Public Health Fund and preserve PPHF funds for workforce training. P.L. 111-148, Patient Protection and Affordable Care Act, Title V and Section 10503 Issue: Funding for Community Health Centers and the National Health Service Corps. Issue: Modify Accountable Care Organization (ACO) proposed rules and implementation Health professions loans reform bill proposal (draft) Issue: Reduce student loan interest rates, expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 1627, Resident Physician Shortage Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. P.L. 111-148, Patient Protection and Affordable Care Act, Title V Issues: Implementing provisions reauthorizing health professions education programs under Title VII of the Public Health Service Act, and reauthorizing National Health Service Corps. H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. Issue: Address workforce shortages & primary care workforce development. Issue: Implementation of Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. H.R. 1852/S. 958, Children's Hospital GME Support Reauthorization Act of 2011 Issue: Support reauthorization of Children's Hospitals Graduate Medical Education. Issue: Promote interprofessional education and training of the health care workforce. S. 799, Commercial Privacy Bill of Rights Act of 2011 Issue: Collection, retention, and dissemination of personal health information. Issue: Funding for the National Healthcare Workforce Commission. Issue: Applications for participation in CMS Bundled Payment Initiative. H.R. 2954/S. 2474, Health Equity and Accountability Act of 2011 Issue: Developing health care workforce that promotes health equity. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Draft legislation to prohibit pelvic exams performed on anesthetized women by medical students and residents. P.L. 111-148, Affordable Care Act, Secs. 5503 and 5506 Issue: Redistribution of unused residency slots and residency slots from closed hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Support legislation to increase Medicare GME accountability and support Issue: Support Medicare physician payment reform Issue: Support draft Legislation to create womens hospital Graduate Medical Education program Issue: Communicated concerns regarding Medicare value modifier and the physician quality reporting system (PQRS) Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Documentation and coding adjustments to inpatient payments rates. Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. H.R. 5651, Food and Drug Administration Reform Act of 2012 S. 3187, Food and Drug Administration Safety and Innovation Act Issue: Support FDA establishing unique device identifier system (UDI). Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. Submitted comments on: CMS 60-day Overpayment NPRM Meaningful Use State 2 Proposed Rule Health Care Consolidation and Competition after PPACA SGR Replacement Medicare Primary Care Proposed Rule Inpatient Prospective Payment System (IPPS) Rule

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill).

Client expense: Not reported · Firm income: $50,000

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), SENATE, Transportation, Dept of (DOT)

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.

See addendum Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program - H.R. 3667 Teaching Health Centers Primary Care Exception under Teaching Physician Regulation Comprehensive Primary Care (CPC) initiative

Client expense: $43,231 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants. S507, Prescription Drug Abuse Prevention and Treatment Act, funding for state monitoring of prescription drug use. No Bill Number, Labor HHS Appropriations Bill, Support for funding Health Professions grants program and funding for HRSA and AHRQ.

Client expense: $767,597 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, White House Office

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5, Medical liability reform and IPAB repeal Protecting Access to Healthcare Act, Medical liability reform. HR452, Medicare Decision Accountability Act, Revamping the Independent Payment Advisory Board. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. HR5888, Physician Reentry Demonstration Program Act, Revise bill so sub-specialists do not reenter practice as primary care docs in CHCs, VA clinics and school based centers. S3187, Synthetic Drug Abuse Prevention Act of 2012, discussion on Opioid abuse and pain management as part of PDUFA reauthorization. Support appropriate prescription drug monitoring which is not burdensome to family physicians. S3295, Department of Labor Appropriations Act 2013, Support increased appropriations for Agency for Healthcare Research and Quality in FY2013, AHRQ funding budget priority, Support increased FY13 spending on Title VII Sec 747 primary care training grants. No Bill Number, FDA/CDER meeting on chronic pain management, Effective pain management. No Bill Number, 2013 Family Physician of the Year competition judge. No Bill Number, Protect access to healthcare act, Medical liability reform. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, National Priorities and Research Agenda, PCORI should focus research on more common medical conditions first. No Bill Number, National School lunch program, Improve school nutrition programs accessed through state education by providing incentives for school nutrition providers to replace foods with little or no nutritional value. No Bill Number, Oppose repeal of subsidies for health insurance exchanges. No Bill Number, Medicare physician fee schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Comprehensive Primary Care Initiative, Promote the CPCI to family physician practices in the seven geographic markets. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, White House meeting on improving health care coordination and quality. Support for Patient Centered Medical Home as a health care delivery model to improve coordination of care. No Bill Number, White House meeting on implementation of meaningful use of HIT, Support for standards of interoperability of HIT systems. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Patient Centered Medical Home, Increasing support for the concept in discussing delivery system reform.

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care.

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Prevent Medicare physician pay cut effective March 1, 2012. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. No Bill Number, Innovative quality and efficiency recognition reward programs that might be adopted by Medicare, Family physicians are focusing on quality, HIT and the PCMH model to transform practices. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, Conference call on FY2013 HHS spending request, AAFP budget priorities. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician pay cuts scheduled for 2013 No Bill Number, Task force on primary care valuation meeting, Medical home and health care reform No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public No Bill Number, Primary care meeting, Medical home and health care reform. No Bill Number, Meaningful use meetings, Medical home and health care reform. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, SGR, Medicare payment, Include a repeal of the SGR within super-committee deliberations and include a primary care differential. No Bill Number, Medicare Part D, Ensure that CMS continues to hear from practicing physicians on drug issues, including Part D. No Bill Number, GME, Advocate for GME pilot project.

HR452, Medicare Decisions Accountability Act, Revamping the Independent Payment Advisory Board. HR2055, Military Construction and Veterans Affairs and Related Appropriations Act, Promoting AAFP federal budget priorities - Title VII Sec 747, NHSC, AHRQ, Rural Health and Workforce Commission. HR3630, Welfare Integrity and Data Improvement Act, Prevent Medicare physician pay cut effective March 1, 2012. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR3671, Judiciary Appropriations Act, 2012, Promoting AAFP federal budget priorities - Title VII Sec 747, NHSC, AHRQ, Rural Health and Workforce Commission. HR4013, Temporary Payroll Tax Cut Continuation Act, Ten month extension of the Medicare physician fee schedule. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. S407, Prescription Drug Abuse Prevention and Treatment Act of 2011, Ensure that Senator Rockefeller's bill is not burdensome to family physicians but increases communication among states to allow them to identify prescription drug abusers. No Bill Number, Title VII Sec 747 primary care grants stakeholders conference call, Supporting Title VII training to family medicine grants, NHSC, AHRQ, Workforce Commission, Rural Health. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Budget allocation for the discretionary spending on health programs and agencies, Ensure adequate federal funds for AAFP budget priorities. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, HHS FY2013 conference call, AAFP budget priorities. No Bill Number, SGR, Medicare payment, Include a repeal of the SGR within super-committee deliberations and include a primary care differential. No Bill Number, Rural Hospital Residency development meeting and discussions, Increasing the number of slots for family physicians to train in community settings. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. HR2119, Ryan Creedon Act of 2011, Opposing a requirement that physicians be specially trained on the dangers of addictive drugs. No Bill Number, Valuation of Primary Care, Strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary Care Incentive Payment (PCIP), Requesting CMS release data on PCIP use. No Bill Number, Innovative quality and efficiency recognition reward programs that might be adopted by Medicare, Family physicians are focusing on quality, HIT and the PCMH model to transform practices. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for Primary Care Physicians. No Bill Number, Legislation to repeal Independent Payment Advisory Board (IPAB), AAFP is dissatisfied with IPAB's composition and process but have not called for IPAB repeal. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician pay cuts scheduled for 2013 No Bill Number, Task force on primary care valuation meeting, Medical home and health care reform No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public No Bill Number, Primary care meeting, Medical home and health care reform. No Bill Number, Meaningful use meetings, Medical home and health care reform. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Invitation to judge the 2013 Family Physician of the Year competition, competition.

HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR2119, Ryan Creedon Act of 2011, Opposing a requirement that physicians be specially trained on the dangers of addictive drugs. S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011, Funding for state monitoring of prescription drug use. PL112-25, Impact of the Budget Control Act on FY13 HHS appropriations process and Medicare payment, AAFP budget priorities funding and Medicare physician payment. No Bill Number, Title VII Sec 747 primary care grants stakeholders conference call, Supporting Title VII training to family medicine grants No Bill Number, Rural Hospital Residency development meeting and discussions, Increasing the number of slots for family physicians to train in community settings. No Bill Number, HHS FY2013 budget briefing, AAFP budget priorities. No Bill Number, AAFP Board Officers meeting to present FY2013 Appropriations priorities, AAFP budget priorities. No Bill Number, AAFP Board Officers met with HRSA Administrator, HRSA portfolio promoting health care access and workforce.

Client expense: $747,230 · Firm income: Not reported

H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012: Sec. 2201 (Medicare physician payment updates), Sec. 2223 (Medicare hospital outpatient updates), and Sec. 2224 (Medicare hospital bad debt payments) H.R. 3667, Primary Care Workforce Access Improvement Act of 2011: entire bill President's FY 2013 Budget Request: funding for Department of Health and Human Services programs, especially for Medicare and Medicaid and other healthcare funding issues Medicaid Provider Reimbursement issues

Client expense: $230,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Education, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Natl Oceanic & Atmospheric Administration (NOAA), Natl Science Foundation (NSF), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

See addendum Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program - H.R. 3667 Teaching Health Centers Primary Care Exception under Teaching Physician Regulation

Client expense: $43,203 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Conrad State 30 Improvement Act (S. 1979): Supported provisions of this legislation including, eliminating the need for repeated reauthorization of the Conrad 30 program, increasing the number of Conrad 30 J-1 waivers to address the increased demand for such waivers by states, while maintaining a well-balanced national distribution, allowing a 120 day grace period for new employment if a physician is terminated due to extenuating circumstances, and a green card cap exemption, which would provide an important incentive for international medical graduates to practice in underserved communities. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Provided comments to the Department of Health & Human Services regarding the value-based modifier, penalties under the electronic prescribing (e-prescribing) program, physician quality reporting system (PQRS) and electronic health record (EHR) incentive program, along with the transition to ICD-10. The College urged CMS to re-evaluate the penalty timelines associated with these programs and examine the administrative and financial burdens and intersection of these various federal regulatory programs, to use its discretionary authority provided by Congress under these programs to develop solutions for synchronizing these programs to minimize burdens to physician practices, and propose these solutions in the physician fee schedule proposed rule for calendar year 2013.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Conrad State 30 Improvement Act (S. 1979): Supported provisions of this legislation including, eliminating the need for repeated reauthorization of the Conrad 30 program, increasing the number of Conrad 30 J-1 waivers to address the increased demand for such waivers by states, while maintaining a well-balanced national distribution, allowing a 120 day grace period for new employment if a physician is terminated due to extenuating circumstances, and a green card cap exemption, which would provide an important incentive for international medical graduates to practice in underserved communities. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Provided comments to the Department of Health & Human Services regarding the value-based modifier, penalties under the electronic prescribing (e-prescribing) program, physician quality reporting system (PQRS) and electronic health record (EHR) incentive program, along with the transition to ICD-10. The College urged CMS to re-evaluate the penalty timelines associated with these programs and examine the administrative and financial burdens and intersection of these various federal regulatory programs, to use its discretionary authority provided by Congress under these programs to develop solutions for synchronizing these programs to minimize burdens to physician practices, and propose these solutions in the physician fee schedule proposed rule for calendar year 2013.